Tips to Avoid Return Trip to the Hospital

TUESDAY, Feb. 19 (HealthDay News) --More than 1 million Americans end up back in the hospital just weeks after they're discharged, and many of those readmissions are preventable, according to an expert from Columbia University School of Nursing in New York City.

Patients can do their part to avoid return trips to the hospital by simply paying attention and speaking up when it's time to go home, advised Mary Donovan-Johnson, program director of the Acute Care Nurse Practitioner Program.

"Discharges are often rushed and patients may be overwhelmed during this stressful time," Donovan-Johnson said in a Columbia news release. "If you don't understand something a medical provider said, don't be afraid to ask your doctor or nurse to repeat the instructions... Ask the person accompanying you home to listen and take notes when instructions are being explained by your medical team."

Other steps you can take to reduce the odds of readmission after discharge include:

Get all discharge instructions and information in writing, including directions for wound care, medications and food restrictions. Keep these instructions in a place where they are easily accessed. After discharge, follow through on your treatment by filling prescriptions and taking medications as directed. If you have questions about your medications or other instructions, call your doctor. Schedule follow-up visits with your doctor and blood tests or other procedures as directed, and keep those appointments.

"Ideally, the same team of doctors and nurses who worked with the patient would discharge them since they know the protocol in their medications, wound care, and how to set up the safest environment at home for them. But unfortunately, that doesn't always happen," Donovan-Johnson said. "So the patient needs to be vigilant about being an active participant in their recovery."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Columbia University School of Nursing, news release, Feb. 18, 2013

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Human Teeth Healthier in the Stone Age Than Today: Study

TUESDAY, Feb. 19 (HealthDay News) -- Something to think about next time you're in the dentist's chair: Ancient humans had healthier teeth than people do today, researchers say.

This decline in oral health over the past 7,500 years is the result of changes in oral bacteria due to human evolution and industrialization, the study authors said. These changes have led to chronic oral and other health problems, according to the report published Feb. 18 in Nature Genetics.

"The composition of oral bacteria changed markedly with the introduction of farming, and again around 150 years ago," explained study leader Alan Cooper, a professor and director of the University of Adelaide's Australian Centre for Ancient DNA, in a center news release. "With the introduction of processed sugar and flour in the Industrial Revolution, we can see a dramatically decreased diversity in our oral bacteria, allowing domination by caries [cavities]-causing strains. The modern mouth basically exists in a permanent disease state."

The international team of researchers examined DNA that had been preserved in tartar -- calcified dental plaque -- found on 34 prehistoric northern European human skeletons. They used these samples to analyze how oral bacteria changed from the Stone Age to the last hunter-gatherers, medieval times and later with the introduction of food manufacturing in the Industrial Revolution.

The evolution of human behavior and diet have had a negative impact on oral health, the investigators said.

"This is the first record of how our evolution over the last 7,500 years has impacted the bacteria we carry with us, and the important health consequences," Cooper said. "Oral bacteria in modern man are markedly less diverse than historic populations and this is thought to contribute to chronic oral and other disease in post-industrial lifestyles," he pointed out.

Study lead author Christina Adler, now at the University of Sydney, added that "dental plaque represents the only easily accessible source of preserved human bacteria." And, she said in the news release, "Genetic analysis of plaque can create a powerful new record of dietary impacts, health changes and oral pathogen genomic evolution, deep into the past."

The researchers said their research is being expanded to include other periods in time, other areas of the world and other species, such as Neanderthals.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Australian Centre for Ancient DNA, news release, Feb. 18, 2013

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Drug, Alcohol Abuse More Likely Among High School Dropouts

TUESDAY, Feb. 19 (HealthDay News) -- The link between poor academic performance and substance abuse just got stronger, with a new U.S. government report showing ties between the two.

High school seniors who dropped out of school before graduating were more likely to drink, smoke cigarettes and use marijuana and other illegal drugs, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration.

The researchers said their findings should prompt communities to develop strategies to keep teens in school and prevent problems with substance abuse.

