FRIDAY, Feb. 24 (HealthDay News) -- Spending long hours at your desk may boost your work productivity, but it can harm your health, an expert warns.
There's growing evidence that the more time you spend sitting each day, the greater your risk of heart disease. Your spine, shoulders and hips may also suffer.
"It's important to get up and move around throughout the day," occupational therapist Julia Henderson-Kalb said in a Saint Louis University Medical Center news release. "Exercise not only helps with how you feel physically, but it also improves your mind and your memory."
It may not be possible for you to go to the gym at lunchtime, but making small changes to your daily work routine can help protect your health, she said.
Henderson-Kalb offered the following suggestions:
Sitting on an exercise ball instead of a chair will strengthen your abdominal and back muscles, and improve your posture.If possible, walk around while you talk on the phone.A timer or alarm set to go off hourly can help you remember to take a moment to stand and stretch.Choose the stairs whenever possible, and use the restrooms on another floor.Avoid the parking spots closest to the building.Wear a pedometer and plan to take between 6,000 and 10,000 steps per day.Keep light weights or exercise bands at your desk to help squeeze in an exercise break.Bring your lunch to work. The time you save can be used for a quick walk or workout.-- Robert Preidt 
Copyright © 2012 HealthDay. All rights reserved. SOURCE: Saint Louis University Medical Center, news release, Feb. 20, 2012
(HealthDay News) -- A muscle cramp occurs when a contracted muscle can't relax, causing pain and tightness.
The American Academy of Orthopaedic Surgeons says these factors increase the risk of getting a muscle cramp:
Being a young child or infant.Being age 65 or older.Taking certain medications.Being overweight.Overexerting yourself.Being an athlete, particularly in the pre-season before the body is fully conditioned.-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.
THURSDAY, March 15 (HealthDay News) -- Children in a neighborhood with an extra-wide walking/bicycle trail were three times more likely to get vigorous exercise than those in a neighborhood with regular sidewalks, a new study shows.
The researchers compared children in two low-income neighborhoods in Chattanooga, Tenn. One has a two-mile trail for cycling and walking that winds from new public housing and single-family residences to a school, library, recreational facility, park and retail shops.
The other neighborhood has similar features, but regular-width sidewalks, according to the study scheduled to be presented Thursday at an American Heart Association (AHA) meeting in San Diego.
"There was more vigorous activity in the park and along the trail. There was more jogging or bike riding, which makes sense because the urban trail was made for that," study author Gregory Heath, an assistant provost for research and engagement at the University of Tennessee at Chattanooga and the UT College of Medicine, said in an AHA news release.
Previous studies of this type of neighborhood feature have focused mostly on suburban or upper-income communities, according to the release.
"Infrastructural changes like these are expensive. But quite frankly in the long run, they're worth it," Heath said.
Because this study was presented at a medical meeting, the conclusions should be viewed as preliminary until published in a peer-reviewed journal.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: American Heart Association, news release, March 15, 2012
By Randy DotingaHealthDay Reporter
WEDNESDAY, March 14 (HealthDay News) -- People who walk briskly an hour a day could beat back a genetic predisposition to be overweight, compared to those who plant themselves in front of the TV, new research suggests.
The findings don't prove that the exercise is the specific factor that makes a difference, because it's possible that something else could explain why those who walked were thinner, the researchers stressed. Also, the difference would amount to less than a pound for many people.
Still, "the message is that while we cannot change genes, we can do something to change the influence of genes by increasing physical activity and reducing sedentary behavior," said study author Qibin Qi, a research fellow with the department of nutrition at the Harvard School of Public Health.
Research has suggested that inherited traits may be responsible for 50 percent of obesity cases, Qi said. As scientists study what makes people fat from a biological point of view, one of the big issues is this: How can you turn back a genetic tide that may make you more likely to put on pounds just because you were born to a specific set of parents?
In the new study, Qi and colleagues tried to tease out an answer. They came up with one, although it has caveats.
The researchers analyzed the results of two studies that tracked about 7,700 female and 4,600 male health professionals. The studies included data about how much time the people spent watching TV and walking in the two years prior to their weight being measured.
The researchers looked at a measurement called body-mass index (BMI) that analyzes whether a person's height and weight are proportional. The formula is kilograms/meter squared (kg/m-squared).
Genes that have been linked to obesity boosted weight by 0.13 kg/m-squared.
Those who briskly walked an hour a day had a 0.06 kg/m-squared decrease in the genetic effect. For each two hours a day people spent watching TV, the BMI went up by 0.03 kg/m-squared.
The differences wouldn't amount to much for many individuals. A 6-foot-tall person who weighs 200 pounds would have a BMI of 27.1, and an increase of one pound would boost the BMI to 27.3 -- a 0.2 difference.
So should you take an hour-long walk every day to beat back our genetic heritage?
"We don't know whether it is just physical activity that reduced the genetic risk, or whether a generally healthy lifestyle would have the same effect," said Ruth Loos, director of Genetics of Obesity and Related Metabolic Traits at the Mount Sinai School of Medicine. "After all, people who are physically active tend to eat more healthily and smoke less, etc., but in these types of studies the contribution of these different aspects of a healthy lifestyle are hard to tease apart."
The study was scheduled to be presented Wednesday at an American Heart Association meeting in San Diego. Data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Qibin Qi, Ph.D., research fellow, department of nutrition, Harvard School of Public Health, Boston; Ruth Loos, Ph.D., professor and director, Genetics of Obesity and Related Metabolic Traits, Mount Sinai School of Medicine, New York City; March 14, 2012, presentation, American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 Scientific Sessions, San Diego
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Some of the tasks that you can perform during your annual spring cleaning may actually improve your family's health. The following ten spring cleaning activities will help make you, and your home, healthier and safer:
Thoroughly dust your home and clean or replace air conditioning and heating filters; clean all ducts and vents to decrease your exposure to pollens and other airborne allergens. For more, please read the Indoor Allergens and Allergy Treatment Begins At Home articles.Organize your medicine cabinet, discarding expired medications and old prescription medications no longer in use. Your pharmacist can advise you about the best way to dispose of old medications, since tossing them into the garbage may be dangerous. Many pharmacies and clinics offer a medication take-back service for free. The U.S. FDA also has issued guidelines about the safe disposal of drugs. You'll reduce your chances of becoming victim of a medication error and gain some storage space. Check the garage and basement for old cans of paint, thinners, oils, solvents, stains, and other forms of "toxic" trash. Call your city or county sanitation department to find the location of the hazardous waste drop-off center, and get rid of anything you're not going to use. Likewise, check under the sink and around the house for old, potentially toxic cleaning products and dispose of these. Have your chimney professionally cleaned. You'll reduce the chances of carbon monoxide exposure from your chimney when it's fire season again. Clean all mold and mildew from bathrooms and other damp areas with non-toxic cleaning products. Mold is a fungus which can trigger allergic reactions in susceptible people. For more, please read the Mold Questions, Answers, and Facts and Mold Patrol for Mold Control articles.Check your rugs to be sure that rugs on bare floors have non-skid mats. Older mats that have become dusty may need to be washed or replaced to provide effective protection from falls. Outfit your bathrooms with non-skid bath mats.Inspect outdoor playground equipment and be sure that it remains sturdy and in good repair. Pay particular attention to guardrails, protruding bolts, and other potential sources of injury. Change the batteries in your smoke detector and carbon monoxide detector. For more, please read the How to Prevent Carbon Monoxide Poisoning article.Collect old batteries throughout the house for disposal in a battery recycling or hazardous waste center. REFERENCE:National Center for Injury Prevention and Control. "Home & Recreational Safety." Centers for Disease Control and Prevention (CDC). 30 Aug. 2011.
Last Editorial Review: 3/22/2012
Tablets Help Relieve Symptoms Such as Runny Nose, Congestion, Watery Eyes
By Charlene Laino
WebMD Health News
Reviewed by Louise Chang, MD
March 5, 2012 (Orlando, Fla.) -- For many allergy sufferers, getting shots is a pesky, even painful part of ragweed season. Now, researchers report success testing an under-the-tongue tablet as an alternative to injections in people with ragweed allergies.
In a study of more than 500 people with ragweed allergies, people who took the experimental tablets had less nasal congestion, eye tearing, and other allergy symptoms than those who took a placebo. Those given the new pills also needed fewer antihistamines and other allergy medications for relief.
The treatment is a type of immune therapy, the most common form of which is the allergy shot. Tiny amounts of the proteins to which you are allergic are injected to weaken the immune system's response to ragweed, grass, or other allergy triggers.
The new treatment works much the same way, but instead you put a tablet containing tiny extracts of allergens -- in this case ragweed proteins -- under the tongue each day until tolerance develops.
Immune therapy is the only treatment that's been proven to modify the natural course of the allergic disease, "actually turning it off and keeping it suppressed over time," says Johns Hopkins' Peter Creticos, MD, who led the new study.
Shots may work, "but some people are afraid of the needle or don't have time to go to the doctor's office [two to four times a month] during allergy season to get them," he says.
