Researchers in the US found that people caring for a spouse with dementia were six times more likely to develop it themselves compared to similar older married adults whose spouse never develops it.

A paper on the study, led by Dr Maria Norton of Utah State University, is about to be published in a May issue of the Journal of the American Geriatrics Society, which is available online.

Norton and colleagues also found that husbands looking after wives with dementia were at higher risk of developing it themselves than wives looking after husbands with the condition.

The authors wrote that while many studies have shown dementia caregivers are at higher risk of poor physical and mental health, none has looked at the specific risk of dementia in caregivers.

Looking after someone with dementia is physically and mentally demanding, and caregivers in this situation tend to report more personal sacrifices and stress than those caring for physically impaired elderly people who do not have dementia.

For the study, Norton and colleagues recruited 2,442 participants (1,221 married couples) aged 65 and over living in Northern Utah. None of the participants had dementia at the start of the study, and they were followed for 12 years.

During follow up, 30 cases (60 individuals) of dementia were diagnosed in both spouses, plus 125 where only the husband developed it, and 70 where only the wife developed the condition.

After adjusting for socioeconomic status (a factor that is known to significantly affect dementia risk and other health outcomes), the researchers found that:

* Incident dementia was not only significantly linked to older age, but also to having a spouse with dementia.

* After adjusting for age, gender, genetic factors (APOE genotype), in addition to socioeconomic status, having a spouse with dementia was linked to a six times higher risk of developing dementia.

* For men caring for a spouse with dementia, the risk was 11.9 times higher, while for women it was 3.7 times.

Norton told the media that more research is needed to find out how much of this risk is due to caregiver stress and how much is due to a shared environment.

She also stressed that on the positive side, most of the participants whose spouses developed dementia did not themselves develop the condition, and therefore “more research is needed to explore which factors distinguish those who are more vulnerable”.

“Given the significant public health concern of Alzheimer’s disease and other dementias, and the upcoming shift in population age composition, continued research into the causes of dementia is urgent,” she added.

From the first tip-off during March Madness to the championship’s final buzzer, and with start of the 2010 Major League Baseball season, on Sunday, April 4, thousands of people will relentlessly scream and shout, placing tremendous strain on their voices. While no one is recommending complete silence, the constant pressure on the vocal cords can cause great damage.

“Yelling at basketball and baseball games, talking too much on your cell phone, and other forms of overuse can damage your voice,” says Lee M. Akst, M.D., assistant professor in the Johns Hopkins School of Medicine Department of Otolaryngology-Head and Neck Surgery and director of the Johns Hopkins Voice Center. “Red flags for an over-used voice are frequent hoarseness, a sense of strain while talking, or discomfort while speaking. If hoarseness lasts for more than two weeks or is accompanied by ear pain, difficulty breathing, or difficulty swallowing, it may indicate a potentially serious vocal cord condition. If these symptoms occur, then you should be evaluated by an ear-nose-throat specialist as quickly as possible.”

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) says nearly three of every 10 people have experienced voice problems. Chronic hoarseness is an occupational hazard not just for singers, but for coaches, teachers, broadcast journalists, clergy, attorneys, and other people who use their voices a lot as part of their professional responsibilities. “According to AAO-HNS statistics, more than one in four people in the United States report voice disorders during their lifetimes,” says Akst, “and this number goes up to more than one in two for high-risk professions such as teaching.”

Akst recommends the following steps to protect your voice:

- Drink plenty of water. Moisture helps keep thin secretions flowing to lubricate vocal cords.
- Try not to scream or yell at ball games or other similar events. This can strain the lining of the vocal cords.
- Don’t overuse your voice. Give it a rest rather than talking on the cell phone all the time.
- Don’t smoke.
- Use good breath support. Fill your lungs before talking and don’t wait until you are almost out of air before taking another breath to power your voice.
- Use a microphone when giving a speech or presentation.
- Most of all, pay attention to how your voice sounds and how your voice feels. If you are getting hoarse or strained, know when to rest your voice so that it can recover.

“A good night’s sleep” has long been the intention of millions of people suffering from sleep disorders around the world. However, this objective is scarcely met with ease. The reality of this scenario is that many will not seek the professional help to address the serious sleep disorders that plague them, resulting in numerous health consequences. The World Association of Sleep Medicine (WASM) will be holding the third annual World Sleep Day on Friday, March 19, 2010. The event is organized by the World Sleep Day Committee and is regarded as a platform for medical professionals to deliver the message of the importance of healthy sleep to the public.

Sleep is a function in which all vertebrates and some invertebrates participate, however the physiological purpose of sleep has yet to be discovered. While sleep is necessary to be alert to optimally navigate daily tasks, research shows sleep may also be a factor in growth, regeneration, and memory. With an estimated one third of adults suffering from clinically recognizable insomnia and approximately 80 additional sleep-related disorders, there is significant concern for the health consequences that occur with the lack of quality sleep. Studies suggest that a lack of sleep is detrimental to health in ways such as the development of high blood pressure, obesity, diabetes and other chronic ailments in those who consume less than 6 hours nightly.

The 10 Commandments of Sleep Hygiene listed below make common sense recommendations that are rarely complied with fully.

