American Journal Of Medicine

Oct. 20, 2009 - H1N1 swine flu has turned flu death statistics upside down, the CDC today confirmed.

In a normal flu season, 90% of deaths are in elderly people. Since September, 90% of deaths have been in people under age 65 -- with almost a quarter of the deaths in young people under age 25.

"It is almost completely reversed. Nearly 90% of our fatalities are occurring in people under 65," CDC respiratory disease chief Anne Schuchat, MD, said at a news conference. "This illustrates this H1N1 virus is disproportionally affecting the young."

As might be expected from the death toll, most people hospitalized with severe H1N1 swine flu are young. Surveillance data from 27 states show that more than half of swine flu hospitalizations -- 53% -- are in people under age 25. Only 7% of people hospitalized with swine flu are elderly.

While the majority of severe H1N1 swine flu cases are in people with conditions that put them at risk of flu complications, not all these conditions are severe. Well-treated asthma, for example, is common. And pregnancy isn't an illnesses at all. Yet the risk is there.

"Completely healthy pregnant women are coming down with horrible, horrible illnesses -- and, tragically more deaths," Schuchat said. "And some conditions like asthma which is well controlled. So even if you have diabetes that's well controlled, if you have asthma that's well controlled, we want to you think of yourself as a higher risk and recommend that you be vaccinated."

H1N1 Swine Flu Vaccine Rollout Still Bumpy

If you're thinking of taking the CDC's advice and getting your H1N1 swine flu shot (or sniff), it's time to start making plans.

The flu.gov web site has a flu vaccine finder that links to each state. Most states have detailed information that show which providers near you will be offering the H1N1 swine flu vaccine.

The first vaccines are going to health care workers and people at risk of flu complications. So far, about 13 million doses have been available to states, more than half in the form of flu shots. States have placed orders for about 11 million of those doses; those orders are being filled quickly.

Spread nationwide, that means not everyone who should get the vaccine will be able to get it this week, or even next week. Availability is increasing, but it's unlikely that the vaccine will reach everyone who wants it before the end of November.

Will that be too late? The CDC's mantra is, "It's too early to say it's too late."

Schuchat points to what happened in 1957, when pandemic flu hit hard in the early fall -- and was followed by a second wave of flu.

"In 1957, the pandemic hit early around September/October, like what we're seeing here. They had another big wave after the first of the year," Schuchat said. "And I think we have an opportunity right now to try to limit the disease and to protect as many people as we can with the vaccine as it becomes available."

Meanwhile, Schuchat said, the CDC is not planning to stop its H1N1 swine flu effort when all 250 million doses of the vaccine have been delivered.

"At CDC, we're planning a long response. We don't want to let our guard down too soon on this," she said.

View Article Sources

SOURCES:

Anne Schuchat, MD, director, National Center for Immunization and Respiratory Diseases, CDC, Atlanta.

CDC news conference.

© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore...

Oct. 20, 2009 (Philadelphia) -- Women who spray their homes and gardens with insecticides may be placing themselves at risk for rheumatoid arthritis and lupus, a study shows. 

In a study of more than 75,000 women, those who used insecticides six or more times a year had nearly two-and-a-half times the risk of developing the autoimmune diseases than women who adopted a live-and-let-live attitude toward bugs. 

Similarly, the risk more than doubled if bug sprays were used in the home for 20 or more years.

Hiring a gardener or commercial company to apply insecticides also resulted in a doubling of risk, but only if they were used long-term, says Christine G. Parks, PhD, an epidemiologist with the National Institute of Environmental Health Sciences in Research Triangle Park, N.C.

"Our new results provide support for the idea that environmental factors may increase susceptibility or trigger the development of autoimmune diseases in some individuals," she says.

Although the study doesn't prove cause and effect, "we need to start thinking about what chemicals or other factors related to insecticide use could explain these findings," Parks tells WebMD.

The researchers used data from the Women's Health Initiative Observational Study of 76,861 postmenopausal, predominantly white women ages 50 to 79. Of the total, 178 of them had rheumatoid arthritis and 27 had lupus. An additional eight women had both disorders. As part of the study, the women were asked a number of questions relating to farming and insecticide use.