"The fact that nearly one in seven students drops out of high school has enormous public health implications for our nation," SAMHSA Administrator Pamela Hyde said in an agency news release. "Dropouts are at increased risk of substance abuse, which is particularly troubling given that they are also at greater risk of poverty, not having health insurance, and other health problems. We have to do everything we can to keep youth in school so they can go on to lead healthy, productive lives, free from substance abuse."

The study revealed high school seniors (typically between 16 and 18 years of age) who dropped out of school were more than twice as likely to be smokers, or have smoked in the past month, than students who stayed in school. The study also found that more than 31 percent of seniors who didn't receive their diploma used drugs, compared with about 18 percent of students who had finished high school.

The researchers also noted that about 27 percent of high school dropouts smoked marijuana, while close to one in every 10 abused prescription drugs. Meanwhile, only about 15 percent of those who completed high school used marijuana and just 5 percent abused prescription drugs.

Dropouts were also more likely to drink -- the study showed that nearly 42 percent of seniors who didn't finish high school drank and about a third engaged in binge drinking.

In contrast, about 35 percent of those students who stayed in school drank and only about one-quarter said they binged on alcohol.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: U.S. Substance Abuse and Mental Health Administration, news release, Feb. 14, 2013

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As Economy Rebounds, More Folks Try Turning Back Hands of Time

TUESDAY, Feb. 19 (HealthDay News) -- Evidence of the economic upturn can be found in more than housing starts and auto sales: A new report shows that the number of cosmetic procedures grew 5 percent in 2012.

Botox injections and other types of minimally invasive treatments led the way as more people opted for these types of facial rejuvenation procedures, while the number who chose to "go under the knife" remained relatively stable, the findings revealed.

In total, there were 14.6 million minimally invasive and surgical plastic surgery procedures in 2012. There were also 5.6 million reconstructive plastic surgery procedures last year, an increase of 1 percent from 2011, according to annual statistics from the American Society of Plastic Surgeons (ASPS).

Minimally invasive procedures increased 6 percent, with more than 13 million procedures in 2012. The top five were:

There were nearly 1.6 million cosmetic surgical procedures in 2012, a 2 percent decrease from 2011. The top five surgical procedures last year were:

Breast augmentation (286,000 procedures, down 7 percent)Nose reshaping (243,000 procedures, no change)Liposuction (202,000 procedures, down 1 percent)Eyelid surgery (204,000 procedures, up 4 percent)Facelift (126,000 procedures, up 6 percent).

While cosmetic breast surgeries among women decreased 2 percent between 2011 and 2012, male breast reduction surgeries increased 5 percent, to nearly 21,000 in 2012, the report said.

"For the third consecutive year, the overall growth in cosmetic surgery continues to be driven by a significant rise in minimally invasive procedures, while surgical procedures remain relatively stable. We are aware, however, that patients who begin with less-invasive treatments with a plastic surgeon may opt for more invasive, surgical procedures once required," Dr. Gregory Evans, ASPS president, said in a society news release.

Reconstructive plastic surgery increased by 1 percent in 2012 and the top five procedures were:

Tumor removal (4.2 million, up 1 percent)Laceration repair (291,000, down 4 percent)Maxillofacial surgery (209,000, up 7 percent)Scar revision (171,000, down 2 percent)Hand surgery (123,000, up 3 percent).

Reconstructive breast reduction increased 8 percent, with 68,000 procedures performed in 2012, the report noted.

"Although breast reduction has many physical and psychological benefits for women with overly large breasts, obstacles remain in acquiring insurance coverage," Evans said. "It's promising to see gains in this and other beneficial, medically necessary surgeries."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Society of Plastic Surgeons, news release, Feb. 19, 2012

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Fraudulent Data May Have Led to Use of Risky Treatment in ICUs

By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.

At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.

"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review.

Luckily for American patients, hydroxyethyl starch is not commonly used in the United States, Taylor said. But the new analysis serves as a cautionary tale on how fraudulent data can end up endangering patients' lives.

As Taylor explained it, critically ill patients often develop leaky vessels, and so quickly require intravenous fluids to keep their blood pressure stable and to improve organ function.