Also, "3% to 6% of people on allergy shots have systemic [throughout the body] allergic reactions that can be severe or life-threatening," Creticos tells WebMD.
That makes the tablets a welcome option, he says.
Merck & Co., which makes the new tablet and funded the study, plans to apply for FDA approval of tablets for both ragweed and grass allergies next year. The grass tablets are already in use in Europe.
The new study was presented here at the annual meeting of the American Academy of Allergy, Asthma, & Immunotherapy.
The new study involved 565 adults with ragweed allergy, some of whom also had asthma. They were given one of two doses of either the once-daily tablet or a placebo for 52 weeks.
During ragweed season, which runs for about four to six weeks in August and September, everyone recorded their symptoms and need for relief medications in electronic diaries.
During the peak two weeks of the season, the tablet reduced symptoms -- including sneezing, runny and itchy noses, congestion, and gritty and watery eyes -- by 17% and 14% at the higher and lower doses, respectively, compared with placebo.
It also reduced the need for standard allergy medications at the two doses vs. placebo.
The most frequent side effects were throat irritation and itching of the mouth. No one died.
Two patients did need epinephrine, an injectable drug used to treat serious allergic reactions. However, one case was due to an unrelated reaction to peanuts.
Asked whether the tablets are as effective as shots, Creticos says a head-to-head comparison of the two is needed to really answer the question.
Mitchell Grayson, MD, an allergy specialist at the Medical College of Wisconsin in Milwaukee, tells WebMD that he welcomes a tablet, as some of his patients find shots annoying or painful. "And the tablets seem to be less likely to cause [life-threatening] reactions than the shots," he says.
One advantage to shots is that many different allergies can be treated at once, Grayson says.
"Most Americans are allergic to many different things, and with injections, you can pretty much cover all of them. So far, the tablets are each directed at different allergies -- one for grass, one for ragweed, for example. That wouldn't be very convenient for a person with [a lot of] allergies," he says.
Allergy shots typically are taken for about two to five years, after which many people can stop them and feel relief for years afterward, according to Grayson. It's not yet known for how long people will have to take the new tablets.
If approved, the tablets would only have to be taken for four months before, and during the four to six weeks of, ragweed season, Creticos says. They were given for 52 weeks in the study so the researchers could better assess their safety.
About 60 million Americans suffer from seasonal allergies, also referred to as hay fever and allergic rhinitis.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES: 2012 Annual Meeting of the American Academy of Allergy, Asthma, & Immunology, Orlando, Fla., March 2-6, 2012.Peter Creticos, MD, associate professor of medicine, Johns Hopkins University, Baltimore; head, Creticos Research Group, Annapolis, Md.; consultant for Merck and other makers of immunotherapy products.©2012 WebMD, LLC. All Rights Reserved.
DRUG CLASS AND MECHANISM: Flunisolide is a synthetic (man-made) corticosteroid. It is administered either as an oral metered-dose inhaler for the treatment of asthma (Aerobid) or as a nasal spray for treating allergic rhinitis. Corticosteroids are naturally- occurring hormones that prevent or suppress inflammation and immune responses. When given as an intranasal spray, flunisolide reduces watery nasal discharge (rhinorrhea), nasal congestion, postnasal drip, sneezing, and itching at the back of the throat that are common allergic symptoms. Eye symptoms such as itching and tearing that may be associated with allergy sometimes also are relieved. A beneficial response usually is noted within a few days but can take as long as 4 weeks. In asthmatic patients, the suppression of inflammation within the airways reduces the swelling caused by inflammation that narrows the airways. At the same time, mucus is reduced. Approximately 50% of flunisolide is absorbed into the blood. Flunisolide was FDA approved in September 1981.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Nasal spray: 0.025 mg or 0.029 mg/spray. Oral Inhaler: 0.25 mg or 0.078 mg/puff.
STORAGE: Flnisolide should be stored at room temperature between 15-30 C (59-86 F) and should be protected from heat, and direct light.
PRESCRIBED FOR: Flunisolide nasal spray is used for relieving symptoms associated with seasonal or perennial rhinitis due to allergies. Rhinitis is an inflammation of the soft, wet tissue lining the inside of the nose. The oral inhaler is used for treating asthma.
DOSING: The canister should be shaken before each use.
For adults, the usual starting dose is two sprays in each nostril twice daily. The dose may be increased to 3 or 4 times per day. In children ages 6-14 years, the usual starting dose is one spray in each nostril three times per day or two sprays in each nostril twice daily. The adult dose for treating asthma is 2 inhalations twice daily not to exceed 8 inhalations per day. The children's dose for treating asthma is 2 inhalations twice daily.DRUG INTERACTIONS: No drug interactions have been described with nasal flunisolide
PREGNANCY: Well-controlled studies on the use of flunisolide during pregnancy have not been done. Studies in animals have shown flunisolide to have damaging effects on the fetus. During pregnancy flunisolide should be avoided unless the physician feels that the potential therapeutic benefit justifies the added risk to the fetus.
NURSING MOTHERS: It is unknown whether flunisolide accumulates in breast milk; however, it is known that other corticosteroids are excreted in breast milk. The effects on the child, if any, are unknown.
SIDE EFFECTS: The most common side effects of flunisolide are nasal irritation and itching, cough, nausea or vomiting, sore throat, nasal congestion, sneezing, flu like symptoms, nasal burning, diarrhea, unpleasant taste, bloody nasal discharge, and nasal dryness. Other adverse effects include headache, dizziness, watery eyes, and upset stomach. Heart palpitations, fungal infections, and growth suppression may also occur.
Reference: FDA Prescribing InformationLast Editorial Review: 3/12/2012
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Back to Medications Index
Chronic Rhinitis and Post-Nasal Drip Allergic rhinitis symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat. Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air. Perennial allergic rhinitis is a type of chronic rhinitis and is a year?“round problem, often caused by indoor allergens, such as dust, animal dander, and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependant upon the type of rhinitis condition. Allergy An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock. Asthma Asthma is a common disorder in which chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness, cough and wheezing.Asthma in Children Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.Hay Fever Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.Asthma: Over the Counter Treatment Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.Nasal Allergy Medications Nasal allergy medications are used to relieve itching, sneezing, and nasal swelling associated with allergies. Antihistamines, decongestants, and steroids are different types of nasal allergy medications. Possible side effects of these medications include dryness, stuffiness, burning, bleeding, nervousness, and palpitations. Asthma Medications There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.Asthma Complexities There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
Hay Fever »
Hay fever is a misnomer. Hay is not a usual cause of this problem, and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Allergic rhinitis is the correct term used to describe this allergic reaction, and many different substances cause the allergic symptoms noted in hay fever. Rhinitis means "irritation of the nose" and is a derivative of rhino, meaning nose. Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis." Rhinosinusitis is the medical term that refers to inflammation of the nasal lining as well as the lining tissues of the sinuses. This term is sometime used because the two conditions frequently occur together.
Symptoms of allergic rhinitis, or hay fever...
Read the Hay Fever article »
DRUG CLASS AND MECHANISM: Deconamine was a brand name medication that contains two different drugs, an antihistamine (chlorpheniramine) and a decongestant (pseudoephedrine). The antihistamine effects of chlorpheniramine account for its effect of reducing allergy symptoms. The decongestant action of pseudoephedrine is a result of blood vessel constriction in the nasal air passages, such as in the nose or sinuses. Brand name and generic formulations of combination products containing only chlorpheniramine and pseudoephedrine have been discontinued in the U. S., most likely due to the regulation of pseudoephedrine distribution.
PRESCRIPTION: No
GENERIC AVAILABLE: No
PREPARATIONS: Tablets of 4 mg chlorpheniramine/60 mg pseudoephedrine; chew tabs of 1 mg c/15 mg p; syrup of 2 mg c/30 mg p.
STORAGE: Combinations of chlorpheniramine and pseudoephedrine should be stored at room temperature in an air-tight container.
PRESCRIBED FOR: The combination drug was used for the temporary relief of runny nose, sneezing, nasal congestion from the common cold. Deconamine also was used for inflamed nasal passages (sinusitis), hay fever (allergic rhinitis) and sinus congestion.
DOSING: The combination drug may be taken with or without food. It must be used cautiously in patients with heart (coronary artery) disease and angina, diabetes, lung diseases, especially asthma, glaucoma, and narrowing of the stomach exit (pyloric stenosis).
DRUG INTERACTIONS: The combination drug can cause drowsiness and impaired ability to operate machinery. It contains pseudoephedrine which should not be taken with MAO inhibitors drugs. Caution must be exercised in the administration of this drug to patients with heart or lung disease. The combination drug should not be combined with other drugs containing pseudoephedrine (such as Sudafed) because of increased risk of side effects on the heart and blood vessels. While misuse of the combination drug for the purpose of getting "high" is unfamiliar to the editors, it is a specific warning from the manufacturer that patients be aware of possible "additive" effects of the drug when taken with alcohol and other central nervous depressants (such as sedatives and tranquilizers). This means that when the drug is taken with, for example, alcohol, the effect of the alcohol could be magnified. Conversely, alcohol increases the sedating qualities of Deconamine.