"Importantly, the relationships we observed were not explained by other factors that we considered, including farm history, age, race, ethnicity, socioeconomic factors such as education and occupation, smoking and other risk factors for disease," Parks says.

Interestingly, a history of working or living on a farm did not appear to increase risk of rheumatoid arthritis or lupus in the study, she adds. Previous studies have linked farming and agricultural pesticide exposure to the disorders.

The findings were presented at the annual meeting of the American College of Rheumatology.

Studies show that as many as three-fourths of U.S. households have reported using insecticides in the home or garden, and 20% of households have applied insecticides in the last month, according to Parks.

"Insecticide exposure in the home can be quite persistent because they don't break down in the home environment," Parks says.

"The findings are fairly compelling" because they show the greater and longer the exposure, the greater the risk, says Darcy Majka, MD, assistant professor of medicine at Northwestern University Feinberg School of Medicine.

"Now we have to go back to the bench. Which products pose a risk? Is skin exposure [to blame], or inhaling?" she says.

For now, Majka tells WebMD, "The important thing is to follow the directions [on the product] and take other measures to limit chemical exposure."

View Article Sources

SOURCES:

American College of Rheumatology Annual Meeting, Philadelphia, Oct. 17-21, 2009.

Christine G. Parks, PhD, epidemiologist, National Institute of Environmental Health Sciences, Research Triangle Park, N.C.

Darcy Majka, MD, assistant professor of rheumatology, Northwestern University, Chicago.

© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore...

Oct. 20, 2009 -- A diagnosis of cardiovascular disease significantly increases the risk of future hip fracture, and there may be a genetic predisposition to both conditions, a new study shows.

Ulf Sennerby, MD, of Uppsala University, Sweden, and colleagues studied records of 31,936 twins in the Swedish Twin Registry. The researchers looked at whether elderly people may be genetically predisposed to develop both cardiovascular disease and hip fractures.

Previous data have suggested that common biologic factors underlie both diseases, and the investigators wanted to determine the extent of any relationship between the diseases and genes or lifestyle factors. 

Their results are reported in the Oct. 21 issue of The Journal of the American Medical Association.

The researchers note that a study that includes twins provides a framework for an ordinary group analysis while simultaneously examining whether the relation between cardiovascular events and hip fracture is explained by genetic and early environmental factors.

The twins were born from 1914 to 1944 and data on each was studied from the age of 50.  Twins with cardiovascular disease and fractures were identified by the National Patient Registry from 1964 through 2005.

Among the study's findings:

•         The absolute rate of hip fractures was highest after a diagnosis of heart failure or stroke. The rate was not as high following a diagnosis of peripheral atherosclerosis or ischemic heart disease, and was lowest for people without cardiovascular disease.

•         Compared to people without cardiovascular disease, patients with heart failure had about a fourfold increase in hip fracture rates; individuals with a stroke had a fivefold increase in hip fracture rates.

"Identical twins without heart failure and stroke also had an increased rate of hip fracture after their co-twins were exposed to these respective diseases," the researchers write. The association was also present, but not as strong for non-identical twins.

This suggests that genes predispose people to the development of both cardiovascular disease and hip fractures, the researchers report.

In the total population studied:

•         The average hip fracture rate was 12.6 per 1,000 person-years after a diagnosis of heart failure.

•         The hip fracture rate also was 12.6 per 1,000 person years after a stroke, 6.6 after a diagnosis of peripheral atherosclerosis, and 5.1 after a diagnosis of ischemic heart disease.

Those numbers compared with just 1.2 per 1,000 person years for those without cardiovascular disease.

"Clinicians should be aware of the considerably increased rate of hip fracture in both sexes, especially after a recent hospitalization for [cardiovascular disease]," the researchers argue. "Genetic predisposition is probably a major determinant of the excess fracture rate."

heart health newsletter

Health information tailored for those living with heart disease. Sign up today to receive WebMD's trusted Heart newsletter.

View Article Sources

SOURCES:

News release, Uppsala University, Sweden.

Sennerby, U. The Journal of the American Medical Association, Oct. 21, 2009; vol 302: pp 1666-1673.

© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore...

Oct. 20, 2009 -- Depressed heart patients don't get extra help from omega-3 fatty acids when they take the supplements along with an antidepressant drug, a clinical trial shows.

Heart patients are often prescribed omega-3 supplements. There's evidence that the supplements can make antidepressants significantly more effective, although not every study has detected this effect.

To see what's going on, Washington University researcher Robert M. Carney, PhD, and colleagues enrolled 122 patients with heart disease and clinical depression in a clinical trial. None of the patients was taking either antidepressants or omega-3 supplements at the time.

All the patients received the antidepressant Zoloft at a dose of 50 milligrams per day, with a two-week run-in period to allow the drug to take effect. Half also got two Lovaza capsules, which together contain about 2 grams of the omega-3 fatty acids EPA and DHA. The other half of the patients got placebo capsules containing corn oil.

People in both groups became less depressed. There was no sign that those taking omega-3 supplements got better or improved faster than those taking placebo pills.

"Although some trials of omega-3 for depression have been strongly positive, others -- including the present study -- have failed to demonstrate a benefit," Carney and colleagues conclude.

The positive results from some studies suggest to the researchers that there may be a subgroup of heart patients that may benefit from the combination treatment. The researchers are analyzing their data to see whether they can identify such a group.

Carney and colleagues report their findings in the Oct. 21 issue of the Journal of the American Medical Association. The study was funded by the National Heart, Lung, and Blood Institute; Pfizer supplied the Zoloft and GlaxoSmithKline supplied the Lovaza.

View Article Sources

SOURCE:

Carney, R.M. Journal of the American Medical Association, Oct. 21, 2009; vol 302: pp 1651-1657.

© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore...

Oct. 20, 2009 (Philadelphia) -- The first in a new class of experimental drugs that targets the disease process involved in lupus beat out standard treatment in a large clinical trial, researchers say.

If the findings hold up, the drug, Benlysta, could become the first new drug for lupus in five decades.

About 1.5 million Americans have lupus, a complex disease in which the immune system attacks a person's own tissues, wreaking havoc on the joints, skin and other organs.  Benlysta dampens the abnormal immune signals, calming down the immune system.

The new study involved 865 patients on standard therapy, including steroids, for lupus. One-third were also given a high dose of Benlysta, one-third a low dose, and one-third received a placebo.

Sandra V. Navarra, MD, head of rheumatology at the University of Santo Tomas, Manila, Philippines, reported the findings at the 73rd Annual Scientific Meeting of the American College of Rheumatology.

After one year, 58% of patients on high-dose Benlysta experienced a significant improvement in symptom severity, compared with just 43% of those on placebo.

Patients taking Benlysta also had fewer disease flare-ups, fewer severe flare-ups, and a longer time between flare-ups. They also reported less fatigue and better quality of life.

Previously reported findings from the study showed that the drug is also more effective at reducing pain, hair loss, and skin rash than placebo.

Of particular note, doctors say, was that more patients taking Benlysta were able to reduce their steroid dose. "One of the most important goals of treatment is to get patients off steroids, which cause so many unforgivable side effects -- bloating, weight gain, acne, high blood pressure, and others," says Joan T. Merrill, MD, medical director of the Lupus Foundation of America.

The most common adverse events were headache, muscle pain, upper respiratory tract infections, urinary tract infection, and influenza, and were comparable between the three treatment groups.  Serious infections were reported by about 6% of patients in all three groups.

Human Genome Sciences Inc. and GlaxoSmithKline, which are developing the drug, funded the study.

Results of another large trial pitting Benlysta against standard care are scheduled to be released next month. If the drug works as well as in this study, the companies plan to apply for FDA approval of the drug.

View Article Sources

SOURCES:

American College of Rheumatology Annual Meeting, Philadelphia, Oct. 17-21, 2009.

Sandra V. Navarra, MD, head of rheumatology, University of Santo Tomas, Manila, Philippines.

Joan T. Merrill, MD, medical director, Lupus Foundation of America; professor of medicine, University of Oklahoma Health Sciences Center.

© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore...