Archive for 2014
The best test for finding hidden lung cancer in smokers is a low-dose CT scan. Its use has been endorsed by the U.S. Preventive Services Task Force (USPSTF), an independent panel that makes recommendations for screening tests. Most insurers follow the recommendations of the task force, and pay for those services. But some opposition to this by Medicare may mean that the test isn’t covered for some of the people who could benefit from it the most. A new report in the New England Journal of Medicine showed that the cost of adding one good year to a person’s life through CT screening is around $80,000. Tests or procedures that cost less than $100,000 per year added are considered cost effective. The analysis identified two groups for whom screening is the most cost-effective—current smokers and people ages 60-74. People with private insurance will have low-dose CT scans covered. But those with Medicare may not, thanks to the decision of a Medicare advisory committee. The CMS is expected to publish a draft of its decision within the next few days and come to a final decision in early 2015.
The FDA’s approval in 2010 of the blood-thinner dabigatran (Pradaxa) got many doctors excited. It was at least as effective as warfarin for preventing stroke-causing blood clots, and possibly caused fewer bleeding side effects. In addition, it is easier to use. Since then, studies of Pradaxa have slightly dampened the enthusiasm for the new drug. For example, a new study from the University of Pittsburgh showed that Pradaxa cause more episodes of serious bleeding (9%) than warfarin (6%). The bleeding sites tended to differ. Bleeding in the stomach and intestines was slightly higher among Pradaxa users. Bleeding in the head was slightly higher among warfarin users. Black patients and those with chronic kidney disease were more likely to bleed from Pradaxa.
More and more experts now recommend that people with high blood pressure regularly check their blood pressure at home. Doing this gives people an idea where their blood pressure stands in between office visits, and can motivate them to care more about their health. It also helps doctors make quick medication adjustments to keep blood pressure in the healthy zone. But according to a new study, up to 15% of home blood pressure monitors as accurate as they should be. Readings can be off by as much as 20 points. If you check your blood pressure at home, bring your monitor and cuff to your doctor’s office and compare the reading you get with the doctor’s known, accurate instrument.
Getting a flu shot can help ward off the flu. It also works to prevent pneumonia, a leading cause of hospitalization (about one million a year) and death (about 50,000) in the United States. Pneumonia can be especially dangerous in young children and older people. For these groups, as well as others who face a high risk of pneumonia, two different vaccines can help prevent pneumonia caused by the bacterium known as Streptococcus pneumoniae. One, called PPSV23 or Pneumovax, is derived from 23 different types of pneumococcal bacteria. A newer vaccine, called PCV13, features parts of 13 different pneumococcal bacteria linked to a protein that helps the vaccine work better. PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and anyone age 6 or older with risk factors for pneumonia. PPSV23 is recommended for all adults 65 years or older and anyone age 2 years through 64 years are at high risk of pneumonia.
Smells and tastes are often sources of great pleasure. They can also spark wonderful memories. But like memories, these senses can fade, or even disappear, with age. A new study suggests that loss of smell may be a canary in the coal mine—an early warning that something else is wrong in the body. In the study, published in PLoS ONE, older people who lost their sense of smell were more likely to have died over a five-year period. Previous research has linked loss of smell to the onset of neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. What to do If your sense of smell has faded? Don’t jump to conclusions. Diminished smell function is usually caused by problems in the nose, not in the brain.
The New York Times has described Thomas Eric Duncan, the first person to die of Ebola virus infection in the United States, as “the Liberian man at the center of a widening health scare.” Use of the term “health scare” about Ebola in the U.S. just isn’t warranted, according to a consensus of several Harvard experts who have looked at Ebola through different lenses. They give four main reasons why an epidemic of Ebola virus disease isn’t likely to happen here: 1) the virus is relatively difficult to spread; 2) we have an effective emergency-response infrastructure; 3) Most hospitals are equipped to treat Ebola safely; and 4) new treatments are in the works.
A report published this week in the Journal of the American Medical Association offers weak-to-no proof that acupuncture helps ease the pain of knee arthritis. In a group of older men and women with arthritis-related knee pain, Australian researchers compared traditional needle acupuncture against laser acupuncture, sham laser acupuncture, and no treatment. People who had needle or laser acupuncture reported slightly less pain and slightly better physical function compared with the group that had no treatment at all. Sham acupuncture worked as well as real acupuncture, suggesting the placebo effect may be at work.
Of all the health issues that loom large with age, memory loss is among those that provoke the most worry. A big reason is the uncertainty: people often wonder if their occasional memory slips are just a normal part of growing old or a sign of impending Alzheimer’s disease, the most common form of dementia. A new study of older adults, published in today’s issue of the journal Neurology, sheds some light—and perhaps offers a bit of reassurance—about the connection between self-reported memory loss and a diagnosis of dementia. Over a 10-year period as 70-somethings turned into 80-somethings, about 1 in 6 developed dementia. About 80% had reported memory changes. But it took about nine years from the first self-report of a memory change to a diagnosis of mild cognitive impairment, an intermediate stage between normal memory loss and dementia. The transition to dementia usually took about 12 years.
Enterovirus D68 is a respiratory infection that has been spreading across the country and making some children quite ill. It is especially problematic for kids with asthma or other respiratory issues. Enterovirus D68 can start out looking like a garden variety cold but lead to serious trouble breathing. What’s a parent to do? The same things he or she would normally do during cold and flu season: hand washing, staying away from people who are sick, regularly cleaning common surfaces like doorknobs, not sharing cups and utensils, and coughing or sneezing into the elbow, not the hands. Those who have children with asthma need to be extra vigilant about their child’s asthma care routine. Most upper respiratory infections are the simple cold. Still, it’s important to stay alert for signs of breathing difficulties.
New guidelines from the American College of Physicians offer drug-free ways women can use to reduce or stop urinary incontinence, a potentially embarrassing condition that affects millions of women. The guidelines recommend that women first try Kegel exercises, bladder training, exercise, and weight loss if needed. These approaches can work for both of the leading types of urinary incontinence: stress incontinence (leakage with laughter, sneezing, or other things that put pressure on the bladder) and urge incontinence, also known as overactive bladder, which is caused by unpredictable contractions of muscles in the bladder wall. Other lifestyle changes, like watch fluid intake and minimizing bladder irritants like caffeine, alcohol, carbonated drinks, and other may also help. If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin to relax overactive bladder muscles.