One such fluid is simple saline or salt water, known as crystalloid solution. This is the cheapest fluid available, but it tends to leak out of blood vessels, which means it can also leak into the lungs, under the skin and into various organs.

As a result, researchers have spent considerable time and effort trying to find less leaky alternatives to saline. The protein albumin, derived from human blood, is commonly used after cardiac surgery, when the risk of fluid collecting in the lungs is high, Taylor explained. Although albumin is less leaky than saline, it is more expensive.

Hydroxyethyl starch is similar to albumin, but it contains starch molecules, which are less likely to leak out of the blood vessels than saline.

Still, many researchers had reservations about using a starch-based solution from the beginning, Taylor said.

"If you have salt water and it leaks out, you just get some salt into the tissue and it goes away with a little bit of time," he explained. On the other hand, "if you have starch in the tissue it's not so easy to get starch out of there, and many people were worried about the possibility of complications."

It turns out there was even more reason to be suspicious of any alleged benefits of hydroxyethyl starch. In 2011, investigators discovered that the lion's share of research on the treatment that was conducted by German anesthesiologist Dr. Joachim Boldt was fraudulent and had to be retracted.

So the author of the current paper wondered: Would the purported benefits of hydroxyethyl starch hold up once Boldt's data was excluded?

Led by Dr. Ryan Zarychanski, of the University of Manitoba in Winnipeg, Canada, the team pooled data from 38 previous studies on the issue, including those by Boldt.

That analysis concluded that patients who received hydroxyethyl starch did not fare any better than other types of fluid.

But when the Boldt studies were excluded from the mix, hydroxyethyl starch was actually associated with an increased risk of death, kidney failure and need for dialysis among patients, the new research found.

It's impossible to gauge how many patients were damaged by Boldt's falsified research, but this new study highlights "how the inclusion or exclusion of the Boldt papers associated with research misconduct can shift the balance toward harm," said Dr. Massimo Antonelli, author of an editorial accompanying the new study.

"It showed also how the worldwide administration of starches for volume replacement therapy have caused the increase of acute renal failure and affected mortality," said Antonelli, a professor of intensive care and anesthesiology at the Catholic University-A.Gemelli University Hospital in Rome.

He added that a task force of the Surviving Sepsis Campaign, an organization devoted to reducing death from sepsis, recently issued guidelines warning against using starches for fluid replacement.

"These findings will reinforce [those] recommendations," he said.

Taylor stressed, however, that it would still be helpful to find alternatives to both albumin and saline.

A person in the intensive care unit (ICU) can have 1-2 liters more of fluid going into their body than out, said Taylor. Each liter weighs 1 kilogram, or 2.2 pounds.

"It's possible to gain anywhere from 8-10 pounds in fluid [in the ICU] so it would be a great to have an alternative to 10 pounds of weight," he said. However, a starch solution "is not a good alternative because it increases the risk of dying or needing dialysis," Taylor said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Taylor, M.D., chairman, pulmonary and critical care medicine, Ochsner Health System, New Orleans; Massimo Antonelli, M.D., professor, intensive care and anesthesiology, Catholic University-A. Gemelli University Hospital, Rome; Feb. 20, 2013, Journal of the American Medical Association

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Blame Common Colds on Your Chromosome 'Caps?'

By Amy Norton
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Some people seem to catch a cold every few weeks while others appear immune. Now a preliminary study suggests that the protective "caps" on your chromosomes could partly explain the mystery.

The study, reported in the Feb. 20 issue of the Journal of the American Medical Association, found that healthy young adults were more prone to catching a cold when their immune system cells had relatively short telomeres.

Telomeres are lengths of DNA that sit at the ends of your chromosomes. Think of them like the plastic caps at the ends of a shoelace: Telomeres help keep your chromosomes -- which carry your genes -- from fraying and sticking together.

As people age, their telomeres gradually get shorter, and research has linked shorter telomere length to older adults' risks of developing and dying from infections, cancer and heart disease.

"But there's been very little known about telomere length in young people, certainly in relation to health," said Sheldon Cohen, a professor of psychology at Carnegie Mellon University in Pittsburgh who led the new study.

