Insomnia scans show brain struggles

30 August 2013 Last updated at 19:01 ET

Woman with insomnia

Brain scans of people who say they have insomnia have shown differences in brain function compared with people who get a full night’s sleep.

Researchers at the University of California, San Diego, said the poor sleepers struggled to focus part of their brain in memory tests.

Other experts said that the brain’s wiring may actually be affecting perceptions of sleep quality.

The findings were published in the journal Sleep.

People with insomnia struggle to sleep at night, but it also has consequences during the day such as delayed reaction times and memory.

The study compared 25 people who said they had insomnia with 25 who described themselves as good sleepers. MRI brain scans were carried out while they performed increasingly challenging memory tests.

One of the researchers, Prof Sean Drummond, said: “We found that insomnia subjects did not properly turn on brain regions critical to a working memory task and did not turn off ‘mind-wandering’ brain regions irrelevant to the task.

“This data helps us understand that people with insomnia not only have trouble sleeping at night, but their brains are not functioning as efficiently during the day.”

A sleep researcher in the UK, Dr Neil Stanley, said that the quality of the sleep each group was having was very similar, even though one set was reporting insomnia.

He said: “What’s the chicken and what’s the egg? Is the brain different and causing them to report worse sleep?

“Maybe they’re perceiving what happened in the night differently; maybe what is affecting their working memory and ability to focus on the task at hand is also causing insomnia.”


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Top Florida health insurer touts Obamacare pain relief

By Tom Brown

MIAMI | Sat Aug 31, 2013 10:01am EDT

MIAMI (Reuters) – Florida’s leading health insurer is reaching out to hundreds of thousands of state residents, touting temporary relief from what it describes as an imminent spike in premium rates due to President Barack Obama’s signature healthcare reform law.

“When the new healthcare law takes effect, you may be surprised how much more you could pay for health insurance,” says an advisory to consumers from Blue Cross and Blue Shield of Florida, also known as Florida Blue.

“Find out how much you’ll save if you buy now,” adds the advisory, which has been mailed over the past month to homes of existing policyholders and potential new clients.

“Let us help you get the best deal on health insurance right now,” the notice says. “We can even tell you if you can get help paying for coverage from the government.”

Under Obama’s Patient Protection and Affordable Care Act, millions of uninsured Americans will be able to buy government-subsidized health coverage on new online state insurance exchanges beginning on October 1. The cost of the new plans, which require insurers to provide more benefits to consumers and bar the exclusion of people with prior illnesses, is a key factor to making the enrollment effort a success.

However, the law also allows consumers to select from existing individual insurance policies now and extend them into 2014. While these existing policies may be cheaper in some states than those under the Obamacare reform plan, many may not contain the same comprehensive benefits.

Florida Blue’s notice marks one of the more aggressive efforts by an insurer to tap into fears of “sticker shock” for the newer Obamacare plans. Republican-led Florida refused to set up its own insurance exchange, leaving the job to the federal government.

The enrollment stakes are big in the Sunshine State, where the U.S. Census Bureau says there are about 3.8 million people without health insurance. About a quarter of Florida’s population is uninsured, giving it the third-highest rate in the country.

Florida’s insurance regulators have said the cost of new insurance plans may rise 30 to 40 percent when compared with a fictional 2013 plan modeled to include the same benefits. But rates in the state are still being finalized between insurers and the U.S. Department of Health and Human Services. The Florida estimates don’t include substantial subsidies that a majority of uninsured people may qualify for.

Florida Blue said the advisory is part of a direct mail advertising campaign aimed at drumming up new business for the Jacksonville, Florida-based giant, which reported $8.9 billion in revenues last year and covers more than 4.3 million people in its primary health business in the state.

The company, a leading contributor to the political action committee of Florida’s Republican Governor Rick Scott, is one of nine insurers that have applied to sell non-group policies on the state’s new marketplace and the only one that promises to cover every county in Florida.

Craig Thomas, the executive responsible for marketing and strategy at Florida Blue, said the consumer advisory – unlike anything seen from other health insurance companies in Florida – was part of what he termed “an appropriate marketing program.”

It primarily targets many people purchasing coverage in Florida’s individual market today who will be ineligible for premium subsidies under Obamacare, Thomas said.

