Listening to music may ease cancer patients' pain

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(Reuters Health) - Listening to music at home may reduce cancer patients’ pain and fatigue and ease symptoms like loss of appetite and difficulty concentrating, according to research in Taiwan.

In the study, breast cancer patients assigned to 30 minutes of music listening five times a week had “noticeably” reduced side effects of cancer and its treatment over 24 weeks, researchers report in the European Journal of Cancer Care.

The patients said the music helped their physical and psychological wellbeing because it distanced them from negative thoughts about cancer.

“Music therapy is convenient, does not involve invasive procedures, and can easily be used by people in the comfort of their homes,” said senior study author Kuei-Ru Chou of Taipei Medical University.

“Home-based music interventions can also be used with no cost,” Chou told Reuters Health by email. “Healthcare services have become expensive in the present time.”

The researchers recruited 60 breast cancer patients and randomly assigned half of them to a group that would listen to music at home on an MP3 player provided by the study team with a selection of classical, parlor, popular, Taiwanese and religious music to choose from. The other patients were also given a player and the same instructions about how often to listen, but their selections were various types of ambient music, mainly consisting of environmental sounds, which research has shown does little to reduce pain or symptoms, the study team notes.

Before the women had surgery, and after six, 12 and 24 weeks of music listening, all patients rated the severity of 25 physical symptoms on a five-point scale, as well as rating five categories of fatigue on a separate five-point scale, and the level of pain they felt on a 100-point scale.

The average symptom severity scores of the music therapy group had dropped by five points at the six-week assessment, seven points at 12 weeks and nearly nine points after 24 weeks. Pain scores and overall fatigue scores fell at each assessment as well.

For those listening to music, physical and mental fatigue had also dropped at six weeks but not later.

In contrast, pain and symptom severity scores in the control group increased and remained higher than at the start of the trial.

Based on the results, music therapy may not relieve long-term physical and mental fatigue, the study authors caution. And future studies should use objective measures of pain and fatigue, in addition to the subjective measures used in this study, Chou said.

The researchers are also interested in learning how and why music therapy reduces symptoms and pain. Because listening to music promotes endorphins, dopamine and serotonin in the brain, the chemicals may spark joy and positive emotions that distract patients from the negative emotions, the study authors speculate.

Music could affect functions of the cardiovascular, respiratory, muscular, skeletal, nervous and metabolic systems as well, relieving muscle tension and pain, they add.

“From the neurophysiological point of view,” said Tereza Alcantara-Silva of the Federal University of Goias in Brazil, music-evoked emotions can modulate activity in a variety of brain areas.

“Music plays a major role in self-regulation of emotional contexts,” said Alcantara-Silva, who wasn’t involved in the study, by email. “Music therapy can bring several benefits to cancer patients, helping them to find ways to deal with stress, fear, and loneliness.”

SOURCE: bit.ly/2Idu5cY European Journal of Cancer Care, online June 5, 2019.

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Experimental mobile app helps manage migraines

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(Reuters Health) - A smartphone-based relaxation app could help migraine sufferers reduce the number of headaches they get each month, a small study suggests.

Using the app twice a week was associated with an average of four fewer headache days per month, according to the report in Nature Digital Medicine.

“Migraine is now the second most disabling condition in terms of disability-adjusted years lost,” said lead author Dr. Mia Minen of NYU Langone Health in New York City.

Migraines affect about 1 in 6 adults in the U.S., with women most at risk.

“Previous research has shown that the best treatment for preventing migraine is a combination of migraine medication and behavioral therapy,” Minen told Reuters Health by email. However, “patients have significant difficulty accessing these safe, top evidence-based treatments.”

Minen and colleagues created RELAXaHEAD, an app based on the technique of progressive muscle relaxation, a proven method of migraine prevention, the authors note. The study team analyzed whether patients recruited from a neurology clinic would use the app regularly and whether they’d have fewer headache days.

During the study, 51 patients in their 30s and 40s who typically had 13 or more headache days per month were asked to complete a daily headache diary and to do progressive muscle relaxation with the app for 20 minutes a day for 90 days. Nearly one third of the participants were considered to have severe migraine disability when they enrolled, meaning they had missed considerable amounts of work, school and family activities due to the headaches.

On average, participants used the app on 22 days per month, for about 11 minutes per day. Roughly half used it once per week and a third used it two or more times per week. Overall, those who used the app twice per week had four fewer headache days the following month, and those who used it once per week had two fewer headaches days. Use of the app tended to drop over time.

Patients with higher depression scores were less likely to use the daily headache diary, and those with higher anxiety scores were more likely to use it.

“The number of mobile health apps available in the iOS and Google Play stores has ballooned, and recent studies show that most people download an app but then rarely use it,” Minen said. “Importantly, we were able to get a considerable number of study participants to use the app.”

The researchers have received inquiries about the app from patients with migraines outside the NYU Langone system, she noted. Although it was created as a research tool, Minen’s team is exploring ways to expand access to the app or include it in office visits. They’re also studying whether the app can help healthcare providers who don’t know where to refer patients with migraines who want behavioral therapy.

“I would encourage people who live with migraines to consider a behavioral treatment,” said Alice Pressman of Sutter Health in Walnut Creek, California, who wasn’t involved in the study.

“The great thing about starting a (behavioral therapy) BT is that you don’t have to stop your other treatments if you feel they are effective,” Pressman said by email. “BTs can be used as add-ons with no added side effects.”

However, an in-person a mindfulness-based stress reduction program targeting migraines that was offered at her center was difficult for some patients to attend due to time and location, Pressman said, so an online program may help. At the same time, patients should know that apps are still new and not fully studied.

“Research here is important to enable therapeutically effective and safe smartphone apps. Lots of apps are offered that are not based on any scientific evidence,” said Thomas Dresler of the University of Tuebingen in Germany, who wasn’t involved in the study.

“There are a lot of migraine apps out there, but customers need to know that the availability of an app per se does not guarantee effectiveness, safety or the developers’ adherence to specific quality standards,” Dresler said by email.

SOURCE: bit.ly/2X9Iwa1 Nature Digital Medicine, online June 4, 2019.

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Pharmacies may not stock naloxone, despite statewide orders

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(Reuters Health) - More than three years after Pennsylvania issued a statewide order expanding access to the life-saving opioid antidote naloxone, the product was still hard to purchase in Philadelphia pharmacies, researchers found.

In 2017, two-thirds of pharmacies in Philadelphia either did not stock naloxone, or they still insisted on a physician’s prescription, which the law said was no longer required.

In the wake of the opioid addiction crisis that has claimed thousands of lives, many U.S. states have passed laws like Pennsylvania’s, which allow the drug to be dispensed without a prescription and mandate that every drugstore carry it.

Laws that let pharmacists sell naloxone without prescription have been associated with a nearly 30% drop in the number of opioid overdose deaths, a separate team of researchers reported last month. (reut.rs/2WM3qMa)

Yet this study is not the first to find that drugstores are slow to comply. Research has shown that most pharmacies in California and Texas, for example, do not carry the drug or make it readily available.

The new results add to the growing body of evidence that these laws are not being enforced, experts said.

“While policy can be put in place, it’s not sufficient and has to be followed up with education, and reinforcement at the county and pharmacy level, and not just assume that the policy itself will ensure access to anyone who needs it,” Dr. Michael Lynch, a toxicologist and emergency medicine physician who was not involved in the study, told Reuters Health.

For the current study, Dima Qato of the University of Illinois, Chicago and colleagues contacted 418 drugstores in Philadelphia between February and August 2017 and found that only about 34% had naloxone in stock - and 38.5% of those drugstores required a physician’s prescription to dispense the drug.

People living in communities with elevated rates of opioid overdose deaths were the least likely to have access to naloxone without a prescription and had to pay more to buy the drug, the researchers wrote in JAMA Network Open.

“Areas that need this policy enforced the most are areas that lack it and that’s a concern,” Qato told Reuters Health by phone.

An overdose of opioids like morphine or heroin slows breathing, reducing the supply of oxygen to the body. Naloxone helps reverse the effects of an overdose and saves lives.

Lynch, who is also the medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center, notes that the high importance of naloxone may not necessarily translate to high demand.

“If patients or individuals are not coming in and asking for it, pharmacies, especially a local independent pharmacy with pretty narrow margins, may not continue to stock a medication that isn’t being dispensed,” he added.

However, Mel Brodsky, executive director of PARD, an association of community pharmacies in Philadelphia, disputes the study’s findings.

“It is from 2 years ago - a lot has changed. Philadelphia mandates that every pharmacy have 2 doses of naloxone in stock. As I travel to my stores, I see 95% having naloxone in stock,” he told Reuters Health by email.

Dr. Michael Fingerhood, of Johns Hopkins Bayview Medical Center in Baltimore, Maryland, told Reuters Health that the low numbers in the study may be partly due to a shortage of naloxone in 2017.

“I would do a similar study now, (when) we don’t have a shortage of naloxone, and see if there has been any difference, two years later,” he said.

SOURCE: bit.ly/2IEd5LZ JAMA Network Open, online June 7, 2019

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Got an antibiotic prescription from your dentist? Chances are, it might be unnecessary

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(Reuters Health) - More than three-quarters of antibiotic prescriptions written by dentists before dental procedures are unnecessary and might do more harm than good, a new U.S. study found.

Dentists write one of every ten antibiotic prescriptions in the United States, and despite national declines, antibiotic prescribing by dentists has held steady over the years, researchers wrote.

Dentists need to be included in the public health conversation regarding appropriate antibiotic use and antimicrobial resistance, lead author Katie Suda of the University of Illinois, Chicago, told Reuters Health by phone.

Antibiotics before dental procedures are recommended for a small subset of patients with certain medical conditions, to prevent a serious heart infection that might arise from the release of oral bacteria into the bloodstream during the procedures. The infection, endocarditis, is an inflammation of the lining of the heart’s chambers and valves.