SIDE EFFECTS: Side effects of antihistamines include drowsiness, impaired ability to accurately operate machinery, worsening of glaucoma or asthma or chronic lung diseases, rash, hives, perspiration, chills dry mouth or throat, low blood counts, restlessness, ringing in the ears, stomach upset, urinary frequency or difficulty. Side effects of pseudoephedrine include stimulation of the nervous system leading to nervousness, restlessness, excitability, dizziness, headache, fear, anxiety, tremor, and even hallucinations and convulsions (seizures).
Reference: FDA Prescribing InformationLast Editorial Review: 3/9/2012
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Back to Medications Index
Sinus Infection Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.Common Cold The common cold (viral upper respiratory tract infection) is a contagious illness that may be caused by various viruses. Symptoms include a stuffy nose, headache, cough, sore throat, and maybe a fever. Antibiotics have no effect upon the common cold, and there is no evidence that zinc and vitamin C are effective treatments.Teen Drug Abuse Drugs commonly abused by teens include tobacco products, marijuana, cold medications, inhalants, depressants, stimulants, narcotics, hallucinogens, PCP, ketamine, Ecstasy, and anabolic steroids. Some of the symptoms and warning signs of teen drug abuse include reddened whites of eyes, paranoia, sleepiness, excessive happiness, seizures, memory loss, increased appetite, discolored fingertips, lips or teeth, and irritability. Treatment of drug addiction may involve a combination of medication, individual, and familial interventions.Hay Fever Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.Nasal Allergy Medications Nasal allergy medications are used to relieve itching, sneezing, and nasal swelling associated with allergies. Antihistamines, decongestants, and steroids are different types of nasal allergy medications. Possible side effects of these medications include dryness, stuffiness, burning, bleeding, nervousness, and palpitations. Sinus Infection »Sinus infections are caused by infections from a pathogenic microorganism (virus, bacterium, or fungus), which grows within a sinus and causes intermittent blockage of the sinus ostium.Most people do not transmit sinus infections; most clinicians agree that except for rare instances, sinus infections are not contagious but arise from mainly viruses and bacteria that, by chance, contaminate a person who sinuses support their proliferation because of minor, and rarely, major abnormalities in the person's sinus tissue (for example, swelling, inflammation, abnormal mucus production, and rarely, facial or nasal trauma).Sinusitis is inflammation of the air cavities within the passages of the nose. Sinusitis can be caused by infection, but also can be caused by allergies and chemical or particulate irritation of the sinuses.Sinusitis may be classified in several ways such as acute sinus infec...
Read the Sinus Infection article »
Knoxville Leads List for a Third Straight Year; 8 Out of 10 Top Spots Are in the South
By Cari Nierenberg
WebMD Health News
Reviewed by Laura J. Martin, MD
March 20, 2012 -- The third time is said to be the charm. But it's doubtful the allergy sufferers in Knoxville find it charming that for a third consecutive year their East Tennessee city has earned the No. 1 spot on the list of the worst places to live with spring allergies.
Knoxville natives have had plenty to sneeze at each spring. In 2009, Tennessee's third largest city placed second in this annual ranking of the 100 "most challenging places to live in the U.S. with spring allergies." And in 2008, the "Marble City" took the sixth spot in this listing, which is done twice a year -- in spring and fall -- by the Asthma and Allergy Foundation of America.
Several factors are considered when ranking each of the 100 largest metro areas, including pollen scores, number of allergy medicines used per patient, and the number of board-certified allergists per patient.
To top the list, Knoxville had "worse than average" pollen counts as well as utilization rates for allergy medications. But it received an "average" score on its number of allergy specialists available to treat patients with allergy-related symptoms, from runny noses and frequent sneezing to watery eyes and sinus congestion.
Here are the worst 10 cities for spring allergies:
Knoxville, Tenn.McAllen, TexasLouisville, Ky.Jackson, Miss.Wichita, Kan.Oklahoma City, Okla.Chattanooga, Tenn.Memphis, Tenn.San Antonio, TexasDayton, OhioFor a complete listing of the top 100 allergy cities for spring, visit allergycapitals.com.
The news that Knoxville has topped the list of most challenging places to live with spring allergies for a third time comes as no surprise to Allan Rosenbaum, MD, an ear, nose, and throat specialist in Knoxville who also treats allergy patients. "A lot has to do with the blessings of east Tennessee," he says.
"It's a beautiful place to live," explains Rosenbaum, "and few places in the U.S. have the variety of plant life." A great variety of trees are blooming right now in Knoxville, including its oaks, hickories, and some maples, he says.
And although spring begins today in terms of the calendar, the daffodils and tulips are already in full bloom. "It's very colorful," says Rosenbaum, and that also means an office filled with seasonal allergy patients, who are in sooner than usual from spring's early arrival in these parts.
It's not just the blooming trees and flowers that contribute to Knoxville's high pollen counts. The city is surrounded by mountains, located between the Smokies and the Cumberland Plateau, and it's also in the Tennessee Valley. That location causes pollen to get trapped in the region, where it can tickle the noses of Knoxville natives.
Rosenbaum says he is seeing more people coming in earlier for their allergy symptoms than last spring. He's also seen an increase in the number of people with seasonal allergies in middle age, who are dealing with hay fever for the first time in their lives.
For those with mild symptoms, he recommends a saline nasal rinse to reduce the pollen load and an over-the-counter allergy product. People with more severe symptoms should see their doctor for prescription medications.
SOURCES: Allan Rosenbaum, MD, ear, nose, and throat specialist, Knoxville, Tenn. News release, Asthma and Allergy Foundation of America.©2012 WebMD, LLC. All Rights Reserved.
(HealthDay News) -- A sprain in the ligaments of the neck can lead to symptoms including spasms, headache, stiffness and numbness in the arm or hand.
The American Academy of Orthopaedic Surgeons suggests how to manage a sprained neck:
Take an over-the-counter pain reliever.Apply an ice pack to the sprain for the first few days after injury, then switch to a heating pad.Gently massage the area.Consider ultrasound or neck traction treatments.Ask your doctor about whether aerobic and isometric exercises could be helpful.-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.
By Serena GordonHealthDay Reporter
TUESDAY, March 6 (HealthDay News) -- Children growing up in the Amish culture in Switzerland have significantly less asthma and allergies than Swiss children who didn't grow up on a farm, according to new research.
What's more, the Amish youngsters even have less risk of asthma and allergy than Swiss children who grew up on non-Amish farms.
The study could support the "hygiene hypothesis" that a too-clean world is causing today's urbanized kids to be more sensitive to allergens than their country cousins.
"In Europe, children living on traditional farms seem to have a very low prevalence of asthma and allergy," noted the study's lead author, Dr. Mark Holbreich, an allergist with Allergy and Asthma Consultants, in Indianapolis. In contrast, he said, "in the general population as many as 50 percent will have evidence of allergic sensitivity. They may not have all the symptoms of allergy, but they will test positive for sensitivity,"
But, "in Swiss children who live on farms, about 25 percent have allergic sensitivity," Holbreich said. "In Amish children, it was only 7 percent. There's something very protective in the Amish children."
He was scheduled to present the study's findings Sunday at the annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI) in Orlando, Fla.
In the study, Holbreich and his colleagues in Switzerland sent out nearly 29,000 questionnaires to families of children between the ages of 6 and 12 years old. The Amish were given a modified version of the questionnaire.
A random sample of those who completed the questionnaires was selected to be given allergy testing.
"The Amish children (138) underwent skin tests," Holbreich explained, and "the Swiss farm children and non-farm children had blood tests for measurement of allergies. For the farm children 3,006 were tested by a blood test and 10,912 non-farm children were tested."
The study authors identified asthma cases by asking if a physician had ever diagnosed the child with asthma, Holbreich said.
Amish children had about half the prevalence of asthma compared to their non-farm-dwelling counterparts (about 5 percent vs. 11 percent). Swiss farm children had a rate of asthma of nearly 7 percent.
The rate of allergic sensitization followed similar patterns. Non-farm children had the highest rates, at about 44 percent, compared with 25 percent in the Swiss farm children and just above 7 percent among the Amish children.
So, what accounts for this striking difference? Holbreich said the researchers don't know for sure, but two factors appeared to be protective against allergy and asthma in the Amish children. One was that they drink raw [unpasteurized] milk directly from the cow, and the other was their exposure to large farm animals from a young age.
"When you have these exposures at a young age, that protection seems to be lifelong," said Holbreich.
He cautioned, however, that these finding in no way suggest that people should start giving their children raw milk, as it can harbor disease-causing germs.
But, the study's findings would seem to support the hygiene hypothesis, which is the idea that allergy and asthma are on the rise in today's world because the immune system isn't exposed to a variety of germs from a young age. This low level of exposure somehow creates dysfunction in the immune system, causing it to attack harmless substances, such as pet dander or peanut proteins.
Two other studies presented at the AAAAI meeting may also provide support for the hygiene hypothesis. One is a Korean study of about 1,800 children. It found that when antibiotics were given during infancy, children were more likely to develop allergies and allergic skin disease (eczema).
