Harvard Health Blog

The United States is in the midst of the largest outbreak of West Nile virus since that virus was first discovered here in 1999. So far this year, more than 1,100 cases of human West Nile infection have been reported, about half of them in Texas, and at least 40 people have died from the virus. More cases are expected, since West Nile virus infections generally peak in late August and September. The virus is transmitted to humans by mosquitoes. Mosquitoes pick it up by feeding on birds carrying the virus. Very rarely, West Nile virus infection occurs due to transfusion of infected blood. It can’t spread from human to human by casual contact. None of the antiviral drugs currently available kill West Nile virus. And no vaccine is available. Prevention is best: stay inside when mosquitoes are most likely to bite, and use insect repellant when outside.

Compared to the pumping intensity of spin or Zumba, a tai chi class looks like it’s being performed in slow motion. But this exercise program is far more dynamic than it looks. As an aerobic workout, tai chi is roughly the equivalent of a brisk walk. And as a resistance training routine, some studies have found it similar to more vigorous forms of weight training. It is especially useful for improving balance and preventing falls—a major concern for older adults. Tai chi helps improve balance because it targets all the physical components needed to stay upright—leg strength, flexibility, range of motion, and reflexes—all of which tend to decline with age. It also offers an emotional boost to balance by removing the fear of falling that can make some people afraid to exercise.

You’ve probably heard the saying, “It takes a village to raise a child.” After reading about Rosie O’Donnell’s heart attack, I’d like to coin a new one: “It takes a celebrity to sound the alarm about important health issues.” The 50-year-old actress, comedienne, and talk show host suffered a surprise (aren’t they all) heart attack last week. Word got out when she wrote about it on her blog. O’Donnell brushed off some chest pain and arm pain as muscle aches related to some heavy lifting, ditto later feelings of nausea and clammy skin. When she went to the hospital the next day, a key artery in her heart was 99% blocked. At age 50, O’Donnell may have thought she was too young for those problems to signal a heart attack. She also wasn’t familiar with a heart attack’s sometimes sneaky signs and symptoms. O’Donnell urges “know the symptoms ladies/listen to the voice inside/the one we all so easily ignore/CALL 911/save urself.”

Taking care of yourself and your nuclear family is not always easy. Add the need to take care of an aging and ailing parent or family member and the stress can become overwhelming. According to some estimates, more than 40 million adults in the United States care for older or sick adult relatives or friends on a regular basis. AARP has estimated that these family and friends provide up to $450 billion worth of care. The responsibility often falls on family members, because long-term care outside the home can be very expensive and most Americans can’t afford private long-term care insurance that might cover these costs. Regular health insurance, or Medicare, does not pay for the kind of regular daily care many adults need later in life. A new ad campaign sponsored by AARP (formerly the American Association of Retired Persons) and the nonprofit Ad Council wants caregivers to know that they are not alone and that help is available. The goal of the ads is to raise awareness of the effects that family caregiving can have and to help people find the resources they need to reduce the stress.

In a new essay entitled “Big Med,” physician-author Atul Gawande muses in The New Yorker if The Cheesecake Factory and other successful chain restaurants could serve as a model for improving health care. He wondered how a large restaurant could deliver “a range of services to millions of people at a reasonable cost and with a consistent level of quality,” while hospitals and other parts of the U.S. health care system can’t. The experience prompted Dr. Gawande to meet with managers, cooks, and other workers at a Boston-area Cheesecake Factory to see how it delivers good food and a good dining experience time after time. He then goes on to compare the restaurant’s procedures with what goes on in hospitals.

There are several good reasons to have cataracts fixed. Restoring clear, colorful vision certainly tops the list. A study published today in the Journal of the American Medical Association (JAMA) adds another benefit—a lower risk of breaking a hip. Researchers analyzed the effect of cataract surgery on the frequency of hip fracture in the following year. Among more than a million adults ages 65 and older who had cataracts, the frequency of hip fracture was 16% lower among those who had cataract surgery compared with those who didn’t have it, and the reduction in risk was even greater (23%) if the cataract was severe. Besides the immediate benefit of improved vision on everyday activities, and the longer-term one of preventing broken hips, cataract surgery may have other, less obvious benefits. These include more independence, better physical fitness, and better mental health.

A recent study in the Archives of Internal Medicine indicates that the risk of having a heart attack is up to 31 times higher immediately following joint replacement surgery. Those relative risk numbers could be terrifying for someone who needs to have a knee or hip replaced. The absolute risk numbers offer some reassurance. In the six weeks following surgery, one in 200 people in the study who got a new hip and one in 500 who had a knee replaced suffered a heart attack. One new point the study underscored is that the elevated risk may last longer than previously thought. Though earlier research had suggested a danger zone lasting four to five days after joint replacement—coincidentally, the period in which many people are discharged from the hospital—the elevated heart attack risk may persist for two to six weeks.

Thanks to medical advances in detecting and treating stroke, the risk of dying from one is now lower than it used to be. Unfortunately, many stroke survivors are left with a disability. In fact, stroke is the leading cause of serious long-term disability in the United States. A new study from Indianapolis suggests that yoga may benefit some stroke survivors. In this study, 47 stroke survivors were divided into three groups. Some took part in a twice weekly group yoga session for eight weeks, and others received standard follow-up but no yoga. There were several benefits in the yoga group, including improved balance, improved quality of life, reduced fear of falling, and better independence with daily activities. Although small, this study adds to findings from other research that yoga may help stroke survivors in several ways.