To see if antibiotics are being prescribed for dental patients according to established guidelines, Suda and her team used an insurance database to analyze prescriptions written during 168,000 dental visits from 2011 to 2015.

They found that 80.9% of prescriptions for antibiotics to be taken before procedures were unnecessary.

Among the 91,438 patients in the study, only 20.9% had a cardiac condition that put them at the highest risk of developing endocarditis and warranted an antibiotic prescription.

Patients with artificial joint implants had more than double the odds of receiving unnecessary antibiotic prescriptions compared with patients who did not have the implants. This is despite the fact that the American Academy of Orthopaedic Surgeons and the American Dental Association now say people with prosthetic joint devices do not need antibiotics before dental procedures.

In particular, the antibiotic clindamycin was highly likely to be unnecessarily prescribed. Clindamycin has been linked with a severe form of diarrhea known as Clostridium difficile (C. diff). A single dose of clindamycin carries the same risk of C. diff infection as a prolonged course of the antibiotic, the researchers wrote, making it all the more alarming that clindamycin was among the overused antibiotics.

Misuse and overuse of antibiotics encourages bacteria to evolve and find ways to resist the medicines. The World Health Organization has called antibiotic resistance a global health emergency.

Why is there so much over-prescribing by dentists? Experts say dentists may face pressure from patients or patients’ cardiologists and orthopedic surgeons, who insist on antibiotics.

“Dentists feel like they are in a really tough position,” said Dr. Emily Spivak of the University of Utah School of Medicine, who wrote an editorial that was published with the study.

“They’re not physicians and they feel like they have to give (antibiotics) because they will be held accountable from the surgeon or the cardiologist if the patient gets an infection,” she told Reuters Health.

Other factors driving unnecessary prescribing may include dentists’ lack of awareness of the most recent guidelines, lack of agreement with these guidelines and the practice of ‘defensive medicine,’ experts said.

Spivak, however, believes the current study may over-inflate the numbers as it includes only commercially insured patients.

The ‘worried well’ or those who suffer from health anxiety may be driving some of this prescribing, she added.

Experts say patients should feel empowered to ask questions when their dentists prescribe antibiotics, and they shouldn’t pressure dentists to provide them with the drugs.

“An informed patient who asks questions can allow for a discussion between the dentist and the patient to truly understand whether they need an antibiotic,” Dr. Salim Virani of the Baylor College of Medicine, told Reuters Health by email.

SOURCE: bit.ly/2KdK109 and bit.ly/2R91tEt JAMA Network Open, online May 31, 2019

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WHO likely to declare Ebola an international emergency: experts

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GENEVA (Reuters) - The World Health Organization (WHO) should and is likely to declare an international emergency over the Ebola epidemic in the Democratic Republic of Congo that has now spread to Uganda, experts said as a WHO advisory panel met on Friday.

A health worker wearing Ebola protection gear enters the Biosecure Emergency Care Unit (CUBE) at the ALIMA (The Alliance for International Medical Action) Ebola treatment centre in Beni, in the Democratic Republic of Congo, April 1, 2019. Picture taken April 1, 2019.REUTERS/Baz Ratner

Congo’s epidemic is the second worst worldwide since West Africa’s Ebola outbreak in 2014-16, with 2,084 cases and 1,405 deaths since being declared in August. The WHO said on Thursday that two people had died in Uganda having arrived with the disease from Congo.

A panel of 13 independent medical experts on the WHO’s Emergency Committee (EC) were meeting from midday to evaluate the latest evidence and whether the epidemic constitutes a Public Health Emergency of International Concern (PHEIC).

Such a decision would lead to boosting public health measures, funding and resources, and could include recommendations on trade and travel, academic experts and aid groups said.

“Will @WHO declare global emergency for #Ebola? I predict yes. My sense is @DrTedros will call PHEIC if #EC recs it. He understands depth of crisis,” Lawrence Gostin, professor of global health law at Georgetown University Law School in Washington, D.C., who is not on the panel, said in a tweet.

People are still dying outside of Ebola treatment centers - exposing their families to the disease - and many don’t appear on lists of known contacts being monitored, he said.

“Vaccines alone can’t work if community hides cases due to distrust. Violence persists. We are in this for the long haul,” Gostin said, referring to deadly attacks on Congo health facilities.

The panel, which twice before decided not to declare an emergency, will make recommendations to WHO director-general Tedros Adhanom Ghebreyesus who takes the final decision.

Only 4 emergencies have been declared in the past decade: the H1 virus that caused an influenza pandemic (2009), West Africa’s Ebola outbreak, polio (2014) and Zika virus (2016).

SECOND WORST EPIDEMIC

Top WHO official Mike Ryan said on Thursday there had been no known person-to-person spread of Ebola in Uganda and that there were encouraging signs in Congo, with the disease’s spread slowing in cities of Butembo and Katwa. However it the virus was now entrenched in rural areas including Mabalako, he said.