Many of those same consumers will be hit with higher rates because of benefit changes and other factors tied to next year’s full implementation of the law, he said.

“Their rates are generally going to go up,” said Thomas. “New expenses are going to be reflected in next year’s premiums.”

HURTING ENROLLMENT

Federal and consumer groups dispute the state’s projections. Health and Human Services Secretary Kathleen Sebelius told reporters on a recent Florida visit that competition for customers should help keep premiums in check.

An HHS spokeswoman declined to comment on the Florida Blue campaign, which comes against the backdrop of a full-court press by Scott and other Republican leaders in the state to undermine Obamacare.

But Ron Pollack, who heads Families USA, the national healthcare consumer advocacy group, strongly criticized the campaign and said it could hurt enrollment in Florida for coverage under the president’s reform plan.

“This letter from an insurer that has tried to appear helpful to consumers is outrageous, misleading and for many, totally erroneous,” Pollack told Reuters.

“People who get suckered into this appeal may very well lose many thousands of dollars in premium subsidies that become available soon if they enroll starting on October 1 in health coverage through the Affordable Care Act,” he said.

Republican opponents of the reform law were the driving force behind Florida Senate Bill 1842. Signed into law by Governor Scott in May, the legislation prohibits Florida’s Office of Insurance Regulation from providing any real protection for consumers from unreasonably high health insurance rates.

The federal government says it lacks the legal authority to regulate insurance premiums in individual states, though it is trying to persuade insurers to alter higher-priced plans when it can.

Sebelius, who has said she was “baffled” by Florida’s move, commented earlier this month that she knew of no other state that had chosen to eliminate its own regulatory oversight, leaving consumers at the mercy of health insurance companies.

“It’s really unconscionable that the Florida legislature and Governor Scott would take what is in essence the insurance cop, regulating insurance companies, off the playing field, take that cop off the beat … It just doesn’t make sense for families or small businesses. They’re supposed to be on our side,” said Tampa’s U.S. Representative Kathy Castor.

Castor, Debbie Wasserman Schultz and seven other Florida Democrats in the U.S. House of Representatives sent a letter to Sebelius decrying their state’s deregulation of health insurers as “a cynical and intentional effort by Governor Scott and the Florida legislature to undermine the Affordable Care Act and make health insurance premiums more expensive on the Florida Health Insurance Marketplace.”

The same law that curtails Florida’s rate-setting authority requires insurers to issue notices to consumers, blaming hikes in premiums on “the impact of federal healthcare reform.”

A copy of one such notice, which all health insurance companies operating in the state will be required to use, was made available to Reuters by the insurance commissioner’s office.

Thomas, who spoke in a telephone interview with Reuters from Jacksonville, said many Florida consumers could benefit financially from buying policies now, even though the plans would expire under Obamacare with no chance of renewal.

“The benefits and rates they buy now would not be changed until the product anniversary date gets here next summer,” Thomas said. It will carry them with their current program well into next year,” he added.

He and other company officials declined to comment on how Florida Blue’s premiums in 2014 would compare to existing rates.

(Editing by Ken Wills)

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Iowa board votes to end 'tele-med' abortions used by rural women

By Kay Henderson

DES MOINES, Iowa | Fri Aug 30, 2013 7:45pm EDT

DES MOINES, Iowa (Reuters) – The Iowa Board of Medicine took a final step on Friday to stop Planned Parenthood of the Heartland from providing abortion-inducing drugs to women via a video-conferencing system, a practice used to serve women in rural areas without doctors.

The board voted 8-2 to ban the practice, with most members arguing the best standard of care for a woman seeking an abortion is to have a doctor perform a physical exam and talk face-to-face with the patient.

Currently, women in remote parts of the state who live far from abortion providers can speak with a physician through Internet video and then take the medication to induce an early-term abortion.

Among those voting to ban telemedicine for abortions was Monsignor Frank Bognanno, pastor of Christ the King Catholic Parish in Des Moines and appointed to the board by Republican Governor Terry Branstad, an abortion foe.

“This is a big deal … This isn’t like taking an aspirin,” Bognanno said.

Ann Gales, a lawyer and board member, voted against the ban, arguing for more examination of the issue and raising concern that the vote was being rushed.

“If this is the right rule, it will still be the right rule after we engage in a more thorough discussion,” Gales said.

State laws requiring doctors to be present when abortion-inducing drugs are administered are becoming increasingly common, particularly in states run by Republican governors or Republican controlled legislatures. Eleven states have them, said Elizabeth Nash, state issues manager for the Guttmacher Institute, a pro-choice research group.

Abortion rights advocates say the laws are unfair to rural residents who do not have access to doctors and depend on telemedicine to get abortions, Nash said.

Greg Hoversten, D.O., the Iowa medical board’s chairman, voted for the ban.

“How can any of us possibly find that a medical abortion performed over the Internet is as safe as one provided by a physician in person, at the bedside?” Hoversten asked.

The ban on so-called “tele-med” abortions was set to take effect on November 6.

A lawyer for Planned Parenthood told reporters after the vote that, “all options are on the table,” including possible legal action to prevent the rule from taking effect.

(Editing by Kevin Murphy, Barbara Goldberg and Andre Grenon)

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Iowa board votes to end ‘tele-med’ abortions used by rural women

By Kay Henderson

DES MOINES, Iowa | Fri Aug 30, 2013 7:45pm EDT

DES MOINES, Iowa (Reuters) – The Iowa Board of Medicine took a final step on Friday to stop Planned Parenthood of the Heartland from providing abortion-inducing drugs to women via a video-conferencing system, a practice used to serve women in rural areas without doctors.

The board voted 8-2 to ban the practice, with most members arguing the best standard of care for a woman seeking an abortion is to have a doctor perform a physical exam and talk face-to-face with the patient.

Currently, women in remote parts of the state who live far from abortion providers can speak with a physician through Internet video and then take the medication to induce an early-term abortion.

Among those voting to ban telemedicine for abortions was Monsignor Frank Bognanno, pastor of Christ the King Catholic Parish in Des Moines and appointed to the board by Republican Governor Terry Branstad, an abortion foe.

“This is a big deal … This isn’t like taking an aspirin,” Bognanno said.

Ann Gales, a lawyer and board member, voted against the ban, arguing for more examination of the issue and raising concern that the vote was being rushed.

“If this is the right rule, it will still be the right rule after we engage in a more thorough discussion,” Gales said.

State laws requiring doctors to be present when abortion-inducing drugs are administered are becoming increasingly common, particularly in states run by Republican governors or Republican controlled legislatures. Eleven states have them, said Elizabeth Nash, state issues manager for the Guttmacher Institute, a pro-choice research group.

Abortion rights advocates say the laws are unfair to rural residents who do not have access to doctors and depend on telemedicine to get abortions, Nash said.

Greg Hoversten, D.O., the Iowa medical board’s chairman, voted for the ban.

“How can any of us possibly find that a medical abortion performed over the Internet is as safe as one provided by a physician in person, at the bedside?” Hoversten asked.

The ban on so-called “tele-med” abortions was set to take effect on November 6.

A lawyer for Planned Parenthood told reporters after the vote that, “all options are on the table,” including possible legal action to prevent the rule from taking effect.

(Editing by Kevin Murphy, Barbara Goldberg and Andre Grenon)

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ESC: Statins May Protect Brain, Eyes

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Meeting Coverage

Published: Aug 31, 2013

By Chris Kaiser, Cardiology Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Statins might help prevent dementia and cataracts, according to two separate studies presented at the European Society of Cardiology meeting.
  • Note that in the cataract study, the greatest benefit was seen when treatment was initiated in younger patients.

AMSTERDAM — Statins might help prevent dementia and cataracts, according to two studies presented here.

In a retrospective analysis of 57,669 Taiwanese patients who were over 65, those in the highest daily dosage tertile had a 59% reduced risk of new-onset dementia compared with controls, according to Cho Kai Wu, MD, of the National Taiwan University Hospital in Taipei, and colleagues.

The protective benefit was smaller but still evident in the lowest and middle daily dosage tertiles — 38% and 31% reduced risk, respectively (P<0.001 for trend), they reported at the annual meeting of the European Society of Cardiology.

In a second study, John B. Kostis, MD, from the UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J., and colleagues found that the risk of cataract was reduced by 20% among statin users versus non-statin users.

The absolute risk reduction was 1.4%, which equates to 71 persons needed to treat with statins to prevent one cataract, Kostis said at a press conference.

For the dementia study, Wu and colleagues used a random sample of 1 million patients covered by Taiwan’s National Health Insurance program. From this they identified 57,669 patients 65 years or older who had no history of dementia in 1997 and 1998. The mean follow-up was 4.5 years.

A total of 42,461 patients had not taken statins and served as controls; another 15,200 patients had taken statins. From both cohorts, researchers found 5,516 cases of new dementia.

In addition to looking at daily dosage outcomes, patients also were divided into tertiles according to their total equivalent dosage — across the entire follow-up period, which averaged 4.5 years.

Those in the highest tertile of total equivalent dosage had a 67% reduced risk of new-onset dementia compared with controls. Again, the protective benefit was still there for those in the lowest and middle tertiles, albeit smaller — 23% and 37%, respectively (P<0.001 for trend).

The protective effect of statins remained in different age, gender, and cardiovascular risk subgroups, Wu reported at a press conference.

The investigators did not distinguish between different types of dementia, but Wu suggested the beneficial effect was most likely driven by a reduction in vascular dementia — one of the most common causes of dementia along with Alzheimer’s disease.

“A disorder of cholesterol metabolism could lead to increased incidence of cerebral vascular disease, and elevated levels of cholesterol may result in a high inflammatory state that is associated with neurodegeneration,” Wu said.

Sidney C. Smith Jr., MD, director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine in Chapel Hill, said that the Chinese people in general have an increased risk of stroke compared with other populations.

“I would speculate that the overall reduction in dementia was related to a decrease in microinfarct dementia. But this hypothesis needs to be examined in prospective studies,” Smith, a past president of the American Heart Association, told MedPage Today.

In fact, the Taiwanese researchers are designing a prospective study as the next step in their line of investigation, Wu told MedPage Today.

Wu noted the warning in February 2012 by the FDA that stipulated all statins must warn of the potential for statin-induced cognitive changes, especially for the older population.

He said that previous studies had considered statin therapy to exert a beneficial effect on dementia, but few large-scale studies have focused on the impact of statins on new-onset dementia in the geriatric population.

The researchers also said the potency of the statins, rather than their solubility, was a major determinant in reducing dementia. They pointed out that high-potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia in a dose-response manner.

In the cataract study, the greatest benefit was seen when treatment was initiated in younger patients. The risk was cut in half for patients in their 40s, for example, compared with only a 10% reduced risk for patients in their 70s.

“It is possible that the two processes — aging and statins — work in parallel or interactively,” Kostis said.

Researchers also found that duration of statin therapy influenced the protective benefit on cataracts. Those on statins for 14 years, for example, had a 55% reduced risk, while those on statins for 6 months only had a 10% reduced risk.

Their meta-analysis included 13 clinical trials comprising 2.4 million patients and 25,618 cataracts. The average duration of statin treatment was 54 months, the average age was 61, and nearly 60% were men.

The results were confirmed by several sensitivity analyses, Kostis pointed out.

“Our findings dispel worries about the safety of statins when it comes to cataracts, and lends additional support to long-term statin use,” he concluded.

Kostis said the meta-analysis is limited because of different study designs, some studies without cataract as a predefined endpoint, potential incomplete adjustment for confounders, and possible reporting and publication bias.

Wu and colleagues noted their study limitations included the retrospective design, the potential for other confounders, and the potential for lost data that could have impacted the results.

The researchers for both studies had no conflicts of interest to declare.


Primary source: European Society of Cardiology
Source reference: Wu C, et al “Statin use and the incidence of dementia in the elderly: a nationwide data survey” ESC 2013.

Additional source: European Society of Cardiology
Source reference:Kostis JB, et al “Statins prevent cataracts: A meta-analysis” ESC 2013; Abstract 80970.

Chris has written and edited for medical publications for more than 15 years. As the news editor for a United Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theater as a writer, director, and occasional actor.

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Lab Notes: What Were We Talking About?

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Lab Notes

Published: Aug 30, 2013

A brain protein apparently mediating age-related memory loss (distinct from neurodegenerative disease) holds promise for keeping “senior moments” at bay. Also this week: new tricks from an old drug.

Memory Loss Linked to … Uh …

A single protein in one region of the brain may be responsible for age-related memory loss, according to researchers led by Nobel laureate Eric Kandel, MD, of Columbia University Medical Center in New York City. A series of experiments in mice suggests that levels of RbAp48 in the dentate gyrus of the hippocampus fall with age, leading to memory impairment.

The dentate gyrus has been implicated in age-related memory impairment. In a human genetic study, Kandel and colleagues found 17 genes the transcription of which varied with age, chief among them the gene for RbAp48, which plays multiple roles in histone acetylation and transcription regulation.

In subsequent lab experiments, young mice with the protein turned off had memory impairment similar to that seen in aged animals, but when the protein was turned on again, their memories returned to normal. Even better, replacing the protein in aged mice restored their ability to remember, the investigators reported in Science Translational Medicine.

One implication of the finding is that age-related memory loss is a syndrome in its own right, separate from dementias such as Alzheimer’s, disease Kandel said in a statement. Another is that such memory loss can potentially be the subject of therapy with compounds that stimulate RbAp48 or one of the pathways it’s involved in, he said.

— Michael Smith

An Old Drug With New Immune Tricks

A cancer drug originally developed in the 1960s has immunosuppressant potential for transplant patients and those with autoimmune diseases, according to researchers from Lund University in Sweden.

Zebularine is a DNA demethylating agent that can induce the expression of two specific immunosuppressive enzymes, indolamine-2,3-deoxygenase-1 and kynureninase. To see if this action could be exploited therapeutically, Leif G. Salford, MD, PhD, and colleagues induced diabetes in a group of rats through injections of streptozotocin, and then grafted islets of Langerhans into the subcapsular space of the kidney. Half of the animals were then treated with zebularine for 14 days and the other received no treatment.

The rats given zebularine remained normoglycemic for a mean of 67 days compared with only 2 weeks among controls. In addition, half of the treated rats still had normal glucose levels after 3 months but subsequently developed hyperglycemia after nephrectomy, suggesting recovery of pancreatic function.

This long-lasting immune suppression was limited to the target cells and therefore might avoid activating the immune system at large, which leaves patients at risk of infections and cancer, the researchers explained in PLOS One.

— Nancy Walsh

A Shot Against Noise-Related Hearing Loss?

Loud noise activates certain cells in the inner ear that detach and damage the endothelial fluid barrier in blood vessels, but boosting levels of the protein they modulate reduces the hearing loss it causes, researchers found in an animal study.

Mice exposed to 120 db — the level of a loud rock concert or jet engine — for several hours 2 days in a row showed changes in a type of macrophage that modulates proteins in the inner ear to maintain hearing. The cells physically detached from capillary walls, resulting in proteins leaking out of the damaged vascular barrier.

But an injection of the signaling molecule of those cells restored barrier integrity and hearing lost from the noise damage, Xiaorui Shi, MD, PhD, of the Oregon Health and Science University in Portland, and colleagues reported in the FASEB Journal.

“It’s easy to say that we should avoid loud noises but, in reality, this is not always possible,” Gerald Weissmann, MD, editor-in-chief of the journal, commented in a statement. “Front-line soldiers or first responders do not have time to worry about the long-term effects of loud noise when they are giving their all. If, however, a drug could be developed to minimize the negative effects of loud noises, it would benefit one and all.”

Crystal Phend

Collagen for an Ailing Heart

Researchers have developed a collagen patch that can help repair the protective outer layer of the heart, according to Vahid Serpooshan, PhD, of Stanford University School of Medicine, and colleagues.

The patch, which is made of structurally-modified collagen, can be grafted onto heart tissue and rather than replacing dead muscle cells, replaces the epicardium to protect and support the myocardium.

Mouse studies have shown that damaged hearts grafted with the collagen patch had speedier generation of new cells and blood vessels in the affected area, they wrote online in the journal Biomaterials.

Mice in the study were given a surgically-induced heart attack. Those getting the patch had significant improvement in overall cardiac function and in echocardiograms 2 weeks later, and new cells proliferated around the patch and surrounding damaged heart tissues. Damaged hearts treated with the patch also had greater development of new blood vessels.

The patch is made of a cell-free collagen, which means a recipient does not require immunosuppression, and the collagen is later absorbed into the organ, the researchers pointed out.

They also noted that the patch might be used to deliver medications or stem cells to a patient.

Cole Petrochko

Gut’s Sugar Sensors Impaired in Diabetes

“Sweet taste” receptors in the gut may be impaired in patients with type 2 diabetes, potentially leading to an increased risk of hyperglycemia after a meal, researchers found.

