Health Care Tips  Health Care News livemedinfo-News: November 2009
Soaring rates to bring unprecedented medical, economic burdens, study predicts.
FRIDAY, N ov. 27 (HealthCare News) -- The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.
That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.
At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.
One factor driving the soaring costs: the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis.
"We believe our model provides a more precise estimate of what the population size will look like and what it will cost the country and government programs like Medicare," said study author Dr. Elbert Huang, an assistant professor of medicine at the University of Chicago.
Prior forecasts, including the ones currently used by the federal government's budget analysts, have underestimated the burden, the researchers said. A 1991 study, for example, predicted that 11.6 million people would have diabetes in 2030. In 2009, there were already more than twice that many living with diabetes.
"In a similar way, we may be underestimating what's happening, which is actually very disturbing," Huang said.
Among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion.
"That essentially means that in 2034, half of all direct spending on diabetes care will be coming from the Medicare population," Huang said.
The study is published in the December issue of Diabetes Care.
The high cost of chronic disease is one of the most pressing issues facing the United States as legislators grapple with financial strains on Medicare and the larger issue of health-care reform, the researchers say.
Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don't use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.
Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said the study is one of several recent papers predicting a dramatic rise in the incidence of diabetes. And though which methodology provides the most accurate predictions is open to debate, he said, the overarching message is that steps need to be taken to prevent diabetes from overwhelming an already overburdened health-care system.
"This is, in a sense, evidence of an iceberg," Kendall said. "What we are seeing currently is only a fraction of the potential future risk."
In making their estimates, the researchers used data on people 24 to 85 years old who took part in the U.S. Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and the National Health Interview Study.
"This is clearly a very pressing problem," said study co-author Michael O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago. "It's one of the few chronic illnesses we have that is growing, and the cost of doing nothing is going to be quite high."
Matt Peterson, director of information resources at the American Diabetes Association, said that community-based intervention programs that include dietary counseling and exercise, such as walking for 30 minutes most days of the week, can help combat the trend.
"We're not talking about massive weight loss or for everyone to become marathon runners," Peterson said. "We are talking about modest weight loss of 10 to 15 pounds. It's a challenge, but it's an achievable goal."
For those with diabetes, the American Diabetes Association recommends modest weight loss, increased physical activity, maintaining A1C (blood sugar) levels below 7, cholesterol control and blood pressure control to prevent complications. |
Fans get a bigger thrill when on an emotional rollercoaster, study finds.
THURSDAY,  Nov. 26 (HealthCare News) -- Call it the fear factor meets the jubilant sports fan.
A new study suggests that spectators - especially those who root for the winning team - enjoy the greatest satisfaction if it's a closely contested match and victory was in doubt, producing feelings of worry and even despair.
Chew on that this Thanksgiving weekend as you're glued to the TV set, watching back-to-back football games.
"Sports entertainment obviously instigates intense emotional experiences," said study co-author Silvia Knobloch-Westerwick, an associate professor of communication at Ohio State University. "You would expect that positive effect is relevant for entertainment enjoyment, but negative affect is crucial, too."
Added study co-author Prabu David, also an associate professor of communication at Ohio State: "When people think about entertainment in general, they think it has to be fun and pleasurable. But enjoyment doesn't always mean positive emotions."
To conduct the study, published in the December issue of the Journal of Communication, Knobloch-Westerwick and David polled 113 college students as they watched a dramatic football showdown in 2006 between the Buckeyes of Ohio State and the Wolverines of the University of Michigan.
Adding to the stakes of the bitter, decades-old rivalry was the fact that Ohio State was ranked number one in the country, Michigan was ranked number two, and the winner would earn the right to play in the national championship game. Ohio States ultimately prevailed, eking out a nail-biting victory, 42-39.
Prior to the game, the study participants had completed a questionnaire that asked which team they were rooting for and how committed they were to that team. Half the students were Ohio States fans, one-third were Michigan backers, and the rest were uncommitted. Then, during the 24 commercial breaks throughout the game, the students were asked questions via the Internet about how up or down emotionally they were feeling, whether they thought their team would win, and how exciting they found the game.
The researchers discovered that the Ohio State fans who at some point during the game were convinced their team would lose ended up thinking the game was the most thrilling and satisfying.
Knobloch-Westerwick, who prefers reading crime fiction to watching sports, summed up the results this way: "Sports fans seek out the 'risky' entertainment of sports [risky because 'their' team might lose after all, which creates disappointment], probably because the intense connection to 'their' team, as well as the real threat of losing the game, create intense suspense -- instead of going for something with a guaranteed happy ending, such as the typical holiday suspense movie."
One outside expert said the study findings echoed previous research that has tackled entertainment and suspense theories.
Stuart Fishoff, senior editor of the Journal of Media Psychology and emeritus professor at California State University, Los Angeles, said that another way to measure a fan's state of mind is to study reactions from game to game or from season to season and assess who the fan surrounds himself - or herself - with while watching those games.
Fishoff added that the new findings can also provide insights beyond the sports-entertainment arena. "You can apply what you learned here to health care -- what do you do to reduce people's anxiety in medical situations?" |
Adding drug to chemo regimen may improve patient outcomes, research suggests.
 MONDAY, Nov. 23 (HealthCare News) - A new combination drug therapy shows promise in treating patients with advanced biliary-tract cancers, researchers say.
The study from the Massachusetts General Hospital Cancer Center in Boston found that survival and tumor response in patients treated with bevacizumab (Avastin), an angiogenesis inhibitor that has helped slow the growth of other cancers, in addition to the chemotherapy regimen of gemcitabine and oxaliplatin - a combined treatment called GEMOX-B -- was comparable to findings in previous studies in which patients were treated with gemcitabine and oxaliplatin alone.
In the new phase 2 trial, 35 biliary-tract cancer patients were given all three drugs intravenously (bevacizumab at 10 milligrams per kilogram, followed by gemcitabine at 1,000 milligrams per square meter, and oxaliplatin at 85 milligrams per square meter) on days 1 and 15, every 28 days. Whole-body PET scans were used to assess patients at the start of the study and at the end of the second cycle of treatment.
The researchers found that the overall tumor response rate was 40 percent (14 patients with confirmed partial responses) and stable disease was noted in another 10 patients (29 percent). The overall survival was found to be 12.7 months, with a median progression-free survival of seven months. However, progression-free survival at six months was below the targeted rate at 63 percent, they noted.
The most common negative side effects of GEMOX-B therapy were fatigue, an abnormally low number of white blood cells, peripheral neuropathy, high blood pressure and gastrointestinal problems, but the therapy was generally well-tolerated, the study authors pointed out.
The findings add to increasing evidence "supporting the combination of molecularly targeted agents with chemotherapy to further improve treatment outcomes in patients with biliary-tract cancers," the researchers wrote.
The findings are published in the Nov. 22 online edition of The Lancet Oncology.
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But, flu activity remains high and is expected to continue, CDC says.
FRIDAY, No v. 20 (HealthDay News) -- Some areas of the United States are seeing declines in H1N1 swine flu activity, a federal health official said Friday, and while the disease remains widespread in 43 states, that's down from the 46 states reported last week.
"We are beginning to see some declines in influenza activity around the country, but there is still a lot of influenza everywhere," Dr. Anne Schuchat, director of the U.S. Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said during an afternoon press conference.
Current flu activity is higher than typically seen during the peak of seasonal flu season in mid-winter, Schuchat said, adding that she expects a lot more swine flu infections in the weeks and months to come.
The H1N1 virus continues to hit young adults and children hard. During the past week, 21 more children died from the flu, bringing to 171 the total number of confirmed deaths among children.
But, Schuchat cautioned, "This is just a partial counting. The estimates we provided last week provide a better estimate of the full toll that the virus has taken in the first six months of the pandemic."
Those estimates showed that at least 22 million Americans have come down with the swine flu since the virus first surfaced in April, and approximately 3,900 people have died, including an estimated 540 children.
Of the children who have died from swine flu, two-thirds had chronic health problems, such as asthma, cerebral palsy and muscular dystrophy, Schuchat said. The remaining one-third of the children were healthy and died of complications from bacterial infections, she said.
By way of comparison, seasonal flu - which poses a greater health threat to older adults -- kills an estimated 36,000 Americans each year.
Meanwhile, the supply of H1N1 swine flu vaccine continues to grow, Schuchat said. As of Friday, 54.1 million doses had been produced by manufacturers , an additional 11 million doses since last week, she said.
Earlier, the CDC predicted there would be 190 million doses available by year's end.
"We are in better shape today than we were a couple of weeks ago," Schuchat said. "I just want to say how sorry I am that people have been so frustrated, that people have had to wait in line, that people haven't always found vaccine at the end of the line."
Schuchat also said that, as of last Friday, a total of 94.5 million doses of seasonal (non-H1N1) flu vaccine were available. Manufacturers of the seasonal flu vaccine expect to produce a total of 114 million doses this flu season.
Also Friday, CDC officials confirmed that four patients infected with H1N1 swine flu who were treated at Duke University Hospital in Durham, N.C., over the past six weeks were found to be resistant to the antiviral drug Tamiflu. Tamiflu and a second antivral medication, Relenza, are considered key weapons against swine flu.
Health officials have been monitoring the H1N1 virus for signs that it might be mutating, making the antivral drugs ineffective. But according to a Duke news release, the patients with Tamiflu-resistant swine flu were no sicker than patients who did not have drug-resistant illness. And all confirmed cases of Tamiflu-resistant virus have been susceptible to Relenza.
As a result, the CDC does not recommend any changes in the use of antiviral medications, the news release said.
On Thursday, a study presented at the American Society of Tropical Medicine and Hygiene annual meeting, in Washington, D.C., reported that people who were vaccinated for seasonal flu last year may have a 45 percent reduced risk of getting the swine flu. But, this protection seems to work for the oldest and youngest people, and not those in between, USA Today reported. Labels: Swine flu |
Findings may not apply to blacks, researchers note.
THURSDAY, Nov. 1 9 (HealthCare News) -- People's genetic makeup has been shown to affect how they respond to asthma medications, but a new study finds that many people respond well to a particular combination treatment regardless of their genes.
However, the study did find a difference in response among blacks.
The drug combo in question combines the long-acting beta-agonist salmeterol (Serevent) and moderate doses of an inhaled corticosteroid. The genes in question relate to a receptor in the body that is crucial to the effectiveness of asthma bronchodilators.
Some research has suggested that a variation in these genes can affect how people respond to the drugs. The researchers tested that theory in 87 people who had two types of the genetic variation - B16 Arg/Arg or B16 Gly/Gly.
They found that lung function did not differ overall in the groups, although there was some difference in blacks. The results are reported online Nov. 19 in The Lancet.
"These findings provide reassurance that, in the general population, patients should continue to be treated with long-acting beta-agonists plus moderate-dose inhaled corticosteroids irrespective of B16 genotype," the researchers wrote.
However, there are still questions to be answered, particularly involving blacks' response to salmeterol, they said. Labels: Asthma |
Study finds complications no greater overall than for other women.
WEDNESDAY, Nov. 18 (HealthCare News) -- New research suggests that having multiple sclerosis puts pregnant women at slightly higher risk for giving birth via cesarean deliveries or having babies that grow at a slower rate in the womb.
But the researchers, whose findings were published online Nov. 18 in Neurology, also reported that pregnant women with MS were not more likely than other women to develop such circumstances as preeclampsia or premature rupture of membranes.
The findings came from an examination of a national database that included details on about 18.8 million childbirths in 38 states, including deliveries by an estimated 10,000 women with MS.
The two groups of pregnant women differed somewhat. Those with MS were more likely than those without chronic medical conditions to have fetuses that suffered from restricted growth, as defined by weight measured through ultrasound. Among women with MS, 2.7 percent had fetuses in that category, compared with 1.9 percent of other women.
Women with MS were also more likely to have a cesarean delivery: 42 percent had a c-section, compared with 33 percent of other women.
However, the study found that women with MS had lower pregnancy complication rates than did women who had diabetes before becoming pregnant.
"These results are supportive for women with MS," study author Dr. Eliza Chakravarty. of Stanford University School of Medicine. said in a news release from the American Academy of Neurology.
"Women and their doctors have been uncertain about the effect of MS on pregnancy, and some women have chosen to delay or even avoid pregnancy due to the uncertainty," Chakravarty said. "We found that women with MS did not have an increased risk of most pregnancy complications." Labels: Pregnancy |
Patients who had bone marrow transplant with surgery did better, study finds.
 TUESDAY, Nov. 17 (HealthCare News) -- Patients who received bone marrow stem cell transplants during coronary bypass surgery (CABG) experienced "excellent long-term safety and survival," say German researchers, who also noted the first promising results for stem cell transplantation during mitral valve repair.
The study included 35 patients who received CD 133+ bone marrow stem cell transplantation during CABG, 20 patients who received only CABG surgery and 10 patients who received stem cell transplantation after mitral valve repair.
Long-term survival among patients in the stem cell transplant/CAGB group was up to five years. Three patients in the stem cell/mitral valve repair group died six months to a year after surgery, including two who developed progressive heart failure, the researchers noted.
The University of Rostock researchers found no sustained or adverse tissue changes in the patients who received stem cell transplants. The stem cell/CABG patients scored better on assessments of clinical effects than those who had only CABG surgery. Both CABG groups had preserved ventricular function, but left ventricular end diastolic volume decreased in the stem cell/CABG patients.
Decreased left ventricular end diastolic volume was also noted in the stem cell/mitral valve repair patients. Two years after the procedure, improved heart function was seen in these patients.
Blood flow scores increased significantly for CABG and mitral valve repair patients who received stem cell transplants, the study authors noted.
The study was to be presented Tuesday at the American Heart Association's annual meeting in Orlando, Fla.
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THURSDAY, Nov. 1 2 (HealthCare News) -- A drug for people with a form of leukemia holds promise as a possible treatment for ovarian cancer, new research suggests.
The drug dasatinib (Sprycel) is used to treat chronic myeloid leukemia. Researchers at the University of California at Los Angeles report that the drug limited the growth and invasive powers of ovarian cancer cells.
It also proved to have even more cancer-fighting powers when it was combined with chemotherapy and used to fight certain kinds of ovarian cancer cells known as Src dependent, according to the report published in the Nov. 10 issue of the BMJ.
Ovarian cancer is the most deadly cancer that strikes the female reproductive system and is expected to kill 15,500 women in the United States this year. The cancer is very difficult to treat.
"It is important to remember that this work is only on cancer cell lines, but it is important enough that it should be used to justify clinical trials to confirm that women with this type of ovarian cancer could benefit," Gottfried Konecny, an assistant professor of hematology/oncology and first author of the study, said in a UCLA news release.
An estimated one-third of women with ovarian cancer have the type known as Src dependent.
"We were able to identify markers in the pre-clinical setting that would allow us to predict response to Sprycel," Konecny said. "These may help us in future clinical trials in selecting patients for studies of the drug." Labels: Leukemia Drug, Ovarian Cancer Patients |
 Office visit questionnaire led to screening in high-risk study patients.
MONDAY, Nov. 2 (HealthCare News) -- A simple questionnaire can identify patients at high risk for lung cancer, researchers say.
In a study that began in 2001 with 1,000 people in Colorado who were seeing their primary care physician for general health issues, patients were asked to complete a five-minute questionnaire that collected information about lung cancer risk factors, including smoking, family history, exposure to chemicals and work environments.
Based on their responses, 430 patients were considered to be at high risk for lung cancer. Of those, 126 underwent a non-invasive breath measurement test called spirometry. Among patients who were found to have airflow obstruction, 88 underwent a full lung cancer screening. Five years later, lung cancer was confirmed in eight patients with obstructed airflow and in 10 patients without obstructed airflow, the researchers reported.
"Simple by design, our initiative received widespread community support from physicians, patients and hospitals," lead investigator Dr. Thomas Petty, said in a news release from the International Association for the Study of Lung Cancer. "By providing the guidelines for pointed questions when patients are face-to-face with physicians, we can begin to identify those at risk."
The study is published in the November issue of the Journal of Thoracic Oncology.
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ov. 27 (HealthCare News) -- The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.
Nov. 26 (HealthCare News) -- Call it the fear factor meets the jubilant sports fan.
MONDAY, Nov. 23 (HealthCare News) - A new combination drug therapy shows promise in treating patients with advanced biliary-tract cancers, researchers say.