“But these can be very volatile, these can go up and down week to week. So we have to be careful looking at one week of data and declaring victory.

“We have a hell of a long way to go in this response,” he told Reuters.

The WHO, in a statement overnight, said that given all three confirmed cases in Uganda belong to a single family cluster, the level of preparedness and experience of Ugandan authorities to manage previous Ebola outbreaks, and their rapid detection of cases in a limited geographical area, “the overall level of risk at national level is assessed as moderate”.

“However, the overall regional risk posed by the outbreak in DRC remains very high. The overall risk at international level remains low,” it said.

Jeremy Farrar, director of the Wellcome Trust global medical charity, said the WHO should declare a public health emergency of international concern.

“Doing so would raise the levels of international political support, which has been seriously lacking so far, show strong support for DRC and neighboring countries and WHO, and release more resources, including finance, healthcare workers, enhanced logistics, security and infrastructure,” he said.

Additional reporting by Kate Kelland in London; Editing by Raissa Kasolowsky

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Father's smoking during pregnancy tied to asthma in kids

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(Reuters Health) - Children who are exposed to tobacco smoke from their fathers while they’re in the womb may be more likely than those who are not to develop asthma by age 6, according to a study of chemical changes to DNA.

While prenatal smoke exposure has long been linked to an increased risk of childhood asthma, the current study offers fresh evidence that it’s not just a pregnant mother’s smoking that can cause harm.

Researchers followed 756 babies for six years. Almost one in four were exposed to tobacco by fathers who smoked while the child was developing in the womb; only three mothers smoked.

Overall, 31% of kids with fathers who smoked during pregnancy developed asthma by age 6, compared with 23% of kids without fathers who smoked, the study found.

Asthma was also more common among kids whose fathers were heavier smokers, senior study author Dr. Kuender Yang of the National Defense Medical Center in Taipei said by email.

“Children with prenatal paternal tobacco smoke exposure corresponding to more than 20 cigarettes per day had a significantly higher risk of developing asthma than those with less than 20 cigarettes per day and those without prenatal paternal tobacco smoke exposure,” Yang said.

About 35% of the kids with fathers who were heavier smokers developed asthma, compared with 25% of children with fathers who were lighter smokers and 23% of kids with fathers who didn’t smoke at all during pregnancy.

Smoking by fathers during pregnancy was also associated with changes in methylation - a chemical code along the DNA strand that influences gene activity - on portions of genes involved in immune system function and the development of asthma.

Researchers extracted infants’ DNA from cord blood immediately after birth and examined methylation along the DNA strand. The more fathers smoked during pregnancy, the more methylation increased on stretches of three specific genes that play a role in immune function.

Children who had the greatest methylation increases at birth, affecting all three of these genes, had up to almost twice the risk of having asthma by age 6 as other kids in the study.

While smoking by fathers during pregnancy was linked to childhood asthma, it didn’t appear to impact children’s sensitivity to allergens or total levels of IgE, an antibody associated with asthma.

This suggests that the risk of asthma from tobacco exposure is unlike allergic asthma, which is driven by allergies or allergic sensitization via IgE antibody, said Dr. Avni Joshi, a researcher at the Mayo Clinic Children’s Center in Rochester, Minnesota, who wasn’t involved in the study.

The study wasn’t designed to prove whether or how prenatal smoking exposure might directly cause so-called epigenetic changes, or how those changes cause asthma in children.

It’s not yet clear how the alterations seen along the DNA strand where methylation increased might cause asthma, the study team notes in Frontiers in Genetics.

Still, the message to parents should be clear, Joshi said by email.

“Smoking is bad at ANY point in time: before the baby is born and after the baby is born,” Joshi said. “Many parents defer quitting until the baby is born, but this study stresses that the prenatal exposure to tobacco creates changes to the unborn child’s immune system, hence it is best to quit as a family decides to have children, even before the conception happens.”

SOURCE: bit.ly/2WG9lhM Frontiers in Genetics, online May 31, 2019.

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Mesh implants work for bladder leakage, long-term safety unclear

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(Reuters Health) - Several different types of mesh implant surgery may be effective for treating bladder leaks, but the long-term safety and effectiveness of the procedures isn’t yet clear, a new analysis suggests.

Researchers examined data from 175 clinical trials that randomly assigned a total of 21,598 women with stress urinary incontinence to receive different types of surgical treatments.

Over the short-term, three types of surgeries appeared most effective at curing the incontinence. Two newer procedures using slings to support the bladder had cure rates of about 89% and an older abdominal surgery to suture the bladder had a cure rate of about 77%.

“With regard to surgical treatments, there is limited evidence to suggest that there is one ‘best’ option for the treatment of stress urinary incontinence. Rather there are several trade-offs and risks that women need to be aware of and consider alongside their clinician when making their treatment choice,” said study co-author Dawn Craig of Newcastle University in the UK.

“Based on our findings, the jury is still out on the long-term risks of vaginal mesh for stress urinary incontinence,” Craig said by email.

Up to half of adult women experience stress urinary incontinence, when the pelvic floor muscles are too weak to support the bladder. As a result, urine leaks during coughing, sneezing or exercise. Childbirth is a common reason for weak pelvic muscles, and obesity worsens the problem.

Surgical treatment for stress urinary incontinence has evolved over the past two decades from open abdominal operations to support the bladder with sutures to less invasive procedures that insert mesh slings instead. Recently, however, the safety of mesh implants for stress incontinence has come under scrutiny due to reports of severe complications, litigation and product withdrawals, researchers note in The BMJ.

One of the more effective mesh sling options in the study was a traditional suburethral sling, which involves placing a sling under the urethra and using one of a variety of techniques to secure it in place.

The other mesh sling option with similar effectiveness was the midurethral sling, a newer minimally-invasive procedure that enables surgeons to insert a narrow strip of synthetic mesh without the need to secure it in place.

In contrast, the older type of surgery known as an open coloposuspension requires cutting through the abdomen to reach the bladder and then using sutures to support the neck of the bladder, the group of muscles that connect the bladder to the urethra. These muscles tighten to hold urine in the bladder and relax to release urine.

Most of the available safety data was for the newer mesh sling procedures.

Mesh procedures done with one vaginal incision and two groin or thigh incisions - known as transobturator midurethral sling surgery - had more repeat surgeries and groin pain but fewer vascular complications, bladder or urethral perforations, or voiding difficulties than so-called retropubic midurethral surgery done with one vaginal incision and two abdominal incisions.

“We do not have good long-term follow up data for any of these surgeries as the trials analyzed lasted up to five years at most and mesh can cause problems many years after insertion,” said Rufus Cartwright of Oxford University Hospitals NHS Trust in the UK, who co-authored an accompanying editorial.

Some women might be able to address stress urinary incontinence without surgery, previous research has found. Lifestyle changes like avoiding caffeine, drinking small amounts of fluid, using the bathroom at scheduled times throughout the day and doing exercises that target the pelvic floor muscles can improve bladder control.

“Women should consider surgery for incontinence if their symptoms are severely affecting their quality of life, and they haven’t responded to conservative treatment (pelvic floor exercises),” Cartwright said by email. “The choice between the different procedures should be based on a process of shared decision making with the surgeon.”

SOURCE: bit.ly/31w78Jv and bit.ly/2KeSIIt The BMJ, online June 5, 2019.

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Female soldiers wanting to suppress periods face barriers

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(Reuters Health) - Military women wanting to stop menstruating while they are deployed may face a number of barriers, a new commentary suggests.

The majority of surveyed military women say they would like to suppress menstruation during deployment but very few are doing so, according to the paper in Obstetrics & Gynecology that explores why more military women are not accessing that option.

One answer may be that not enough military women and their health providers even know that hormonal contraceptives used continuously will suppress menstruation.

“Women are counseled to stop taking contraceptives before deployment and that negates all the valuable health benefits, including suppression, that come with them,” said the commentary’s author, Sheena Eagan, an assistant professor at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and a specialist in military medicine ethics. “There’s a recurring theme in surveys: women want to access cycle control and they want to suppress menstruation before they are deployed.”

Unfortunately, there are many barriers blocking women’s access to menses suppression in the military, Eagan said, including the instructions to stop taking contraceptives before deployment because there is a rule against sexual intercourse while deployed. “I wanted to highlight the misconception I saw throughout the literature that equates contraceptive use with pregnancy prevention,” she said.

After reviewing the medical literature on the topic of menses suppression in the military, Eagan found that 66% to 86% of women surveyed wanted the ability to stop menstruating during deployment. In contrast, a mere 7% reported having done so.

Part of the problem may be lack of education among both the women and their health providers, Eagan said. A 2009 report found that only a third of service women had received any pre-deployment counseling on menstrual regulation and suppression. Moreover, nearly 70% of women reported that their primary healthcare providers were medics or corpsmen. Although training varies depending on the branch of service, these types of providers normally do not hold professional or graduate degrees, Eagan noted.

Eagan said she isn’t suggesting that menses suppression be mandated for all female soldiers, but “it should be part of women’s autonomous choice.”

The issues of menses regulation and control aren’t limited to military women, said Dr. Charles Ascher-Walsh, director of gynecology for the Mount Sinai Health System in New York City. “Obviously, when women are deployed it’s more convenient not to be menstruating,” he said. “But there are many women who would have the same kinds of benefits, such as when they are traveling for work.”

In general, Ascher-Walsh said, “there’s a lack of education among women and their doctors that this is a possibility - and a safe possibility. And doctors don’t offer it as much as I think they should.”

Still, the article may have made the process sound more straightforward than it sometimes is, Ascher-Walsh said. “It’s not as simple as: do this and you are guaranteed not to bleed,” he explained.

That’s because not all women will stop cycling on hormonal contraceptives, Ascher-Walsh said. With some methods, “you can end up with spotting every day and that’s worse than having your period,” he added. “So you don’t want to do it right before you are deployed since that can make it worse rather than better.”