In a small study, expression in the gut of the sweet taste receptor T1R2 fell off 30 minutes after a glucose infusion in healthy patients, but rose in patients with type 2 diabetes, Richard Young, PhD, of the University of Adelaide, and colleagues reported online in Diabetes.

That could indicate a faulty “braking” system for glucose absorption in patients with type 2 diabetes, potentially exacerbating postprandial hyperglycemia.

“This shows that diabetes is not just a disorder of the pancreas and of insulin,” Young said in a statement. “The gut plays a bigger role than researchers have previously considered.”

For their study, the researchers took endoscopic biopsies of the duodenum in 14 healthy patients and 13 type 2 diabetes patients at baseline and then 30 minutes after a glucose infusion.

They found that expression of T1R2 in the gut fell off a half hour after the infusion in healthy patients, but rose in those with type 2 diabetes — leading to greater glucose absorption in these patients, they reported.

“By gaining a better understanding of how these mechanisms in the gut work, we hope that eventually this will assist to better manage or treat diabetes in the future,” Young said.

— Kristina Fiore


MedPage Today Staff

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CDC Details Use of Sleep Meds

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Primary Care

Published: Aug 30, 2013

By John Gever, Deputy Managing Editor, MedPage Today

Some 4% of American adults used prescription sleep medications in the past month, government survey data showed, with the highest rates among women, the elderly, whites, and the college-educated.

Results from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 indicated that 4.1% of respondents 20 and older said they had used a prescription sleep aid in the previous 30 days, according to a new data brief from the CDC’s National Center for Health Statistics.

The report represents the first large, nationally representative survey on prescription sleep drug use not reliant on administrative claims data, the authors indicated.

Among NHANES respondents 80 and older, the use rate was 7.0%, compared with 1.8% for individuals in their 20s and 30s (P<0.05 for age trend).

Women reported use of the agents at a rate of 5.0% versus 3.1% in men (P<0.05), the report said. Among racial-ethnic categories, the highest rate was in non-Hispanic whites (4.7%), followed by non-Hispanic blacks (2.5%) and Mexican-Americans (2.0%).

The report also showed a significant association between increasing education and use of prescription sleep drugs, with 3.0% of respondents with less than high school education reporting use versus 3.9% of those with only a high school diploma or the equivalent, and 4.4% of those with some college experience (P<0.05 for trend).

There was a U-shaped relationship between NHANES respondents’ recent average sleep duration and their use of prescription sleep drugs. Among individuals reporting 5 hours or less of sleep nightly, 6.0% said they used prescription sleep drugs, whereas 3.2% of those who said they averaged 7 hours nightly used sleep aids.

But sleep durations greater than 7 hours were associated with increasing use of drugs, reaching 5.3% of those reporting 9 or more hours of sleep nightly (P<0.05 for quadratic trend and in comparison with the 7-hour group).

Not surprisingly, sleep drug use was relatively high among NHANES participants who said they had been diagnosed with a sleep disorder or had told a doctor about problems sleeping (16.3% and 12.7%, respectively).

Yet 1.1% of participants who did not report any sleep problems to their doctors still reported using prescription sleep aids, as did 3.1% of those who reported no physician diagnosis of a sleep disorder.

The NHANES did not ask participants about factors that could help explain these findings, such as the time of initiation or the overall duration of sleep drug use, or whether respondents thought the drugs were effective.

Hence it was unclear, for example, whether the high percentage of respondents averaging 9 hours or more of sleep nightly who used sleep drugs reflected overuse of such products versus appropriate efficacy.

The report also offered no explanation for the use of prescription sleep drugs in the absence of either a diagnosed sleep disorder or discussion of sleep problems with a physician.

Like most government health surveys, the NHANES excludes individuals living in institutions such as nursing homes and prisons. It is conducted annually with about 5,000 new participants each year. In addition to completing a questionnaire, participants also undergo a physical exam with blood sampling and other testing.


John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University. Now based in Pittsburgh, he is the daily assignment editor for MedPage Today as well as general factotum on the reporting side. Go Pirates/Penguins/Steelers!

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Health Tip: At Risk for Alzheimer’s?