For some people with depression that isn’t alleviated by medication or talk therapy, a relatively new option that uses magnetic fields to stimulate part of the brain may help. Called repetitive transcranial magnetic stimulation (rTMS), it was approved by the FDA in 2008. Although more and more centers are beginning to use transcranial magnetic stimulation, it still isn’t widely available. Transcranial magnetic stimulation directs a series of strong magnetic pulses into the brain. These pulses create a weak electrical current that can increase or decrease activity in specific parts of the brain. In two large studies, rTMS improved depression in 14% of people who underwent it, compared to 5% who underwent sham, treatment. The cost can range from $6,000 to $10,000, depending on the clinic and how many sessions are needed. Insurance may not cover the cost of treatment.

New guidelines now urge adults who have been infected with HIV to start taking HIV-fighting drugs as soon as possible, ideally within two weeks of being diagnosed with the infection, rather than waiting to see what happens with white blood cell counts. By preventing the virus from multiplying in the body, this strategy can maintain health and slow—or even stop—the progression to AIDS. Equally important, taking anti-HIV drugs early can decrease the odds that a person will spread HIV to someone else as much as 96%. The new guidelines, from the International Antiviral Society—USA Panel, were presented at the 19th International AIDS Conference, now going on in Washington DC. The new guidelines aren’t without their challenges. Patients must be “ready and willing” to stick with drug therapy, which can be complicated. Another hurdle is cost. An effective anti-HIV drug strategy costs more than $1,000 a month.

Is there a spring in your step—or a wobble in your walk? The speed and stability of your stride could offer important clues about the state of your brain’s health. According to new research, an unsteady gait is one early warning sign that you might be headed for memory problems down the road. A group of studies reported last week at the Alzheimer’s Association International Conference in Vancouver, Canada, revealed a strong link between walking ability and mental function. What’s behind this connection? Walking is a complex task that requires more than just moving the leg muscles. Walking requires scanning the environment for obstacles and safely navigating around them, all while talking and carrying out various other tasks. The studies found that walking rhythm was related to information processing speed; walking variations and speed were associated with executive function (the mental processes we use to plan and organize); and walking speed became significantly slower as mental decline grew more severe.

Controlling high blood pressure is a good thing—unless you are a frail older person. Then it might be harmful. That’s the surprising finding of a study of more than 2,000 seniors published online in the Archives of Internal Medicine. In the study, high blood pressure was linked to an increased risk of dying only among older adults who were relatively fit. Among those who couldn’t walk 20 feet, those with high blood pressure were less likely to have died. It’s possible that frail older adults benefit from having higher blood pressure. It’s also possible that using multiple medications drive down blood pressure in older, frail adults may do more harm than good.

If you start an exercise program, it only seems fair that you should see your hard work reflected in lower numbers on the scale. If it isn’t, don’t despair—or quit exercising. You are still helping your heart, lungs, and every other part of your body. A study in the Journal of the American College of Cardiology looked at the effects of exercise and/or weight loss on cardiovascular health among more than 3,000 men and women who were initially overweight. As I write in the July issue of the Harvard Health Letter, those who exercised consistently and lost weight had the biggest reduction in heart attack risk over six years of follow-up. Exercising without losing weight and losing weight without exercising offered smaller benefits. Although exercise and weight don’t always move in the same direction, they are both important for health.

Although dying is a fact of life, few people want to think about it. One group that must think about dying are people with advanced cancer who are told they have just a few months to live. What helps them end their days as peacefully as possible? A new study from Harvard-affiliated Dana-Farber Cancer Center and Brigham and Women’s Hospital found that being at home instead of in the hospital, talking with a chaplain or other minister, and spending time in private religious activity helped achieve this. When it’s clear that there’s no stopping cancer, heart failure, or other conditions, palliative care can help create a situation that maintains quality of life and leads to a “good death.”

After a hospitalization, being discharged is a key step on the road to recovery. But that road can take a dangerous turn—namely, a serious problem with one or more medications. It’s a common problem that many people experience within a few weeks of leaving the hospital. Researchers at Brigham and Women’s Hospital reported in the […]

Daily exercise appears to reduce a woman’s risk of developing breast cancer, according to a study published online in the journal Cancer. The type or intensity of the exercise didn’t seem to matter, as long as it was done often. How much exercise is needed to lower breast cancer risk? In this study of 3,000 women, 10 to 19 hours a week (about two hours a day) had the greatest benefit. Age didn’t seem to matter—physical activity reduced breast cancer risk in younger women during their reproductive years and older women after menopause. What did make a difference in the effect of exercise was weight gain—especially after menopause. Gaining a significant amount of weight essentially wiped out the benefits of exercise on breast cancer risk in older women.

The FDA has approved a new kind of PSA test for prostate cancer that its maker claims can help doctors do a better job of telling the difference between prostate cancer and less worrisome conditions such as prostate infection or benign prostate enlargement. The test, called the Prostate Health Index (PHI), should become available in the U.S. later this summer. The PHI combines measurements of three kinds of prostate specific antigen (PSA), a protein produced by the prostate gland. In theory, the combination could help reduce the number of men who undergo prostate biopsies when their PSA levels are slightly above normal, in the 4 to 10 nanogram per milliliter range. But doctors must take care not to allow use of the PHI test to worsen the existing overdiagnosis and overtreatment of low-risk cancers, according to Dr. Marc B. Garnick, an expert in prostate cancer at Harvard Medical School and editor in chief of HarvardProstateKnowledge.org.