The best option if a female soldier wants to try a method to halt menstruation is to experiment with it well before deployment, Ascher-Walsh said. Among the possible options, continuous birth control is “the most likely to stop a woman’s periods and be reliable,” Ascher-Walsh said.

SOURCE: bit.ly/2F89nsS Obstetrics & Gynecology, online June 11, 2019.

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Many epinephrine self-injectors still potent long after expiration date

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(Reuters Health) - EpiPens and other autoinjectors filled with epinephrine to treat severe allergic reactions may still be potent enough to work many months past their labeled expiration date, according to a new study that concludes patients might need expensive refills less often.

These autoinjectors contain a pre-set dose of epinephrine, a life-saving drug used by people at risk of experiencing anaphylaxis, a severe allergy attack. Untreated, anaphylactic shock can be fatal because blood pressure can drop suddenly and airways can narrow, making it difficult to breathe.

Patients who need these life-saving devices must carry at least one with them at all times and have access to one everywhere they go. Soaring prices and out-of-pocket costs for the autoinjectors have made it increasingly difficult for many patients to keep throwing out and replacing unused devices when they expire, researchers note in the Journal of Allergy and Clinical Immunology: In Practice.

The U.S. Food and Drug Administration (FDA) requires autoinjector expiration dates to ensure that the devices never contain less than 90% of the original dose of epinephrine, the study team notes.

For the study, researchers tested the contents of 46 different autoinjectors to see how much epinephrine remained after the expiration dates on the labels. Half of the devices were tested at least two years after their labeled expiration date. At this point, 80% of the devices still retained 90% or more epinephrine, indicating they were still effective under the FDA rules.

“If the expiration dating on these devices was changed, this means that patients would not need to replace their auto-injectors as frequently, limiting cost to them, their insurance, and the healthcare system, while still feeling secure that they have access to adequate treatment for anaphylactic reactions,” said lead study author Lynn Kassel of Drake University College of Pharmacy & Health Sciences in Des Moines, Iowa.

Devices six months past their labeled expiration date in the study still had 100% of the original epinephrine dose. One year after the labeled expiration date, devices still had 95% of the original epinephrine dose.

And all of the autoinjectors tested that were up to 30 months beyond their labeled expiration date still had 90% of the dose remaining.

The study tested far too few devices to help determine with certainty whether all epinephrine autoinjectors in the U.S. might be safely used past their expiration dates, Kassel said by email.

The authors also note that they did not test the expired injectors’ effectiveness in stopping an anaphylaxis episode.

“Until the FDA changes the expiration dating guidance for these devices, patients with anaphylactic allergies should carry auto-injectors that have not yet expired,” Kassel advised.

“The greatest risk of using an expired auto-injector is that the epinephrine is no longer potent enough to combat the anaphylactic reaction, and this could result in death or critical illness.”

Right now, the expiration date is 18 months from the time the product is manufactured, a duration that is shorter than the expiration date for most other medications, said Dr. Kao-Ping Chua of the C.S. Mott Children’s Hospital and the University of Michigan Medical School in Ann Arbor.

While the study results build on a growing body of evidence suggesting that expiration dates for epinephrine autoinjectors could be extended, in the meantime, patients should use the devices as labeled, Chua, who wasn’t involved in the study, said by email.

“I don’t think anyone should postpone refilling an epinephrine auto-injector if they can afford it,” Chua said. “In a life-or-death situation, you want to have as much certainty as possible that the rescue medication is going to work.”

SOURCE: bit.ly/2F7WrTT Journal of Allergy and Clinical Immunology: In Practice, online May 28, 2019.

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Chronic depression after heart attack tied to increased risk of death

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(Reuters Health) - Heart attack survivors with chronic mood disorders may be more likely to die prematurely than their counterparts who don’t suffer these problems, a recent study suggests.

Patients with anxiety or depression have previously been shown to have longer hospital stays and a worse prognosis after a heart attack, researchers note in the European Journal of Preventive Cardiology. But earlier research hasn’t given doctors a clear sense of whether patients with specific types of emotional distress might put patients at greater risk for serious complications or premature death.

For the current study, researchers assessed almost 58,000 patients for emotional distress two months after a heart attack, and again at 12 months after the event. Overall, 21% of the patients reported persistent psychological problems in both assessments.

Researchers followed a majority of patients for at least 4 years. Compared to those who didn’t report any emotional distress at all, people who felt depressed or anxious at both assessments were 46% more likely to die of cardiovascular causes during the follow-up period and 54% more likely to die from other causes.

“Temporary mood swings, if they are not too frequent or dramatic, are a normal part of life,” said senior study author Erik Olsson of Uppsala University in Sweden.

“Feeling a little depressed after a heart attack might even be a good thing if it makes you withdraw a bit and get some rest,” Olsson added. “Emotional states help us regulate our behaviors.”