Because colds and other respiratory infections are the most common health woe in younger people, Cohen's team decided to see whether telomere length mattered in their risk of developing a cold.

The researchers recruited 152 healthy 18- to 55-year-olds, and measured telomere length in the volunteers' T cells -- immune system cells that fight off infection. They then exposed the men and women to a cold virus via nasal drops, and quarantined them in a hotel to be monitored.

Over the next five days, 22 percent of the volunteers developed cold symptoms, and the odds were higher among those with shorter telomeres in a particular subtype of T cell. Of the one-third with the shortest telomeres, 26 percent became sick, versus 13 percent among the one-third with the longest telomeres.

"This is something new and provocative," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved in the research.

"All of us know some people who get one cold after another, and others who seem like they're able to be around people with colds but remain robust," said Schaffner, who is also a spokesman for the Infectious Diseases Society of America.

These findings, Schaffner said, raise the possibility that there is some role for the telomeres in our T cells.

"We're not all created equal in terms of our telomeres," he said. "Just like some of us are short, and some are tall."

What does that mean for you during cold and flu season? Nothing right now, according to both Schaffner and Cohen.

For one, nobody knows if they have skimpy telomeres. And even if they did, it's not clear whether there's anything they could do about it.

"There is a lot of research interest right now in whether it's possible to alter telomere length, either through some kind of behavioral change or a medication," Cohen said. "But we're pretty far from that point."

What's more, the current findings do not prove that shorter telomeres, per se, mean more cold misery. The researchers did account for other factors, such people's age, weight and race. But Cohen said there could be other explanations. It's possible, for example, that some genetic factor makes people have shorter T-cell telomeres and renders them more vulnerable to colds.

On the other hand, shorter telomeres may impair T cells' ability to battle cold viruses, Cohen said.

Still, no one knows yet whether these findings could one day have practical use.

"This is really the first evidence that this biomarker of aging may be important for 25-year-olds as well as 65-year-olds, and for acute health conditions as well as chronic," Cohen said.

Of course, you do not need to wait for any telomere-lengthening therapy to curb your risk of catching a cold. "Wash your hands," Schaffner advised. "And try to avoid people who are sneezing and coughing."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Sheldon Cohen, Ph.D., professor, psychology, Carnegie Mellon University, Pittsburgh; William Schaffner, M.D., chair, preventive medicine, Vanderbilt University School of Medicine, Nashville, Tenn.; Feb. 20, 2013, Journal of the American Medical Association

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Injuries Rising Among Young Dancers

TUESDAY, Feb. 19 (HealthDay News) -- A new study finds that 113,000 children and teens were treated for injuries related to dancing from 1991 to 2007, and the annual number of injuries grew by more than a third over that period.

Sprains and strains, or both, were most common, causing 52 percent of injuries, followed by falls, responsible for 45 percent of dance-related mishaps.

The study looked at dance injuries among children and young adults aged 3 to 19. All were treated in U.S. emergency rooms.

"Adolescents are still growing into their bodies and as such often develop imbalances that can lead to injury," said Eric Leighton, an athletic trainer in sports medicine at Nationwide Children's Hospital, in a hospital news release. "It's critical that intervention and injury prevention be made available to them to address balance, strength and functional body control deficits as they grow."

According to the study, the annual number of dance-related injuries grew from 6,175 injuries in 1991 to nearly 8,500 injuries in 2007. Forty percent of injuries occurred in dancers aged 15 to 19.

"We believe this could be due to adolescent dancers getting more advanced in their skills, becoming more progressed in their careers and spending more time training and practicing," Kristin Roberts, lead study author and a senior research associate at the Center for Injury Research and Policy at the hospital, said in the news release. "We encourage children to keep dancing and exercising. But it is important that dancers and their instructors take precautions to avoid sustaining injuries."

Senior author Lara McKenzie, principal investigator at the Center for Injury Research and Policy, added: "Safety precautions such as staying well-hydrated, properly warming up and cooling down, concentrating on the proper technique and getting plenty of rest can help prevent dance-related injuries."

The study appears in the February issue of the Journal of Physical Activity and Health.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Nationwide Children's Hospital, news release, Feb. 11, 2013

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