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Monthly Archives: November 2016

Cell Phones Affect Brain Activity

Holding a cell phone to your ear for a long period of time increases activity in parts of the brain close to the antenna, researchers have found.

Glucose metabolism — that’s a measurement of how the brain uses energy — in these areas increased significantly when the phone was turned on and muted, compared with when it was off, Dr. Nora Volkow, director of the National Institute on Drug Abuse, and colleagues reported in the Journal of the American Medical Association.

“Although we cannot determine the clinical significance, our results give evidence that the human brain is sensitive to the effects of radiofrequency-electromagnetic fields from acute cell phone exposures,” co-author Dr. Gene-Jack Wang of Brookhaven National Laboratory in Long Island, where the study was conducted, told MedPage Today.

Although the study can’t draw conclusions about long-term implications, other researchers are calling the findings significant.

“Clearly there is an acute effect, and the important question is whether this acute effect is associated with events that may be damaging to the brain or predispose to the development of future problems such as cancer as suggested by recent epidemiological studies,” Dr. Santosh Kesari, director of neuro-oncology at the University of California San Diego, said in an e-mail to MedPage Today and ABC News.

There have been many population-based studies evaluating the potential links between brain cancer and cellphone use, and the results have often been inconsistent or inconclusive.

Most recently, the anticipated Interphone study was interpreted as “implausible” because some of its statistics revealed a significant protective effect for cell phone use. On the other hand, the most intense users had an increased risk of glioma — but the researchers called their level of use “unrealistic.”

But few researchers have looked at the actual physiological effects that radiofrequency and electromagnetic fields from the devices can have on brain tissue. Some have shown that blood flow can be increased in specific brain regions during cell phone use, but there’s been little work on effects at the level of the brain’s neurons.

So Dr. Volkow and colleagues conducted a crossover study at Brookhaven National Laboratory, enrolling 47 patients who had one cell phone placed on each ear while they lay in a PET scanner for 50 minutes.

The researchers scanned patients’ brain glucose metabolism twice — once with the right cell phone turned on but muted, and once with both phones turned off.

There was no difference in whole-brain metabolism whether the phone was on or off.

But glucose metabolism in the regions closest to the antenna — the orbitofrontal cortex and the temporal pole — was significantly higher when the phone was turned on.

Further analyses confirmed that the regions expected to have the greatest absorption of radiofrequency and electromagnetic fields from cell phone use were indeed the ones that showed the larger increases in glucose metabolism.

“Even though the radio frequencies that are emitted from current cell phone technologies are very weak, they are able to activate the human brain to have an effect,” Dr. Volkow said in a JAMA video report.

The effects on neuronal activity could be due to changes in neurotransmitter release, cell membrane permeability, cell excitability, or calcium efflux.

It’s also been theorized that heat from cell phones can contribute to functional brain changes, but that is probably less likely to be the case, the researchers said.

Dr. Wang noted that the implications remain unclear — “further studies are needed to assess if the effects we observed could have potential long-term consequences,” he said — but the researchers have not yet devised a follow-up study.

“The take-home message,” Dr. Kesair said, “is that we still don’t know, more studies are needed, and in the meantime users should try to use headsets and reduce cell phone use if at all possible. Restricting cell phone use in young children certainly is not unreasonable.”

Exercise and Talk Help Ease Chronic Fatigue Syndrome

Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling— improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.

Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.

Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.

In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.

In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”

“The number of serious adverse events was miniscule,” she added.

Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.

“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.

However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.

“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.

In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”

The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.

“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.

“We know that cognitive behavioral therapy and gentle physical conditioning help people cope with any chronic disease — even congestive heart failure and multiple sclerosis,” Natelson said in an interview with MedPage Today.

Chronic fatigue syndrome is characterized by persisting or relapsing fatigue for at least six months that cannot be explained by any other physical or psychiatric disorder.

The fatigue is debilitating, and often is accompanied by joint and muscle pain, headaches, and tenderness of the lymph nodes.

In an editorial published with the study, Dr. Gijs Bleijenberg, and Dr. Hans Knoop, of Radboud University in Nijmegen, the Netherlands, explained the differences in these types of treatment for chronic fatigue.

“Both graded exercise therapy and cognitive behavior therapy assume that recovery from chronic fatigue syndrome is possible and convey this hope more or less explicitly to patients. Adaptive pacing therapy emphasizes that chronic fatigue syndrome is a chronic condition, to which the patient has to adapt,” Bleijenberg and Knoop wrote.

Graded exercise therapy and cognitive behavioral therapy have both been recommended by the U.K. National Institute for Health and Clinical Excellence, although evidence supporting these approaches remains sparse.

Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.

These groups advocate exercise pacing and specialist medical care, according to the investigators.

To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.

Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.

More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.

At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:

  • Cognitive behavioral therapy, 59 percent
  • Graded exercise therapy, 61 percent
  • Adaptive pacing therapy, 42 percent
  • Specialist medical care, 45 percent

The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:

  • Cognitive behavioral therapy, 30 percent
  • Graded exercise therapy, 28 percent
  • Adaptive pacing therapy, 16 percent
  • Specialist medical care, 15 percent

Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.

Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.

White’s group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.

They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.

Dangerous Bacteria Outside Hospitals

The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body’s “good” bacteria for several months.

That’s when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficileshould be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, “All these recommendations are fine; the problem is they are not going to work, you can’t stop these practices. This bug exists in a climate of overuse of antibiotics.”

It is hard to eradicate C. difficile because it buries itself in the colon, then recurs and testing isn’t always accurate, Siegel said. “It’s a pervasive problem in hospitals, and even in communities,” he said.

Medications Safety

The U.S. Food and Drug Administration (FDA) judges a drug to be safe enough to approve when the benefits of the medicine outweigh the known risks for the labeled use.

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:

  • Speak up
  • Ask questions
  • Find the facts
  • Evaluate your choices
  • Read the label and follow directions

Speak Up

The more information your health care team knows about you, the better the team can plan the care that’s right for you.

The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.

They also need to know all the medicines and treatments you use, whether all the time or only some of the time. Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn’t.

It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one.

Be sure to include:

  • prescription medicines, including any samples your doctor may have given you
  • over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)
  • dietary supplements, including vitamins and herbs
  • any other treatments
  • any allergies, and any problems you may have had with a medicine
  • anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost

Ask Questions

Your health care team can help you make the best choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.

Find the Facts

Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:

  • brand and generic (chemical) names
  • active ingredients — to make sure that you aren’t using more than one medicine with the same active ingredient
  • inactive ingredients — if you have any problems with ingredients in medicines, such as colors, flavors, starches, sugars
  • uses (“indications” and “contraindications”) — why you will be using it, and when the medicine should/should not be used
  • warnings (“precautions”) — safety measures to make sure the medicine is used the right way, and to avoid harm
  • possible interactions — substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine
  • side effects (“adverse reactions”) — unwanted effects that the medicine can cause, and what to do if you get them
  • possible tolerance, dependence, or addiction – problems that some medicines can cause, and what you can do to avoid them
  • overdose — what to do if you use too much
  • directions — usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food
  • storage instructions — how and where to keep the medicine
  • expiration — date after which the medicine may not work, or may be harmful to use

Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers. If you have questions, ask your health care team.

Evaluate your Choices — Weigh the Benefits and Risks

After you have all the information, think carefully about your choices. Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you. This is how you weigh the benefits and risks. The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

Read the Label and Follow Directions

Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use. Using too much of any active ingredient may increase your chance of unwanted side effects.

Read the label each time you buy an OTC medicine or fill your prescription. When buying an OTC, read the “Drug Facts” label carefully to make sure it is the right medicine for you. Prescription and OTC medicines don’t always mix well with each other. Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too. Ask the pharmacist if you have questions.

Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it. If you’ve bought the medicine before, make sure that this medicine has the same shape, color, size, and packaging. Anything different? Ask your pharmacist. If your medicine tastes different when you use it, tell your health care team.

Read and save all the information you get with your medicine.

Read the label each time before you use the medicine. Be sure it’s right in 5 ways:

  1. the right medicine
  2. for the right patient
  3. in the right amount
  4. at the right time
  5. in the right way (for example, swallow instead of chew a pill)

Follow directions on the label and from your health care team. When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.

If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member. Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner. When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.