Month: July 2013

Kathryn Doyle

NEW YORK (Reuters Health) – Among people in their 70s, anemia may flag an increased risk of developing dementia later in life, according to a new study.

Researchers following more than 2,500 U.S. adults in their 70s for over a decade found that those who started out with anemia were 65 percent more likely to develop dementia by the end of the study period.

“Anemia is common in the elderly and occurs in up to 23 percent of adults ages 65 and older,” said senior author Dr. Kristina Yaffe of the University of California, San Francisco.

People with anemia lack enough healthy red blood cells to carry oxygen throughout the body.

Fewer healthy red blood cells could mean less oxygen travelling to the brain and may result in cognitive decline, she said.

Several conditions, including kidney disease and nutritional deficiencies, can cause anemia.

Previous studies have found an association between anemia and dementia, but they had not followed anemic adults over time to see if they developed cognitive problems, as the current study did, Yaffe told Reuters Health.

She and her coauthors used medical records to follow 2,552 people between the ages of 70 and 79 at the beginning of the study period. They were tested for anemia early in the study and given memory and thinking tests over a total of 11 years.

At the start of the study, 393 participants had anemia. And at the end of the study, 445, or about 18 percent of participants, had developed dementia, based on records of their hospital visits, prescribed dementia medication use or a significant downward change on the memory and thinking tests.

Of the roughly 400 men and women who were anemic at the start, 23 percent developed dementia, compared to 17 percent of the 2,000 others who were not anemic, according to the results published in the journal Neurology.

That six percent difference is a large change in risk on a population level, Yaffe said.

“I think doctors should be aware of this important connection especially as both anemia and dementia are common with aging,” she said.

The increased risk for dementia linked to anemia did not change based on race or gender.

Despite the association, the study does not prove that anemia causes dementia, cautioned Dr. Ruth Peters, who researches risk factors for dementia at Imperial College London and was not involved in the new study.

“There are many risk factors that are associated with dementia and these kinds of studies are very useful in identifying and clarifying these,” she told Reuters Health by email. “Each individual will have their own mosaic of risk factors.”

It is possible that a third influence, like chronic kidney disease, caused both anemia and dementia in the participants with both conditions, but the authors tried to rule that out, Yaffe said.

Low iron levels, which are one cause of anemia, can cause heart problems for older people, so doctors usually check iron and recommend getting more of it from foods like spinach or over the counter vitamins if levels are low, she said.

“However, a third of the time, doctors cannot find a common cause for the lower hemoglobin levels (anemia) in older adults,” said Dr. Raj Shah of Rush University Medical Center in Chicago.

Anemia can also result from poor nutrition, bleeding disorders or cancer, among other things, said Shah, who studies cognitive decline in older people but was not involved in the study.

“We still have to understand what is the mechanism by which low hemoglobin is associated with cognitive decline and risk of developing dementia in older persons,” Shah told Reuters Health.

Future research should investigate whether correcting anemia also improves cognitive health, Yaffe said.

SOURCE: bit.ly/a55XCO Neurology, online July 31, 2013.

Kathryn Doyle

NEW YORK (Reuters Health) – Among people in their 70s, anemia may flag an increased risk of developing dementia later in life, according to a new study.

Researchers following more than 2,500 U.S. adults in their 70s for over a decade found that those who started out with anemia were 65 percent more likely to develop dementia by the end of the study period.

“Anemia is common in the elderly and occurs in up to 23 percent of adults ages 65 and older,” said senior author Dr. Kristina Yaffe of the University of California, San Francisco.

People with anemia lack enough healthy red blood cells to carry oxygen throughout the body.

Fewer healthy red blood cells could mean less oxygen travelling to the brain and may result in cognitive decline, she said.

Several conditions, including kidney disease and nutritional deficiencies, can cause anemia.

Previous studies have found an association between anemia and dementia, but they had not followed anemic adults over time to see if they developed cognitive problems, as the current study did, Yaffe told Reuters Health.

She and her coauthors used medical records to follow 2,552 people between the ages of 70 and 79 at the beginning of the study period. They were tested for anemia early in the study and given memory and thinking tests over a total of 11 years.

At the start of the study, 393 participants had anemia. And at the end of the study, 445, or about 18 percent of participants, had developed dementia, based on records of their hospital visits, prescribed dementia medication use or a significant downward change on the memory and thinking tests.

Of the roughly 400 men and women who were anemic at the start, 23 percent developed dementia, compared to 17 percent of the 2,000 others who were not anemic, according to the results published in the journal Neurology.

That six percent difference is a large change in risk on a population level, Yaffe said.

“I think doctors should be aware of this important connection especially as both anemia and dementia are common with aging,” she said.

The increased risk for dementia linked to anemia did not change based on race or gender.

Despite the association, the study does not prove that anemia causes dementia, cautioned Dr. Ruth Peters, who researches risk factors for dementia at Imperial College London and was not involved in the new study.

“There are many risk factors that are associated with dementia and these kinds of studies are very useful in identifying and clarifying these,” she told Reuters Health by email. “Each individual will have their own mosaic of risk factors.”

It is possible that a third influence, like chronic kidney disease, caused both anemia and dementia in the participants with both conditions, but the authors tried to rule that out, Yaffe said.

Low iron levels, which are one cause of anemia, can cause heart problems for older people, so doctors usually check iron and recommend getting more of it from foods like spinach or over the counter vitamins if levels are low, she said.

“However, a third of the time, doctors cannot find a common cause for the lower hemoglobin levels (anemia) in older adults,” said Dr. Raj Shah of Rush University Medical Center in Chicago.

Anemia can also result from poor nutrition, bleeding disorders or cancer, among other things, said Shah, who studies cognitive decline in older people but was not involved in the study.

“We still have to understand what is the mechanism by which low hemoglobin is associated with cognitive decline and risk of developing dementia in older persons,” Shah told Reuters Health.

Future research should investigate whether correcting anemia also improves cognitive health, Yaffe said.

SOURCE: bit.ly/a55XCO Neurology, online July 31, 2013.

(Reuters) – A severe stomach illness linked to prepackaged salad has struck two new patients in Iowa, state health officials said on Wednesday, as the bug spread through 16 states.

The salad mix has been blamed for most of the 145 total cases in Iowa and the 78 in Nebraska of the rare parasite cyclospora, which causes gastrointestinal illness. The two states account for nearly two-thirds of at least 378 cases in the United States since mid-June.

The cause of outbreaks in other states is still under investigation, but officials with the federal Centers for Disease Control and Prevention said they are working to determine whether the prepackaged salad mix, the brand name of which has not been released, is responsible for outbreaks in states from New York and New Jersey to Florida and Texas.

At least 21 people have been hospitalized in three states with the bug, CDC officials said.

Symptoms caused by the one-cell parasite include watery diarrhea, vomiting and body aches. The virus is commonly associated with contaminated fresh produce and can be difficult to wash off.

Officials in Iowa and Nebraska said the salad mix was distributed nationally and there is no indication that local produce was involved in the outbreak.

The mix, sold as prewashed and ready to eat, was described by health officials as a combination of iceberg lettuce, carrots and red cabbage.

The product has been pulled from the shelves in Iowa and appears to have been consumed by the stricken residents in mid-June, health officials said. It was unclear whether the product had been removed from distribution in Nebraska.

Nebraska health officials said earlier this week that the same salad mix appeared to be responsible for the outbreak there as well.

New cases are being reported in Nebraska daily, officials there said, but it is unlikely that the same batch is still on shelves or in refrigerators, as the product’s shelf life is short.

Cyclosporiasis symptoms usually manifest within several days of eating the contaminated food, and include diarrhea, cramps, nausea and fatigue. If not treated, the illness may last from a few days to a month or longer and patients have been known to relapse, the CDC said.

The first cases were reported in Iowa in late June, with the majority of the illnesses logged in early July. The CDC has not released the age range of those infected, but said it was working closely with the U.S. Food and Drug Administration and state officials to gather more information.

(Reporting by Karen Brooks in Austin, Texas; Editing by Greg McCune and Richard Chang)

A public inquiry was triggered at Stafford Hospital after a higher than expected number of deaths at the trust

A report by administrators running the scandal-hit Stafford Hospital into the future of services there will be published later.

The Mid Staffordshire NHS Trust went into administration on 16 April after a report concluded it was not “clinically or financially sustainable”.

A public inquiry, led by Robert Francis QC, was triggered by a higher than expected number of deaths at the trust.

The Trust Special Administrators’ (TSA) report will be published at 14:00 BST.

The administrators were initially given 45 days to design new patient services, but health regulator Monitor granted them an extra 30 days.

The consultation on the draft report will start on 6 August and end on 1 October.

‘Fragile offering’

Conservative-controlled Staffordshire County Council, which took on the public health remit in April, said a single trust should be created to provide health and social care for Staffordshire.

Campaigners demonstrated in April to keep major health services at the hospital

Council leader Philip Atkins said: “Instead of looking to break up an already fragile offering we need to look at creating a stronger, single Staffordshire NHS Trust offering integrated health and social care as a basis for a sustainable NHS.”

The Mid Staffordshire trust, which also runs Cannock Chase Hospital, was the first NHS foundation trust to be put into administration.

Mr Francis’s inquiry, into one of the biggest scandals in the history of the NHS, looked at why the problems at Stafford Hospital, where hundreds of needless deaths were caused by abuse and neglect in 2005-08, was not picked up earlier.

The report concluded patients had been “betrayed” because the NHS put corporate self-interest ahead of patients.

It argued for “fundamental change” in the culture of the NHS to make sure patients were put first.

The inquiry ran for a year between 2010 and 2011, and took evidence from more than 160 witnesses over 139 days, at a cost of £13m.

The findings of the Francis Report prompted a separate review of 14 NHS hospitals in England with high mortality rates.

As a result of that review, 11 of the hospitals were placed in “special measures” for “fundamental breaches of care”.

On Thursday 25 July, two Stafford Hospital nurses who falsified A&E discharge times were struck off the nursing register.

The Nursing and Midwifery Council panel found that Tracey-Ann White and Sharon Turner had brought their profession into serious disrepute.

On Tuesday 23 July, it was announced the director of nursing at the hospital, Colin Ovington, was to leave and become the new chief nurse of Sandwell and West Birmingham Hospitals NHS Trust.

He was recruited in 2010 to help improve the quality of care at the Mid Staffordshire trust.

Sandwell and West Birmingham Hospitals NHS Trust, which runs Sandwell Hospital and City Hospital in Birmingham, has said Mr Ovington was expecting to take up his new post later this year.

Paul Lamb was severely injured in a car accident in 1990

The Court of Appeal is to rule on Wednesday on the case of a paralysed man who wants to be helped to die.

Paul Lamb wants the law changed so he can kill himself with a doctor’s help.

Mr Lamb, from Leeds, has been almost completely paralysed from the neck down since a car accident 23 years ago and says he is in constant pain.

Unable to end his own life, he wants a court ruling that any doctor who helped him die would have a defence against the charge of murder.

The defence – known as “necessity” – would be that it had been necessary for the doctor to act to stop intolerable suffering.

This is the same argument put forward by another paralysed man, Tony Nicklinson, who died shortly after his case was rejected by the High Court last year.

Mr Nicklinson’s widow is challenging that ruling, which stated that it was for Parliament, not judges to decide whether the law on assisted dying should change.

The Appeal Court will also rule on the case of another paralysed man, known only as Martin, who wants the Director of Public Prosecutions to change his policy on suicide. Martin wants it to be lawful for a doctor or nurse to help him travel abroad to die with the help of a suicide organisation in Switzerland.

At the beginning of the appeal, the lord chief justice said that despite the desperate situation of those involved, the case had to be decided on the basis of principles of law rather than as a matter of sympathy.

Mr Lamb has no function in any of his limbs apart from a little movement in his right hand. He says he has been in pain for 23 years, needs 24-hour care and his life consists of “being fed and watered”.

In a statement to the courts, he said: “I am in pain every single hour of every single day. I have lived with these conditions for a lot of years and have given it my best shot.

“Now I feel worn out and I am genuinely fed up with my life. I feel I cannot and do not want to keep living. I feel trapped by the situation and have no way out.

“I am fed up of going through the motions of life rather than living it. I feel enough is enough.”

Mr Lamb, a divorced father of two, said he was not depressed and just wanted to end his life in a dignified way, with his loved ones around him.

A Tea Party member reaches for a pamphlet titled ”The Impact of Obamacare”, at a ”Food for Free Minds Tea Party Rally” in Littleton, New Hampshire in this October 27, 2012 file photo.

Credit: Reuters/Jessica Rinaldi//Files

WASHINGTON (Reuters) – A Tea Party-inspired plan to kill President Barack Obama’s healthcare law by forcing a government shutdown unless funds to implement the law are denied has not gained traction among senior Republicans in the U.S. House of Representatives, lawmakers said on Wednesday.

“I think leadership is giving other options that they think are more effective,” said Republican Representative Pat Tiberi, a close ally of House Speaker John Boehner.

Tiberi, speaking to Reuters following a closed-door meeting of House Republicans, said that while a final decision probably had not been made, his colleagues are more likely to continue pushing for Congress to repeal individual provisions of “Obamacare.”

Republicans have been on a continuous campaign to kill Obama’s landmark healthcare law, which aims to help provide medical insurance for millions of people who cannot afford it on their own. They argue that the law, which is taking effect in stages, will discourage job creation and saddle businesses with higher costs.

Tea Party-backed conservatives in the Senate, including Senators Marco Rubio, Ted Cruz and Mike Lee, have been trying to persuade enough of their fellow Republicans to join them in a high-stakes gamble that would threaten a government shutdown on the start of the new fiscal year, October 1, unless legislation to keep Washington operating specifically defunds Obamacare.

More senior Senate Republicans have savaged the idea, with some calling it “dumb,” “silly,” “feckless” and “dishonest.”

On September 30, federal funding expires for hundreds of federal programs, ranging from military activities and NASA space exploration to federal parks, education and job training.

A dozen funding bills for the fiscal year starting on October 1 are pending in Congress but are unlikely to be completed by that deadline.

The result is that Congress will either have to pass a temporary funding bill, called a continuing resolution or CR, or risk government closings. Tea Party-backed senators who want to attach the Obamacare provision have complicated already difficult negotiations over government spending levels.

House Appropriations Committee Chairman Harold Rogers, asked about chances of his chamber going along with demands of Tea Party-backed senators on the funding bill, told reporters: “This is just something the White House will not accept and we’ve got to have a CR.”

Representative Tom Cole, another longtime House Republican, told reporters that he had seen “an awful lot of push-back” on the idea, adding, “I don’t sense that there’s nearly enough unanimity in either the Senate or the House Republican conferences to push an approach like that.”

With Congress about to start a month-long break, Boehner said he will keep mulling ways to tackle end-of-fiscal-year funding problems.

“I’m confident that when we get into the fall, it may be a messy process, but I suspect we’ll find a way to deal with it,” Boehner told reporters.

(Editing by Vicki Allen)

A Tea Party member reaches for a pamphlet titled ”The Impact of Obamacare”, at a ”Food for Free Minds Tea Party Rally” in Littleton, New Hampshire in this October 27, 2012 file photo.

Credit: Reuters/Jessica Rinaldi//Files

WASHINGTON (Reuters) – A Tea Party-inspired plan to kill President Barack Obama’s healthcare law by forcing a government shutdown unless funds to implement the law are denied has not gained traction among senior Republicans in the U.S. House of Representatives, lawmakers said on Wednesday.

“I think leadership is giving other options that they think are more effective,” said Republican Representative Pat Tiberi, a close ally of House Speaker John Boehner.

Tiberi, speaking to Reuters following a closed-door meeting of House Republicans, said that while a final decision probably had not been made, his colleagues are more likely to continue pushing for Congress to repeal individual provisions of “Obamacare.”

Republicans have been on a continuous campaign to kill Obama’s landmark healthcare law, which aims to help provide medical insurance for millions of people who cannot afford it on their own. They argue that the law, which is taking effect in stages, will discourage job creation and saddle businesses with higher costs.

Tea Party-backed conservatives in the Senate, including Senators Marco Rubio, Ted Cruz and Mike Lee, have been trying to persuade enough of their fellow Republicans to join them in a high-stakes gamble that would threaten a government shutdown on the start of the new fiscal year, October 1, unless legislation to keep Washington operating specifically defunds Obamacare.

More senior Senate Republicans have savaged the idea, with some calling it “dumb,” “silly,” “feckless” and “dishonest.”

On September 30, federal funding expires for hundreds of federal programs, ranging from military activities and NASA space exploration to federal parks, education and job training.

A dozen funding bills for the fiscal year starting on October 1 are pending in Congress but are unlikely to be completed by that deadline.

The result is that Congress will either have to pass a temporary funding bill, called a continuing resolution or CR, or risk government closings. Tea Party-backed senators who want to attach the Obamacare provision have complicated already difficult negotiations over government spending levels.

House Appropriations Committee Chairman Harold Rogers, asked about chances of his chamber going along with demands of Tea Party-backed senators on the funding bill, told reporters: “This is just something the White House will not accept and we’ve got to have a CR.”

Representative Tom Cole, another longtime House Republican, told reporters that he had seen “an awful lot of push-back” on the idea, adding, “I don’t sense that there’s nearly enough unanimity in either the Senate or the House Republican conferences to push an approach like that.”

With Congress about to start a month-long break, Boehner said he will keep mulling ways to tackle end-of-fiscal-year funding problems.

“I’m confident that when we get into the fall, it may be a messy process, but I suspect we’ll find a way to deal with it,” Boehner told reporters.

(Editing by Vicki Allen)

Uruguayan President Jose Mujica speaks to the media after a joint news conference in Santana Do Livramento, July 30, 2010.

Credit: Reuters/Andres Stapff