The other was a study from Johns Hopkins Hospital that looked at environmental exposures to chemicals. Researchers found that exposure to triclosan, a commonly used antibacterial agent found in hand sanitizers and mouthwashes, was significantly associated with allergies to food and airborne allergens, such as dust or pollen.
While the Swiss study found an association between Amish farm life and lower incidence of allergy and asthma, it could not prove a cause-and-effect relationship.
Dr. Jennifer Appleyard, chief of allergy and immunology at St. Hospital and Medical Center in Detroit, said one protective factor that the authors of the Amish study didn't mention is that the Amish live a fairly secluded existence and thus, have a fairly protected gene pool. Since genetics are one suspected aspect in the development of asthma and allergy, it may just be that the Amish aren't passing down the genes for those conditions, she reasoned.
"These are interesting things to think about, but there are so many confounding factors to look at. I don't think it's just Amish living or farm life. Genes play a role, access to care, environmental exposures. Maybe it's not that they're drinking raw milk, but that they're drinking milk without hormones. Or, they're not getting other environmental exposures that non-farm children are," she noted.
Because this research was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Mark Holbreich, M.D., allergist, Allergy and Asthma Consultants, Indianapolis; Jennifer Appleyard, M.D., chief, allergy and immunology, St. John Hospital and Medical Center, Detroit; March 4, 2012, presentations, American Academy of Allergy, Asthma and Immunology annual meeting, Orlando, Fla. By Serena GordonHealthDay Reporter
THURSDAY, Feb. 23 (HealthDay News) -- That constant sneezing you thought was a winter cold might just be the beginning of your spring allergies instead.
Many areas of the United States have had warmer-than-average winter weather, which is causing trees to start pollinating earlier in some places, according to Dr. Stanley Fineman, president of the American College of Allergy, Asthma & Immunology (ACAAI).
"What we're finding is the warmer weather is bringing earlier pollination of the trees. Here in Atlanta, we already have unusually high pollen counts for this time of the year, and people are starting to have symptoms already," he said.
Asked if the early start would also mean an early end to allergy season, Fineman said he didn't think so. "I think the spring allergy season will probably be longer. In the past few years, it's seemed to start earlier, but then seems to last as long as usual," he noted.
Another expert agreed. "If you have a warmer winter, it's likely that you'll have a longer and worse pollen season," said Dr. Punita Ponda, an attending physician in the pediatric allergy and immunology division at Cohen Children's Medical Center of New York in New Hyde Park.
But, Ponda pointed out that it's not always a warmer winter that brings more pollen. Last year, it was a particularly wet winter in the New York area, with much greater than normal snowfall.
"Last year was a cold, cold winter with a lot of snow, and it was followed by a pretty impressive pollen season," she said, adding that the longer pollen seasons may actually have more to do with global warming than the year-to-year variations in weather. "So, it may be that next year we'll have a long spring pollen season, whether or not it was a warm winter," she said.
So, how can you tell if your runny nose is caused by a cold or allergies? The biggest clue is time, say the experts. If you have what you think is a cold that lasts longer a week, it may be allergies, according to the ACAAI. Also, allergies don't cause fevers and body aches, whereas a cold or flu can. If the discharge from your nose is clear, it's likely that an allergy is to blame from your misery, according to the ACAAI.
Both Fineman and Ponda said it's important to see an allergist to help identify your triggers through allergy testing. Once you know exactly what makes your allergies flare up, you can take steps to prevent them.
If tree pollen is an issue, Ponda says that she advises her patients -- or their parents -- to follow pollen counts in their area, and if the levels are moderate or high to start taking preventive measures, such as keeping the windows closed. She said it's especially important to take steps to avoid pollen between the hours of 5 a.m. and 10 a.m. when pollen counts are often at their highest.
Other things you can do are to stay inside during high pollen hours whenever possible, and if you have to go out, to use the recirculated air setting for your car's vents. When pollen levels are elevated, it's also a good idea to shower as soon as you come home or at least before bed to avoid spreading pollen in your home and bedroom.
In addition to these self-care steps, Fineman said that there are preventive medications that can often help keep allergies at bay. The first line in treatment is generally over-the-counter antihistamines, such as Allegra or Zyrtec or generic equivalents. For more severe allergies, he said that doctors will often prescribe nasal steroids or antihistamines.
And, for those with really intolerable allergies, Fineman said to consider allergy shots. "Allergy immunotherapy is a long-term treatment that develops a sustained tolerance. It's a more life-changing way of dealing with allergies," he said.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Stanley Fineman, M.D., president, American College of Allergy, Asthma & Immunology, and allergist, Atlanta Allergy and Asthma Clinic, Atlanta; Punita Ponda, M.D., attending physician, division of pediatric allergy and immunology, Cohen Children's Medical Center of New York, New Hyde Park, N.Y. SATURDAY, March 10 (HealthDay News) -- Letting pollen drift in through open windows and using the wrong air filter can contribute to allergy flare-ups in spring, experts say.
Some 35 million Americans suffer from sneezing, sniffling, stuffiness and itchy eyes due to spring allergies, according to experts from the American College of Allergy, Asthma and Immunology (ACAAI).
"People with spring allergies often don't realize how many things can aggravate their allergy symptoms, so they just muddle along and hope for an early end to the season," said Dr. Myron Zitt, former ACAAI president, in a college news release. "But there's no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable."
Allergists recommend allergy-sufferers keep their house and car windows closed so pollen can't drift in from outdoors. They also recommend making sure to use the right air filter. Inexpensive central-furnace or air-conditioning filters and ionic electrostatic room cleaners aren't helpful, the allergists said. Ionic electrostatic air filters release ions that can irritate allergies. And whole-house filtration systems can only be effective if the filters are changed regularly.
The experts also note that some people with seasonal allergies, particularly to grass or birch trees, may also suffer from allergies to closely related fruits, vegetables and nuts. About one in five people with grass allergies and as many as 70 percent of people with birch allergies have these cross-reactions, known as pollen food allergy syndrome.
People with allergies to birch or alder trees may experience tingling, itching and swelling around the mouth when they eat celery, cherries or apples. People with grass allergies sometimes find tomatoes, potatoes or peaches problematic.
Although often not serious, reactions to these foods can be life- threatening in a small percentage of people. A life-threatening allergic reaction is called anaphylactic shock, and high-risk people should carry a portable epinephrine pen.
Allergists also encourage people to take their medicine even before their symptoms flare, and to see an allergist who can suggest the best course of treatment.
-- Mary Elizabeth Dallas Copyright © 2012 HealthDay. All rights reserved. SOURCE: American College of Allergy, Asthma and Immunology, news release, Feb. 24, 2012
Surveys: 1 in 3 Kids With Food Allergies Teased or Harassed
By Charlene Laino
WebMD Health News
Reviewed by Laura J. Martin, MD
March 9, 2012 (Orlando, Fla.) -- Parents of kids with food allergies should be aware that their children may be teased or harassed because of their condition, experts say.
Some bullies even chase kids with the allergy-producing food or throw it in their faces, says A. Erika Morris, MD, of the University of Mississippi Medical Center in Jackson.
She headed one of two surveys that showed that about 1 in 3 food-allergic kids is taunted or physically abused at school due to their allergies.
That figure is "only a little out of proportion" to the number of children overall who are teased or bullied by their classmates for everything from their weight to their hairstyle, says Todd Mahr, MD.
Mahr, director of pediatric allergy/immunology at the Gundersen Lutheran Medical Center in La Crosse, Wis., and chair of the American Academy of Pediatrics' allergy & immunology section, reviewed the findings for WebMD.
"But it's something most parents -- and a lot of us who take care of food-allergic kids -- don't think about," he says.
Indeed, one of the surveys showed that 32% of parents of kids harassed about their food allergies were unaware of it.
Not surprisingly, classmates and siblings most often did the bullying, both surveys showed. But in a few cases, teachers or other adults were to blame.
The surveys were presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
The findings come at a time when both bullying and food allergies in kids are on the rise. In 2007, about 1 in 3 middle school and high school students reported having been verbally or physically abused at school, an increase of 17% since 2001. Nearly 4% of children reported food allergies in 2007, an increase of 18% since 1997.
Morris and colleagues administered a 16-question survey to 32 food-allergic children or their parents in the Jackson, Miss., area; 81% were aged 5 to 11 years. Most were allergic to peanuts or eggs.
Results showed that 11 children, or 34%, had been bullied: Ten of the cases involved verbal teasing and six involved physical abuse, including being pushed, tripped, hit, or struck by the offending food.
"One child had an allergic reaction as a result," Morris tells WebMD.
Eight of the 11 children had also been bullied for other reasons, including their size or age.
The second survey, led by Scott Sicherer, MD, of Mount Sinai Medical Center in New York City, involved 111 food-allergic children aged 8 to 17 in that city. Their parents were also surveyed.
Overall, 29% were "bullied, harassed, or teased" due to their food allergies.
Sicherer's previous survey, in 2010, was the first to show that food allergies can make kids -- and adults -- a target of bullying.
While much larger surveys are needed to draw firm conclusions about the proportion of kids bullied due to food allergies, the findings sound a cautionary note for parents, Mahr says.
"Open a dialogue with your child so they know it's OK to talk to you about the problem. A lot of kids are embarrassed to mention being teased or abused, or are afraid their parents will make the situation worse," he says.
Also, "talk to the staff at school to ensure they know about the potential problem. It's important to deal with this early so it doesn't become a pattern," Mahr says.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES: 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, Orlando, Fla., March 2-6, 2012.A. Erika Morris, MD, fellow, University of Mississippi Medical Center, Jackson, Miss.Scott Sicherer, MD, assistant professor, pediatrics, Jaffe Food Allergy Institute, Mount Sinai Medical Center, New York City.Todd Mahr, MD, director, pediatric allergy/immunology, Gundersen Lutheran Medical Center, La Crosse, Wis.; chair, allergy & immunology section, American Academy of Pediatrics.©2012 WebMD, LLC. All Rights Reserved.
Medical Author: Charles Patrick Davis, MD, PhD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Remember:
Prepare ahead of time for the "routine" questions that doctors almost always ask (for example, location, duration, severity, time of onset, and possible initiating factors for your symptoms). Prepare your own list of questions, in writing, for the doctor. Bring a copy of old pertinent medical records, if you have been seen by allergy/asthma specialists in the past. Bring a list of medications that you have tried in the past and those that you are currently using.10 Questions to Ask Your Doctor:
What is my diagnosis and how can I learn more about it?What areas of my body can be affected by my allergy condition? How will they be affected?What tests will you do to diagnose my allergy and/or asthma problem? How safe are these tests?What is the likely course of my problem? What is the long-term outlook?What are my treatment options? Do I take treatments regularly or as needed?What can I do on my own to improve my condition?I have certain special concerns (e.g. exercise, travel, work environment, certain foods, pets, pregnancy, surgery, alternative medicines, and relatives with serious outcomes with similar disease or medications). How do these issues relate to my situation?Regarding my medications, how much do I take and for how long? What does this medication do and when will I feel/know that they are working? What are the possible side effects of the medications and how should we monitor for them (e.g. laboratory testing, blood pressure reading)? Will these medications interact with the other medication that I am taking? What happens if I forget to take it?If my symptoms worsen, what should I do on my own? When should I call your office versus going to the emergency room? What should I do late at night?If you have asthma, ask your doctor to give you an Asthma Care Plan in writing.MedicineNet Reminder: Establishing an accurate diagnosis is a key to proper treatments. You are the most important person in this diagnostic process. An accurate description to your doctor of the character, location, duration, and time of onset of your symptoms factors heavily in determining your diagnosis. You should also inform your doctor about vitamins, herbs, and all medications you are taking because these items may be causing some symptoms. For example, long-term use of certain vitamins and non-prescription medications may be the cause of your abnormal liver tests; magnesium-containing antacids and supplements may be causing your diarrhea; certain blood pressure pills can be the reason for your constipation.
Note: We recommend you use this page as a reference for your consultation with your doctor.
Last Editorial Review: 3/22/2012
WEDNESDAY, March 21 (HealthDay News) -- In many parts of the United States, the infrastructure and systems to deliver health care during or after catastrophic disasters such as major earthquakes or widespread disease outbreaks are rudimentary at best, experts warn.
An Institute of Medicine (IOM) report released Wednesday provides a resource manual to help providers -- hospitals and outpatient clinics, public-health departments, emergency medical systems, public-safety agencies and government offices -- deliver health care as effectively as possible to the greatest number of people during a major disaster.
"When a truly catastrophic event occurs, the nation's health system will be under enormous stress," report committee chairman Lawrence Gostin, associate dean and a professor of global health law at Georgetown University Law Center, said in an IOM news release.
The report recommends a systems-based approach to allocating resources and delivering care during catastrophic events. It also provides the organizations and agencies involved in disaster planning and response with tools and guidelines to help them identify their core functions during a major disaster, the release said.
"Health professionals can bring the best care to the most people by using a systems approach that involves thoughtful coordination among all stakeholders and good planning and coordination among all levels of government," Gostin said. "This report provides an overarching framework for action in such events and provides detailed standards for each responsible group."
Only a few communities in the United States have the level of organization needed to provide oversight and care for a huge number of victims, according to the report.
"Crisis standards of care planning and implementation will significantly increase the likelihood of saved lives and reduced suffering when catastrophic disasters occur," report committee vice chairman Dan Hanfling, an emergency physician and special adviser on emergency preparedness and disaster response at Inova Health System in Falls Church, Va., said in the news release.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: Institute of Medicine, news release, March 21, 2012
HealthDay Reporter
THURSDAY, March 22 (HealthDay News) -- The U.S. Supreme Court seems likely to uphold the sweeping health-reform legislation known as the Affordable Care Act when it takes up the case next week, according to a small survey of legal experts.
The experts base this prediction on a number of factors linked to the nine justices' legal history, political considerations and the constitutional questions raised by the case itself.
"The folks [26 states] who are challenging the act have somewhat of an uphill battle," said Gregory Magarian, a professor at Washington University Law School in St. Louis. "It's been some time since the court has struck down a major piece of federal legislation on the theory that it exceeds Congress' constitutional authority."
The major argument over the constitutionality of the law -- passed by Congress and signed by President Barack Obama in March 2010 -- centers on the so-called individual mandate. That's the piece of the Affordable Care Act that requires most adults in the United States to have some sort of health insurance or face a fine.
The individual mandate offers the law's opponents fodder for debate, Magarian said, because it requires people to purchase health insurance whether they want it or not.
"That's something the federal government has never exactly done before," he said.
State governments have made related requirements of people -- auto insurance being the most prominent example. But even a requirement to purchase auto insurance isn't universal.
"You can avoid buying auto insurance by not having a car," Magarian said. "Being alive is what triggers the requirement for health insurance."
But, many of the legal experts surveyed believe the justices will conclude that the individual mandate falls squarely within the confines of the Commerce Clause, the part of the U.S. Constitution that gives Congress the right to govern interstate economic activity.
"There really is an interstate commercial effect of not having a federal health-care policy," said Leslie Meltzer Henry, an assistant professor at the University of Maryland School of Law. "In the absence of federal intervention in this area, individuals who desperately need insurance can't get it."
The law professors said the individual mandate is needed to make many of the Affordable Care Act's provisions work. For example, insurance companies that will be required to cover everyone -- even people with preexisting health conditions -- can only survive financially if most adults are required to buy health coverage, whether they are healthy or sick. That will ensure there's enough money in the risk pool.
Neil Siegel, a professor of law and political science at Duke University School of Law, noted that the U.S. Supreme Court has in recent years acted to limit some of Congress' powers under the Commerce Clause. But those cases involved social issues such as banning the carrying of firearms in public schools. Conversely, Congress' economic powers under the Commerce Clause have been upheld and protected by the high court, he added.
"The court has held that in issues of economic activity, Congress can act as if we have an integrated national economy," Siegel said. "Here you have economic conduct [health care] with massive interstate effects. Health care is an area of already pervasive federal regulation."
There are other considerations at work that will affect the justices' decisions, the experts said.
While the Supreme Court hasn't been shy about reversing some legislation, the experts said you have to go back to the Great Depression and President Franklin D. Roosevelt's New Deal to find an example of the High Court striking down a landmark piece of legislation as large and momentous as the Affordable Care Act.
"I think it's unlikely the court wants to create a major public or policy upheaval, which is what it would be doing if it overturned the law," said Robert Field, a professor of law in the department of health management and policy at Drexel University's School of Public Health in Philadelphia. He added that a rejection of the law could potentially have consequences for other major federal programs such as Medicare, Medicaid and Social Security.
But Stephen Presser, professor of legal history at Northwestern University School of Law, believes the health-reform law will be ruled unconstitutional in a narrow 5-4 decision.
"I think [Justices Antonin] Scalia, [Clarence] Thomas, [Samuel] Alito and [John] Roberts will all have to view this as Congress going much too far and virtually ignoring the 10th Amendment," Presser said. "Justices [Stephen] Breyer and [Ruth Bader] Ginsburg have always been strong voices for expanded Congressional power, and Justices [Elena] Kagan and [Sonia] Sotomayor are not going to embarrass the man [Obama] who appointed them, so there are four sure votes to uphold the legislation as well. That leaves only [Anthony] Kennedy as the swing vote, as most commentators, I think, understand."
And Presser believes Kennedy will vote with the conservative justices, based on prior rulings that have argued for states' rights as the best way to preserve individual liberty. "If he follows that logic he will have to vote to overturn the ACA's individual mandate," Presser added.
Political considerations will also be in the back of the justices' minds, the experts said. The challenge to the Affordable Care Act is taking place in a presidential election year, and could strongly affect President Obama's re-election chances.
"If the court strikes down the act," Magarian said, "all of a sudden, the left/center-left is going to be whipped into a frenzy. The path of least resistance would be to uphold the thing and let the status quo stand."
But, some of the experts believe there's also a good chance the Supreme Court will punt on the issue, declaring that the time isn't right for judicial review of the Affordable Care Act.
"I think it's interesting they're going to spend a lot of time -- a third of oral arguments -- on whether the case is 'ripe' for judicial review," said Drexel's Field. "That could be a signal from the court that they're spending that much time on that part of the argument."
Added Allison Orr Larsen, an assistant professor of law at the College of William & Mary in Williamsburg, Va.: "My best guess would be they don't decide it on the merits."
The reason why: the individual mandate, which takes effect in 2014, is a form of tax, and federal law doesn't allow a legal challenge to a tax that has yet to be collected.
"You can't challenge a tax until after you've paid it, and then you can sue for a refund," Larsen said, noting that this legal argument has come up in some lower court rulings on the law.
Such a ruling would delay any challenge to the Affordable Care Act until 2015. This would give the Supreme Court the chance to take the issue off the table in an election year while not explicitly endorsing or scuttling the law. "That's why I think it would be an attractive option for them," Larsen said.
Field agreed. "There's a good chance that they'll do that," he said. "The public might be left very frustrated, from not having a definitive answer, but we should be prepared for that outcome."
All the legal observers believe that the court's reasoning will become much clearer during the three days of arguments that begin on Monday.
"Because the hearing is going to be so long, I think we're going to come out of it with a good idea of what the justices are thinking about," Magarian said.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Gregory Magarian, J.D., professor of law, School of Law, Washington University in St. Louis; Leslie Meltzer Henry, J.D., assistant professor of law, Francis King Carey School of Law, University of Maryland, Baltimore; Neil Siegel, J.D., Ph.D., professor of law and political science, Duke University School of Law, Durham, N.C.; Robert Field, J.D., Ph.D., professor of law, department of health management and policy, School of Public Health, Drexel University, Philadelphia; Stephen Presser, J.D., Raoul Berger Professor of Legal History, Northwestern University School of Law, Chicago; Allison Orr Larsen, J.D., assistant professor of law, College of William & Mary, Williamsburg, Va.
By Maureen SalamonHealthDay Reporter
WEDNESDAY, March 21 (HealthDay News) -- A new anti-cholesterol drug appears safe and effective in people already taking statins such as Lipitor, making it a potential addition to statin therapy or an alternative, a preliminary new study suggests.
Two single-dose trials in healthy volunteers and a multiple-dose trial in a group with high cholesterol showed that the drug, known as a monoclonal antibody, reduced low-density lipoprotein (LDL, or "bad") cholesterol levels an average of 40 percent. The injectable drug was also well-tolerated by all participants, with headache the most commonly reported side effect.
The drug works by attacking a destructive enzyme in the liver, keeping LDL cholesterol from spilling into the bloodstream, according to the report published in the March 22 issue of the New England Journal of Medicine.
"It was entirely safe, as best they could tell, and LDL levels plummeted within a matter of a few days and remained low for three months," said Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City, who was not involved in the study. "If this antibody turns out to be as safe and effective as it appears, this may very well be a very important method for controlling LDL cholesterol, particularly in patients with [drug-resistant] cases."
The study, by Dr. Evan Stein, of the Metabolic and Atherosclerosis Research Center in Cincinnati, and colleagues, was funded by Sanofi and Regeneron Pharmaceuticals -- makers of the antibody.
About one in four Americans aged 45 and older takes statins, which interfere with the production of cholesterol in the liver, to control their high cholesterol levels and improve their odds against heart disease, according to the U.S. Centers for Disease Control and Prevention. While widely effective, some patients experience intolerable side effects -- which include liver damage or muscle pain -- and others don't achieve the recommended LDL blood levels of 70 milligrams (mg) per deciliter or lower for those at risk of heart disease.
Two randomized, single-dose studies of the antibody, known as REGN727, were administered either intravenously (in 40 participants) or by injection (in 32 participants) and compared with a group given an inactive placebo. These trials were followed by a randomized study of multiple doses in 51 adults with high cholesterol who were taking atorvastatin (brand name Lipitor) and whose baseline LDL levels were more than 100 mg per deciliter.
Higher doses of REGN727 lowered LDL cholesterol levels by up to 64 percent, and the effect was similar across the board whether or not participants were also taking a statin, which works by a different mechanism.
Commenting on the study, Christine Metz, head of the Laboratory of Medicinal Biochemistry at the Feinstein Institute for Medical Research in Manhasset, N.Y., said, "The next step would be to test a much larger group of people for a much longer time. But this is very promising, apparently safe under the conditions used, and worth very quickly going forward."
Garratt noted that the new drug, which could take at least several years to reach the market, would need to be injected, since antibodies typically can't be formulated into pills. Such a compound would likely be extremely expensive, especially when compared to statins, which are now available as generic drugs. Also, like statins, such a drug would probably need to be taken for life, he said.
Metz pointed out that the trials were very small and consisted heavily of men, making it hard to generalize results for a broader population.
However, "I thought the study was very beautifully conceived and well done," she added. "It did everything it set out to do."
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Kirk Garratt, M.D., clinical director, interventional cardiovascular research, Lenox Hill Hospital, New York City; Christine Metz, Ph.D., head of the Laboratory of Medicinal Biochemistry, Feinstein Institute for Medical Research, Manhasset, N.Y.; March 22, 2012, New England Journal of MedicineHealthDay Reporter
THURSDAY, March 22 (HealthDay News) -- The most ambitious government health-care initiative since the Medicare and Medicaid programs of the 1960s, and the legislative landmark of President Barack Obama's presidency, is about to face its biggest challenge.
Starting Monday, the U.S. Supreme Court will hear an unprecedented six hours of arguments over three days on the constitutionality of the controversial and massive health-reform initiative known as the Affordable Care Act.
The law -- the first national legislative effort to rein in health-care costs -- aims to extend insurance coverage to more than 30 million Americans through an expansion of Medicaid and a provision that people buy health insurance starting in 2014 or face a penalty.
"There are 50 million people in this country who don't have health insurance. The Affordable Care Act will probably extend coverage to an estimated 30 to 32 million of those people," said Renee Landers, a professor at Suffolk University Law School in Boston.
The key sticking point in the legal showdown is whether Congress exceeded its authority with the law's so-called "individual mandate," which requires almost all adult Americans to maintain health insurance or risk a penalty in the form of a tax.
The individual mandate -- scheduled to take effect in January 2014 -- is the pivotal piece of the law.
"The requirement that people purchase insurance is the key to having health insurance be there for everyone when they need it," said John Rother, president of the National Coalition on Health Care, which works to achieve reform of the U.S. health-care system.
Opponents call the mandate a stunning government intrusion into the private lives of Americans and argue that Congress has no right to tell an individual to buy a certain product.
Grace-Marie Turner, president of the Galen Institute, a conservative public policy group, and a critic of the new law, is thrilled that the High Court has agreed to hear challenges to the legislation.
"This case is before the Supreme Court in record time. Two years from the law being enacted to the case being heard is really remarkable," Turner said. "And you have 26 states -- the majority of states -- challenging the law."
The Supreme Court will also hear arguments on whether the law is unconstitutional in requiring states to either comply with an expansion of Medicaid to cover more lower-income people without health insurance, or lose federal matching funding. At issue is the concept of "federalism," the division of powers between the federal and state governments.
Finally, the court will address "severability" -- that is, whether the individual mandate can be struck down while leaving the rest of the law intact.
In a recent New England Journal of Medicine commentary, Landers described arguments for and against severability.
Opponents have said that provisions of the legislation are too intertwined for the law to stand without the individual mandate. The Obama administration has said the law can still work without the mandate, but provisions such as prohibiting insurance companies from denying coverage to people with preexisting conditions would be greatly compromised without the mandate.
Budget office sees savings; opponents skeptical
Here's how the health-reform law is designed to provide health insurance to uninsured Americans:
Individual mandate. It requires most adults to purchase health insurance or pay a tax penalty. By 2016, the phased-in penalty will reach either $695 or 2.5 percent of yearly taxable income, whichever is greater. People with incomes below tax-filing thresholds will be exempt from the provision. Up to 16 million people are projected to join the rolls of the insured under the mandate.Medicaid expansion. This would increase eligibility to all people under age 65 with annual incomes up to 133 percent of the federal poverty level -- about $14,850 for a single adult and $30,650 for a family of four in 2012. Non-disabled adults under 65 without dependent children were previously ineligible. Another 16 million people are estimated to gain insurance under the expansion.State-run insurance exchanges. They will be created to help small businesses and individuals purchase insurance through a more organized and competitive market.In February 2011, the Congressional Budget Office estimated that savings from the Affordable Care Act would cut the federal deficit by $210 billion during the next decade.
But opponents say that the cost-cutting provisions probably won't work.
Devon Herrick, a health economist at the free-market National Center for Policy Analysis, said the law sets up a "slippery slope" that will increase costs, not lower them.
"If Congress and company have the legal authority to decide the minimum coverage you must have, all manner of lobbyists and special interests and providers for specific diseases will descend on Washington and state capitals, as they always have, to make sure that their respective services are covered by that mandate," Herrick said.
The law's supporters argue that without the requirement that people have insurance coverage while they're healthy, there won't be enough money in the risk pool to pay to take care of them when the need for health care eventually -- and inevitably -- arises.
"If people don't feel like paying, then get sick and go to the emergency room or the hospital, those people's costs will be added on to our insurance bills as they are today, which makes it much more expensive," Rother said.
Lower courts, different interpretations
The legal trail of challenges leading up to the Supreme Court has involved more than two dozen lawsuits and appeals.
Last June, the Cincinnati-based 6th Circuit Court of Appeals ruled that the individual mandate was valid because of the Constitution's Commerce Clause, which allows Congress to regulate commerce that takes place among states.
In August, a district judge in Florida ruled that the individual mandate was unconstitutional. However, the 11th Circuit Court of Appeals, which reviewed his decision, rejected that argument and found that the Affordable Care Act could stand even if the individual mandate provision were removed, Landers said.
Then in November, the U.S. Court of Appeals for the District of Columbia also upheld the individual mandate based on the Commerce Clause.
The U.S. Supreme Court chose to review the Florida case, which now includes 25 other states as plaintiffs, along with the National Federation of Independent Business.
The law has been controversial since it was passed by Congress and signed by Obama in March 2010. Poll after poll has found that Americans don't like the individual mandate. But a recent Harris Interactive/HealthDay poll revealed that people are starting to warm up to certain key provisions of the law -- such as the ban on insurance companies turning away applicants with preexisting health problems.
Some popular provisions -- including allowing children to stay on their parents' health plans until age 26 -- are already in place.
Other provisions meant to help older Americans began in 2011, with changes to continue through 2020.
Medicaid expansion a vital component of the law
States must comply with the Medicaid expansion no later than 2014. But some worry that a big influx of new enrollees could strain medical specialties such as obstetrics/gynecology, pediatrics and family practice.
Dr. Peter Carmel, president of the American Medical Association, called the expansion "an important step in the right direction," even though many "physicians are currently unable to accept Medicaid patients due to low reimbursement rates."
Added Dr. Glen Stream, president of the American Academy of Family Physicians: "For the time being, [the new law] seems like the best option to get everyone covered with health insurance. Otherwise, people are carved out from good primary-care services, good preventive care and wellness services, and care of their chronic illnesses until sometimes it's too late."
The Supreme Court ruling is expected in June. The court could go one of several ways:
It could rule the individual mandate is unconstitutional and the entire law invalid.It could rule the mandate is constitutional and the entire law can stand.It could reach a middle ground: that the individual mandate is unconstitutional but the rest of the law can stand.It could decline to rule on the case and the health reforms would proceed.The decision may pivot on the vote of Justice Antonin Scalia, a court conservative. Suffolk University's Landers said that in a previous case that centered on the Commerce Clause, "Scalia wrote a concurrence in which he took a very broad view of Congress' authority. So I think he has a lot of work to do to get himself out from under that concurrence."
She said it's also possible -- though unlikely -- that the court could decide to delay ruling on the case altogether.
That would be a major setback for opponents, said Turner at the Galen Institute. "By 2017, 'Obamacare' would have such deep roots that it would be hard to overturn," she said.
Whatever the court decides, it will provide plenty of fodder for the 2012 elections. And even if the Affordable Care Act survives the legal challenge, Landers said, "with upcoming elections -- a new Congress -- it doesn't mean that everything is set for all time."
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Renee M. Landers, J.D., professor of law, Suffolk University Law School, Boston; John Rother, president, National Coalition on Health Care, Washington, D.C.; Grace-Marie Turner, president, Galen Institute, Alexandria, Va.; Devon Herrick, health economist and senior fellow, National Center for Policy Analysis, Dallas; Peter Carmel, M.D., president, American Medical Association; Glen Stream, M.D., president, American Academy of Family Physicians, Leawood, Kan.; Feb. 29, 2012, New England Journal of Medicine; Congressional Budget Office, March 30, 2011, CBO's Analysis of the Major Health Care Legislation Enacted in March 2010
(HealthDay News) -- It may be a challenge to select diabetes-friendly meals from a huge menu of options.
The American Diabetes Association suggests how to find healthy meals for diabetics:
Always ask what's in a dish and how it's prepared; request that dishes be made without extra butter.Request small portion sizes, and eat your meal slowly.Skip high-fat dressings and toppings.Choose dishes that aren't breaded or fried.Substitute high-fat choices with healthier sides.Don't be afraid to ask for lower-calorie choices, such as vinegar or olive oil, even if you don't see them on the menu.Don't drink too much alcohol.-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.
(HealthDay News) -- Gastroesophageal reflux disease (GERD) is a condition that occurs when the muscle at the base of the esophagus allows fluids from the stomach to rise into the esophagus.
The National Digestive Diseases Information Clearinghouse lists these common symptoms of GERD:
A burning sensation, known as heartburn, in the chest or upper abdominal area.A frequent dry cough.Symptoms of asthma.Difficulty swallowing.Tasting food or fluid from the stomach at the back of the mouth, called acid reflux.Acid reflux that occurs more than twice a week.-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.
HealthDay Reporter
THURSDAY, March 22 (HealthDay News) -- The Medicaid program is bracing for an expansion that will bring an estimated 16 million more Americans into the health-care safety net, as required by the Affordable Care Act.
But whether that happens depends on how the U.S. Supreme Court rules on the legal challenges to the massive health-care reform legislation.
Twenty-six states are challenging the requirement to comply with the new Medicaid eligibility rule or lose federal matching funds, calling it coercive and a violation of states' rights. On March 28, they will argue before the Supreme Court that that provision of the Affordable Care Act is unconstitutional.
The Medicaid expansion opens eligibility to all people with household incomes up to 133 percent of the federal poverty level -- whether unemployed or the so-called working poor -- starting in January 2014. That translated into an annual income of approximately $14,850 for an individual and $30,650 for a family of four in 2012, according to the U.S. Department of Health and Human Services.
Until now, the main groups of people served by the Medicaid program have been low-income parents and children, the frail elderly and the disabled.
The Medicaid expansion provision is considered more likely to survive the legal challenge than the Affordable Care Act's most controversial provision: the individual mandate, which requires most adults to have health insurance or pay a fine.
"I don't think [the Medicaid expansion] is as vulnerable, but it isn't an entirely trivial issue. The basic point is that the [U.S. Supreme] court has been very clear for a very long time that Congress can require states to do things using Congress' spending power," said Renee M. Landers, a professor at Suffolk University Law School in Boston.
"The problem the challengers have in [arguing] that the [Medicaid expansion] is coercive is that the federal government is paying for 100 percent of the expansion for the first 10 years that the law is in effect," Landers said.
On Feb. 17, a group of 12 state attorneys general filed a brief in support of the expansion's constitutionality.
"In a cooperative federalist program, the federal government establishes the program's core requirements and gives the states the freedom to implement their own programs within those requirements," an excerpt from the brief states.
At least five states are expanding their Medicaid programs early: California, Connecticut, Minnesota, New Jersey and Washington, along with Washington, D.C. Illinois is planning an early expansion as well.
Will there be enough doctors to handle Medicaid patients?
Some physician groups are concerned about the effects of a massive influx of enrollees into the already-strained Medicaid system.
Shortages of doctors already exist in specialties most likely to work with Medicaid patients -- such as pediatricians and family practitioners. And doctors say current Medicaid reimbursement rates from government are too low to encourage more doctors to treat Medicaid participants.
"While expanding Medicaid access to more low-income Americans under the Affordable Care Act was an important step in the right direction, more progress is needed," said Dr. Peter Carmel, president of the American Medical Association. "Most physicians are currently unable to accept Medicaid patients due to low reimbursement rates, and this problem must be addressed as new patients enter the program."
One opponent of the Affordable Care Act said expansion of the Medicaid program would hurt current enrollees by reducing access to health-care providers and forcing longer waiting times -- without helping the newly eligible.
"Medicaid may give them insurance cards -- good luck getting that care," said Grace-Marie Turner, president of the conservative Galen Institute.
Dr. Glen Stream, president of the American Academy of Family Physicians, cited parts of the new law that, he said, should attract and train more physicians in settings that serve Medicaid patients.
"Components like teaching health centers are part of the Affordable Care Act," he said. "That's to take a federally qualified health center and do medical residency, medical education in that health center."
And he said a provision for student loan forgiveness could help overcome a barrier to medical students choosing family medicine and other primary-care specialties.
"It's important to acknowledge for our membership that [the new law] was controversial," Stream said. "We have 100,000 members across the country and certainly they represent the political diversity in our society.