About 15% of the patients in the study experienced some symptoms of emotional distress two months after the heart attack that they no longer reported after one year. Their odds of dying during the study period were no different from people who didn’t have anxiety or depression at either assessment.

It’s possible that people who reported depression and anxiety at both assessments had a harder time following doctors’ orders for an ideal recovery, Olsson said by email.

“Chronic emotional distress makes it harder to adopt the lifestyle changes that improve prognosis after a heart attack,” Olsson said. “These include quitting smoking, being physically active, eating healthily, reducing stress and taking prescribed medications.”

About 11% of the patients initially reported no symptoms of emotional distress but did feel some degree of depression or anxiety after one year.

These people didn’t appear at increased risk for dying of cardiovascular causes during the study period compared with patients reporting no emotional distress, but did have a 46% greater risk of dying from other causes.

These people may have had distress that wasn’t directly related to their heart attack, Olsson said. Instead, they might have experienced depression or anxiety due to other risk factors for mood disorders like poverty, limited education or lack of a spouse or job.

The study wasn’t a controlled experiment designed to prove whether or how mood disorders might directly hasten death after a heart attack.

It’s also possible that some people in the study had undiagnosed depression or anxiety prior to the heart attack that influenced their survival odds, the study authors note.

Researchers also looked at depression and anxiety combined, making it impossible to identify any differences in how each of these conditions might independently impact survival after a heart attack.

It’s also unclear whether treating depression or anxiety could impact outcomes, said Dr. Robert Carney of Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri, who wrote an accompanying editorial.

“We do not know for certain whether treating depression or anxiety improves survival, but there is some evidence that it probably does,” Carney said by email. “At the very least, being free of depression and anxiety improves quality of life.”

SOURCE: bit.ly/2XJOo6Y and bit.ly/2IcxqJg European Journal of Preventive Cardiology, online June 3, 2019.

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New review suggests proven ways to cut back on sugary drinks

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(Reuters Health) - With sugary sodas and other sweetened drinks considered a key driver of the obesity epidemic worldwide, a new research review evaluates how well various measures work to reduce consumption of these calorie laden drinks.

Strategies including limited availability of sodas in schools, removal from children’s menus at restaurants and better labeling could help reduce consumption, according to the analysis published in The Cochrane Database of Systematic Reviews.

The authors of the new report did not respond to requests for an interview. Study coauthor Hans Hauner said in a statement, “Rates of obesity and diabetes are rising globally, and this trend will not be reversed without broad and effective action.” Hauner, a professor of nutritional medicine at the Technical University Munich, added, “Governments and industry in particular must do their part to make the healthy choice the easy choice for consumers. This review highlights key measures that can help accomplish this.”

The researchers pored through the literature seeking studies that evaluated so-called environmental strategies for reducing sugary drink consumption - meaning interventions that change the physical or social setting in which a person chooses what drink to consume or buy. Fifty-eight studies involving a total of more than 1 million adults, teens and children met their criteria. Most lasted about a year and were done in schools, stores or restaurants.

Some of the studies were less well designed, the researchers allowed, simply asking participants how much sugary soda they consumed, for example.

Ultimately, the researchers found moderate-to-low-certainty evidence supporting a number of measures that appeared to help people cut back on sugary drinks. These included: labels that were easy to understand and that rated the healthfulness of beverages; limits on availability of sugary sodas in schools; price increases on sugary sodas in restaurants, stores and leisure centers; inclusions of healthier beverages in children’s menus; and promotion of healthier beverages in supermarkets.

Strategies that raise the price of sugar-sweetened drinks were also supported by moderate-quality evidence while lowering prices on low-calorie drinks was not as well supported.

The new study “lays out evidence that there are things that actually do work,” said Dr. Bruce Y. Lee, executive director of the Global Obesity Center and an associate professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

What makes these sugary beverages especially bad for health is the fact that they represent “empty calories,” said Lee, who was not involved in the review. “So you’re essentially drinking sugar.”

While these strategies may not be the entire solution, “we are clearly having an obesity and diabetes epidemic,” said Dr. Robert Rapaport, a professor of pediatrics and director of the division of pediatric endocrinology and diabetes at the Kravis Children’s Hospital at Mount Sinai in New York City. “Anything that can be done to improve that would certainly be welcome.”

Rapaport welcomes strategies such as removing sugary drinks from schools and making labels easier to read. In general, he said, it makes sense to “tell children to drink water. If they want it with carbonation and flavors that’s fine. All are preferred to having drinks that contain high calories.”

The new study highlights the importance of education, especially for kids, said Shelly Kendra, clinical nutrition manager at the Magee-Womens Hospital of the University of Pittsburgh Medical Center, who also wasn’t involved in the review. “What we learn as kids is what we’re going to carry with us into adulthood,” Kendra said. “Having an environment to help support that is potentially creating the building blocks to healthier choices.”

SOURCE: bit.ly/2IbuoVp The Cochrane Database of Systematic Reviews, online June 12, 2019.