Latest Alzheimers News

  • Health Tip: At Risk for Alzheimer’s?
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(HealthDay News) — Researchers believe they’ve identified at least some of the risk factors for Alzheimer’s disease. While there are some factors that you have no control over, you may be able to influence some potential triggers.

The Alzheimer’s Association offers this list of examples:

  • Head trauma — Serious head injuries are thought to predispose some people to Alzheimer’s. You can help prevent head injuries by always wearing your seat belt in a car, wearing a bike helmet or sports helmet, and by safeguarding your home against falls.
  • Heat health — There’s growing evidence that the health of your heart is linked to the health of your brain. With the help of your doctor, be sure to monitor your heart health and treat any problems that surface.
  • Age healthy — Get enough exercise, skip junk food in favor of lots of fruits and vegetables, and be sure to lose any excess weight.

— Diana Kohnle

MedicalNews
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Management of rheumatoid arthritis just as good with specialist nurses as with doctors

Main Category: Arthritis / Rheumatology
Also Included In: Nursing / Midwifery;  Primary Care / General Practice
Article Date: 31 Aug 2013 – 0:00 PDT

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Patients attending clinical nurse specialist clinics do not get inferior treatment to that offered by consultant rheumatologists, the results of a major new clinical trial have revealed.

The results of the multi-centre trial at the University of Leeds, funded by Arthritis Research UK, showed that there may be some clinical benefit to people with rheumatoid arthritis, whose condition is managed in clinics run by rheumatology clinical nurse specialists, especially with respect to their disease activity, pain control, physical function and general satisfaction with their care.

Rheumatoid arthritis is a chronic inflammatory disease, which if untreated may lead to severe disability or death. However, the management of the disease has changed significantly over the past ten years due to better understanding of the disease process, an emphasis on early diagnosis, intensive treatment and the use of more efficacious drug therapies.

The nation-wide trial was led by Dr Mwidimi Ndosi, of the University’s Institute of Rheumatic and Musculoskeletal Medicine, and former University academic Dr Jackie Hill. It compared the outcomes of 180 people with rheumatoid arthritis in 10 out-patient clinics around the UK, half run by clinical nurse specialists, and the other by rheumatologists.

In both groups the nurse or doctor took a patient history, carried out a physical examination, discussed pain control, change of drugs or dose (including steroid injections) and offered patient education and psychosocial support. The nurse-led clinics’ appointment times were on average longer than the consultants’ (20 vs 15 minutes).

The results of the study, published in the Annals of the Rheumatic Diseases, found that although the nurses made fewer changes to a patient’s medication and ordered fewer x-rays and steroid injections, their patients saw greater improvement in disease activity than those under rheumatologists’ care. Nurses also provided patient education and psychosocial support more frequently than rheumatologists, and their patients also had fewer unplanned hospital admissions or visits to accident and emergency units.

“The results of this study show that clinics run by rheumatology clinical nurse specialists can manage many people with rheumatoid arthritis without any reduction in the quality of care and treatment,” said Dr Ndosi.

In addition to better improvements in the disease activity, nurse-led clinics had overall lower healthcare costs, representing a cost-effective service. The economic evaluation took into account healthcare resource use, including consultation costs, investigations, hospital admissions and treatments including over-the-counter medications.

Interestingly, throughout the 12-month follow-up period, the proportion of patients receiving expensive biologic drug treatment remained more or less constant in the nurse-led clinics, while that of rheumatologist-led clinics doubled.

“The development of the role of clinical nurse specialist in rheumatology has resulted in great improvements in rheumatology service, providing a high quality, accessible and person-centred care to people with rheumatoid arthritis,” said Dr Hill.

“The results of this research are encouraging, demonstrating that this model of care is effective, safe, and associated with more patient satisfaction. At a time when deficiencies have come to light in some areas of the NHS, it’s good to know that in rheumatology there are high levels of satisfaction with the care we provide.”

Professor Alan Silman, medical director of Arthritis Research UK commented: “Rheumatoid arthritis is, despite modern treatment, a chronic condition requiring long-term expert professional care to help patients manage their symptoms and control disease. This care necessarily involves many different healthcare professionals.

“Why this study is so important is that it shows that specialist trained nurses can improve outcome, enhance the patient experience and reduce costs when compared to conventional doctor-led services.

“There will obviously always be a place for specialist medical input at certain times in the patient journey, but this study shows the importance of specialist rheumatology team work, and is a future model of care which requires serious consideration for widespread implementation within the NHS.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.

The full paper: Mwidimi Ndosi, Martyn Lewis, Claire Hale, Helen Quinn, Sarah Ryan, Paul Emery, Howard Bird, Jackie Hill, ‘The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial ‘, Annals of the Rheumatic Diseases (2013) Ann Rheum Dis doi:10.1136/annrheumdis-2013-203403

University of Leeds

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Knee osteoarthritis risk unaffected by moderate exercise

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Academic Journal
Main Category: Arthritis / Rheumatology
Also Included In: Seniors / Aging;  Sports Medicine / Fitness
Article Date: 31 Aug 2013 – 0:00 PDT

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A new study suggests that the risk of middle-aged and older adults developing knee arthritis is unaffected by doing up to 150 minutes per week of moderate physical activity, the level recommended by the US goverment.

Researchers from the University of North Carolina (UNC) and the Centers for Disease Control and Prevention (CDC), came to this conclusion after studying data on over 1,500 participants aged 45 and over.

The study was published online on August 27th in Arthritis Care & Research.

Lead author Dr. Kamil Barbour, who is with the CDC’s Arthritis Program in the Division of Population Health, says moderate physical activity is that which results in a raised heart rate or breathing.

Examples include brisk walking, ballroom dancing, conditioning exercises, or even general housework, gardening and yard work.

Dr. Barbour says:

“Meeting physical activity recommendations through these simple activities are a great way to reduce your risk of heart disease, stroke, high blood pressure, diabetes, and other diseases.”

Knee arthritis leading cause of disability and joint pain

Osteoarthritis occurs when the cartilage and underlying bone in a joint break down, leading to bony overgrowth, pain, swelling and stiffness.

The joints most affected are the knees, hips and those of the hands and spine. The condition, for which there is currently no cure, develops gradually, usually in the over-40s.

In 2008, a US government study said that half of adults are at risk for painful knee arthritis.

In their background information, the authors confirm how knee osteoarthritis is a leading cause of disability and joint pain in the US, and they say that while other risk factors have been identified, the effect of physical activity is not very clear.

Physical activity guidelines and risk of knee arthritis

For their study, the researchers analyzed participant data collected between 1999 and 2010 in UNC’s long-running Johnston County Osteoarthritis Project.

The project is a prospective, population-based study of knee, hip, hand and spine osteoarthritis and disability, and it is funded by the CDC and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS).

The study data covers 1,522 African Americans and Caucasians, aged 45 years and older, who were followed for around 6 years.

The purpose of the new analysis was to see if there were any links between meeting the Department of Health and Human Services’ recommended 150 minutes of moderate exercise per week and the development of knee osteoarthritis, as confirmed both by X-rays and the presence of knee pain or other symptoms.

The results showed that for participants aged 45 and over who did up to 150 minutes a week of moderate physical activity, there was no increased risk of developing knee osteoarthritis.

Participants who exercised at a higher level, up to 5 hours a week, had a slightly higher risk of developing knee osteoarthritis, but the researchers found the difference was not statistically significant.

Senior author Dr. Joanne Jordan, director of the Thurston Arthritis Research Center at the University of North Carolina School of Medicine, describes the findings as good news:

“This study shows that engaging in physical activity at these levels is not going to put you at a greater risk of knee osteoarthritis. Furthermore, we found this held true no matter what a person’s race, sex or body weight is. There was absolutely no association between these factors and a person’s risk.”

Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our arthritis / rheumatology section for the latest news on this subject.

Meeting physical activity guidelines and the risk of incident knee osteoarthritis: The Johnston County Osteoarthritis Project; K.E Barbour, J.M Hootman, C.G Helmick, L.B Murphy, Kristina A. Theis, T.A Schwartz, W.D Kalsbeek, J.B Renner and J.M Jordan; Arthritis Care & Research online 27 August 2013; DOI: 10.1002/acr.22120; Abstract

Additional source: University of North Carolina Health Care news release 28 August 2013.

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31 Aug. 2013. <http://www.medicalnewstoday.com/articles/265442.php>


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Paddock, C. (2013, August 31). “Knee osteoarthritis risk unaffected by moderate exercise.” Medical News Today. Retrieved from
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