"Our academy is focusing -- because the Affordable Care Act is now law -- on helping to preserve and expand and implement those pieces that we see as important to the health of people in our country," he added.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Renee M. Landers, J.D., professor of law, Suffolk University Law School, Boston; Grace-Marie Turner, president, Galen Institute, Alexandria, Va.; Peter Carmel, M.D., president, American Medical Association; Glen Stream, M.D., president, American Academy of Family Physicians, Leawood, Kan.; Feb. 17, 2012, news release, Oregon Department of Justice
WEDNESDAY, March 21 (HealthDay News) -- Two long-term studies from the Netherlands suggest that routine mammography screening does save women's lives.
One of the longest national breast cancer screening programs in the world led to a significant drop in deaths and caused limited harm, such as false-positive results and over-diagnosis, according to one of the new studies.
Another study found that regular mammography screening helped save lives even after adjusting for improvements in breast cancer treatment.
"These results show why mammography is such an effective screening tool," said one U.S. expert, Dr. Kristin Byrne, chief of breast imaging at Lenox Hill Hospital in New York City. She was not involved in the new research.
Both studies were slated to be presented Wednesday at the European Breast Cancer Conference in Vienna, Austria.
In one study, researchers analyzed data collected during the first 20 years of the mammography breast cancer screening program launched in the Netherlands in 1989.
"Compared with the pre-screening period 1986 to 1988, deaths from breast cancer among women aged 55-79 fell by 31 percent in 2009," Jacques Fracheboud, a senior researcher at the Erasmus University Medical Center in Rotterdam, said in a meeting news release.
"We found there was a significant change in the annual increase in breast cancer deaths: before the screening program began, deaths were increasing by 0.3 percent a year, but afterwards there was an annual decrease of 1.7 percent," he added. "This change also coincided with a significant decrease in the rates of breast cancers that were at an advanced stage when first detected."
Most Dutch women seemed amenable to regular mammography. Over the first 20 years of the screening program, 16.6 million personal invitations for breast cancer screening were sent to 3.6 million women ages 50-75 (the present screening age in the Netherlands). Overall acceptance during that time was 80 percent, increasing from 73.5 percent in 1990 to 81.5 percent in 2009.
During that time, 13.2 million breast cancer screening examinations were performed among 2.9 million women (an average of 4.6 examinations per woman), resulting in nearly 180,000 referral recommendations, nearly 96,000 biopsies and more than 66,000 breast cancer diagnoses.
For a woman who was 50 in 1990 and had 10 screenings over 20 years, the cumulative risk of a false-positive result (something being detected that turned out not to be breast cancer) was 6 percent.
Over-diagnosis (detection of breast tumors that would never have progressed to be a problem) occurred in 2.8 percent of all breast cancers diagnosed in the total female population and 8.9 percent of screening-detected breast cancers.
The study also found that the screening program had reasonable costs.
"We are convinced that the benefits of the screening program outweigh all the negative effects," Fracheboud said.
Byrne agreed that the statistics were impressive. Regular screening "decreases deaths by over 30 percent, [with] limited harm and reasonable costs. Additionally, cancers are detected at an earlier stage, which means not only decreased mortality but also morbidity; the patient may not have to have chemotherapy or a mastectomy," she noted.
In the second study, Dutch researchers found that even after accounting for improved treatments for breast cancer, mammography screening programs still saved a significant number of lives.
The researchers found that adjuvant therapy (treatment given in addition to primary therapy such as surgery) reduced breast cancer deaths by about 14 percent in 2008 compared to no treatment. However, they also found that breast cancer screening every two years reduced deaths by an additional 15.7 percent.
Using a computer modeling program, the researchers estimated that adjuvant treatment reduced breast cancer deaths from 67.4 to about 58 per 100,000 women years (cumulative years during which study participants were followed). The addition of screening for women ages 50-75 further reduced deaths to about 49 per 100,000 women years. This means that adjuvant therapy plus screening reduced deaths by a total of 27.4 percent.
If screening were extended to women ages 40-49, deaths would be reduced by a further 5.1 percent, according to Rianne de Gelder, a graduate student and researcher at the Erasmus University Medical Center.
"The effectiveness of breast cancer screening has been heavily debated in the last couple of years. One of the arguments that critics have is that, since breast cancer patients can be treated so effectively with adjuvant therapy, the relative effects of screening become smaller and smaller," de Gelder explained in a meeting news release.
However, "our study shows that, even in the presence of adjuvant therapy, mammography screening (between age 50 and 75) is highly effective in reducing breast cancer deaths and, in fact, is slightly more effective than adjuvant treatment," she said. For that reason, "screening women of these ages should definitely continue."
Byrne agreed, noting as well that the sometimes onerous side effects of chemotherapy treatment make catching tumors early via mammography even more crucial. Chemotherapy can "result in a significant decrease in quality of life," she said. "However, this study shows, even in the presence of adjuvant therapy, mammography screening reduces breast cancer deaths."
De Gelder and her colleagues said further investigation is still needed to determine "the ideal age for starting screening, taking into account not only the effects, but also the risks and costs of extending the lower age limits."
In the United States, the U.S. Preventive Services Task Force in 2009 advocated that women not begin mammography screening until age 50, a decision that touched off an ongoing debate over whether women in their 40s should get such screening. Groups such as the American Cancer Society still support regular mammography screening for women ages 40 to 49.
Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCES: Kristin Byrne, M.D., chief, breast imaging, Lenox Hill Hospital, New York City; European Breast Cancer Conference, news release, March 21, 2012
By Serena GordonHealthDay Reporter
WEDNESDAY, March 21 (HealthDay News) -- A new medication called tenecteplase may be more effective at treating strokes caused by clots in large blood vessels in the brain than the current standard therapy, Australian researchers report.
"This study compares a newer thrombolytic medicine [tenecteplase] to the standard thrombolytic medicine [alteplase] in the treatment of patients with acute ischemic stroke," explained study author Dr. Mark Parsons, an associate professor at the University of Newcastle School of Medicine and Public Health and a senior staff specialist in neurology at John Hunter Hospital, in Newcastle.
Thrombolytic drugs are essentially clot-busters. The researchers found that tenecteplase was better at restoring blood flow to the brain after a stroke than alteplase. In addition, fewer people treated with a higher dose of tenecteplase had a serious disability at 90 days after their stroke compared to those on alteplase.
Results of the study are published in the March 22 issue of the New England Journal of Medicine. Funding for the study came from the Australian National Health and Medical Research Council.
Acute ischemic strokes occur when a clot blocks blood supply to the brain. Both tenecteplase and alteplase are from a class of medications known as a tissue plasminogen activator (tPA). When given within three hours of the first stroke symptoms, intravenous tPA can open up the blocked blood vessel in the brain and prevent further brain damage.
Recovery after receiving one of these medications can be fast and dramatic, though this isn't always the case. And, excessive bleeding is a significant risk factor associated with these medications.
The current study included 75 people treated within six hours after an acute ischemic stroke. All received advanced computed tomography (CT) imaging to ensure that there wasn't any stroke-induced brain damage yet, and the researchers also looked for people who were having strokes in a large blood vessel.
Parsons said the researchers used the advanced CT screening to "identify stroke patients with the greatest potential to benefit from thrombolytic treatment."
The patients were randomly assigned to receive either a standard dose of alteplase, or one of two different doses of tenecteplase (0.1 milligrams (mg) per kilogram (kg) of body weight or 0.25 mg per kg). A kilogram is about 2.2 pounds. All received the medication less than six hours after the onset of symptoms, according to the study.
Blood flow of both tenecteplase groups was restored more effectively than for the alteplase patients. People in the tenecteplase groups also showed greater clinical improvements than those on alteplase after 24 hours.
The higher dose of tenecteplase appeared to be more effective. After 90 days, 72 percent of those treated with the higher dose of tenecteplase were free of serious disability compared to just 40 percent of those on alteplase.
There were no significant differences in excessive bleeding in the brain or other serious adverse events, according to the study.
"The perfect clot-busting drug would open up the blockage without causing any hemorrhage. Short of that, the goal is to find a drug that works at least as well, if not better, and that's as safe," said Dr. Keith Siller, director of the Comprehensive Stroke Center at NYU Langone Medical Center in New York City.
"They showed that under ideal circumstances, this drug works well. It still remains to be seen if other types of strokes will be helped as much," said Siller.
Hemorrhagic strokes, which occur when a blood vessel in the brain bursts, are less common than ischemic strokes.
Parsons said he and his colleagues hope to broaden the study population in their next study. They said the current findings warrant moving on to a study comparing the drugs' performance within a shorter window for treatment.
Siller said that while researchers are trying to refine the type of clot-busting drug that might work best, the message to the public remains clear: If you have any symptoms of stroke, get to the hospital as soon as possible.
"All of these treatments require patients to come to the hospital as soon as possible," noted Siller, who added that treatments currently need to be administered within three hours after the onset of symptoms.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Mark Parsons, M.D., senior staff specialist, neurology, John Hunter Hospital, and associate professor, University of Newcastle School of Medicine and Public Health, Newcastle, Australia; Keith Siller, M.D., director, Comprehensive Stroke Care Center, NYU Langone Medical Center, and assistant professor, neurology and psychiatry, NYU School of Medicine, New York City; March 22, 2012, New England Journal of Medicine