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Traumatic injuries linked to later social dysfunction

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(Reuters Health) - Nearly half of trauma patients, even those without brain injuries, experience social deficits that make it harder for them to interact with friends and stay involved in the community, a recent study suggests.

Traumatic brain injuries have long been linked to an increased risk of a wide range of short-term and long-term physical and mental health problems that can dramatically reduce quality of life, researchers note in the journal Surgery. But doctors don’t yet have a clear picture of what type of social impairments may follow other types of traumatic injuries.

“Social functioning is considered a critical determinant of quality of life,” said lead study author Dr. Juan Herrera-Escobar of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Broadly speaking, social function includes the ability to participate in organized and informal activities with friends, relatives, and people in the community or the workplace. Serious injuries can lead to physical and emotional issues that contribute to social deficits, and long hospital stays that keep patients away from their daily routines for weeks on end can make matters worse.

For the current study, researchers followed 805 adults hospitalized for moderate to severe traumatic injuries. During the year after the injury, 364 of them, or 45%, reported experiencing social dysfunction.

In the study, researchers assessed social function 6 months and 12 months after injuries. Each time, they asked patients how often physical or emotional challenges interfered with social activities in the previous four weeks.

Compared to patients who reported no social dysfunction, those who did tended to be younger and were more likely to be African American and have no more than a high school education. Patients with social dysfunction were also more likely to have had longer hospital stays, required mechanical ventilation in the hospital and have previous psychiatric illness.

People with a history of a major psychiatric illness, for example, were almost three times more likely to experience social dysfunction. Low education, meanwhile, more than doubled the risk of social dysfunction.

In addition, people with social dysfunction were over 16 times more likely to have post-traumatic stress disorder (PTSD) than those without social dysfunction, and about five and a half times more likely to have not returned to work after their accident.

It’s possible that people with lots of social support from family and friends or from patient support groups might have fewer challenges with social dysfunction after their injuries, Herrera-Escobar said by email.

“A strong family environment fosters resilience, which has been associated with better long-term outcomes after trauma,” Herrera-Escobar added. “We also believe that getting appropriate and timely treatments (rehabilitation, mental health services, etc.) for physical and mental health conditions can also help improve their social outcomes.”

The study lacked data on social functioning before patients’ injuries, and it’s possible that some people had impairments beforehand, the study team notes.

Even so, the results underscore the importance of considering social function in trauma care from the start instead of waiting to address this until after patients go home from the hospital, said Dr. Tim Platts-Mills, an emergency medicine researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.

Pain management and treating people for depression, PTSD and other psychiatric issues may help minimize the social dysfunction, Platt-Mills said by email.

“The best approach is not to wait six weeks and then conclude that there is a problem,” Platt-Mills said. “A better approach is to work with the patient’s clinical team to try to address these problems early on.”

SOURCE: bit.ly/2Xb9NsA Surgery, online May 17, 2019.

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Harrysong hospitalized after food poisoning in Ghana (Photo)

Nigerian singer, Harrysong has been hospitalized after food poisoning in Ghana.

Harrysong who is currently in Ghana has been hospitalized and the doctors have confirmed that it is as a result of food poisoning.

 

The Delta State born singer was hospitalized after he developed serious health challenges from a meal he ate last night

Sources close to the singer when he developed complications had this to say.

“This happened after eating last night he felt dizzy and troubled all over his body…. couldn’t even see…. he was was rushed to the hospital and after all the tests the doctors..confirmed its food poisoning and fever”, according to an insider.

Harrysong missed out on appointments, interviews and meetings he was to have for the day due to his health challenges. He later took to his Instastory to reassure his followers, he wwrote

“Nothing too serious, doctor said it’s ok to break down… ve missed all my interviews and meetings today, but my doctor said I may make it to @verchimusic ‘Shabba listening party tonight… I pray”

Friends and colleagues sent their wishes to him, praying that he gets well soon. This includes Terry G who wished him speedy recovery on Instagram.

How ‘Game Of Thrones’ Affected My Health – Marsie Williams

Marsie Williams, popularly known for her role as Arya Stark in American series, ‘Game of Thrones’ has revealed how the series had a negative effect on her mental health.



Marsie in an interview on CNN disclosed that her role and criticisms on Game of Thrones affected her mental health and self-esteem. She opened up about how difficult her life as a teenager was while also managing her fame from the “Game of Thrones.”

Williams, who was 13 years old when she was cast as Arya Stark, said there was a time she was sad after becoming overwhelmed by the criticism on social media.

She said: “It gets to a point where you’re almost craving something negative, so you can just sit in a hole of sadness.

“When I tried to move past what people said online, I still end up thinking about the comments.

“I still lie in bed at, like, 11 o’clock at night telling myself all the things I hate about myself. It’s just really terrifying that you’re ever going to slip back into it.

“That’s still something that I’m really working on because I think that’s really hard. It’s really hard to feel sad and not feel completely defeated by it.”

“Honestly, I want a normal life, I don’t want any of this crazy, crazy world because it’s not worth it.”