1. Fix a bedtime and an awakening time.

2. If you are in the habit of taking siestas do not exceed 45 minutes of daytime sleep.

3. Avoid excessive alcohol ingestion 4 hours before bedtime and do not smoke.

4. Avoid caffeine 6 hours before bedtime. This includes coffee, tea and many sodas, as well as chocolate.

5. Avoid heavy, spicy, or sugary foods 4 hours before bedtime. A light snack before bed is acceptable.

6. Exercise regularly, but not right before bed.

7. Use comfortable bedding.

8. Find a comfortable temperature setting for sleeping and keep the room well ventilated.

9. Block out all distracting noise and eliminate as much light as possible.

10. Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room.

Violation of these commandments causes poor quality of nocturnal sleep, short duration of sleep, fragmentation of sleep and serious sleep deprivation. These infringements may lead to poor alertness, lack of attention, reduced concentration, decreased work and academic productivity, and even motor vehicle accidents. Physical health problems come next.

It is due to the widespread effects of sleep disorders and increasing number of sufferers worldwide, that World Sleep Day dedicates its efforts in 2010 to educate the world on important sleep topics. The day’s events will take place online, featuring the organization of local groups promoting sleep health, presentation of educational materials, an award presentation to the best creation and exhibition of historic videos.

Extreme obesity is affecting more children at younger ages, with 12 percent of black teenage girls, 11.2 percent of Hispanic teenage boys, 7.3 percent of boys and 5.5 percent of girls now classified as extremely obese, according to a Kaiser Permanente study of 710,949 children and teens that appears online in the Journal of Pediatrics.

This is the first study to provide a snapshot of the prevalence of extreme obesity in a contemporary cohort of children ages 2 – 19 years from a large racially and ethnically diverse population using the recent 2009 U.S. Centers for Disease Control and Prevention extreme obesity definition. Previous research was based on recent National Health and Nutrition Examination Survey (NHANES) data and included information on obesity but not extreme obesity.

“Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children’s futures. Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their twenties that we typically see in 40 – 60 year olds,” said study lead author Corinna Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena, Calif. “For example, children who are extremely obese are at higher risk for heart disease, type 2 diabetes, fatty liver disease and joint problems, just to name a few.”

Researchers used measured height and weight in electronic health records to conduct a cross-sectional study of 710,949 children ages 2 – 19 years in the Kaiser Permanente Southern California integrated health plan in 2007 and 2008. Children in the study had an average of 2.6 medical visits per year where height and weight were measured.

The study found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, translating into more than 45,000 extremely obese children in this cohort. The percentage of extreme obesity peaked at 10 years in boys and at 12 years in girls. The heaviest children were black teenage girls and Hispanic boys. The percentage of extreme obesity was lowest in Asian-Pacific Islanders and non-Hispanic white children.

According to the recent CDC recommendations, extreme obesity is defined as more than 1.2 times the 95th percentile, or a body mass index (BMI) of more than 35 kilograms/meter squared. Obesity is defined as more than the 95th percentile or a BMI of more than 30 kg/m(2). Overweight is defined as more than the 85th percentile or a BMI of more than 25 kg/m(2). The BMI is a reliable indicator of body fatness and calculated based on height and weight. For children, BMI percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age.

“Our focus and concern is all about health and not about appearance. Children who are morbidly obese can do anything they want — they can be judges, lawyers, doctors — but the one thing they cannot be is healthy,” said study co-author Amy Porter, MD, a Kaiser Permanente Baldwin Park pediatrician who leads the Pediatric Weight Management Initiative for Kaiser Permanente’s Southern California Region.

“The most important advice to parents of extremely obese children is that this has to be addressed as a family issue. There is rarely one extremely obese kid in a house where everyone else is extremely healthy. It’s important that everyone in the family is invested in achieving a healthier lifestyle,” Porter said.

“This publication is only the beginning. Now we are trying to quantify the health risks and long-term effects associated with extreme obesity, determine which groups are affected most, and develop strategies for population care management to reduce these health risks. Children’s health is important and we have a long way to go,” Koebnick said.
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In an editorial on bmj.com today, experts are demanding further funding to establish appropriate infection control guidelines to deal with the growing number of acupuncture-transmitted diseases.

The number of reported cases is described as “the tip of the iceberg” by Professor Patrick Woo and colleagues from the University of Hong Kong.

Acupuncture is one of the most widely practiced strands of alternative medicine. It is based on the theory that inserting and manipulating fine needles at specific points in the body helps to promote the flow of Qi or energy.

Professor Woo is the lead author. He argues that acupuncture may pose risks to patients as needles are inserted up to several centimeters beneath the skin.

Most patients recover from infections. However, Professor Woo explains that 5 to 10 percent of the reported pyogenic bacterial infections end up with serious problems including:

• joint destruction
• multi-organ failure
• flesh eating disease
• paralysis

Most infections caused are bacterial. But Woo comments there have been outbreaks of hepatitis B, and perhaps cases of hepatitis C and HIV that are believed to have been transmitted via acupuncture.

He comments that in the 21st century a new clinical syndrome has emerged, known as acupuncture mycobacteriosis. This is an infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period but the infection usually leads to large abscesses and ulcers.

The authors say in closing that “to prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques. Stricter regulation and accreditation requirements are also needed.”

“Acupuncture transmitted infections: the tip of the iceberg of a global emerging problem”

M. D. Anderson Cancer Center are encouraging men and women to learn more about colon polyps and how they affect a person’s risks for cancer.

“Finding out you have colon polyps doesn’t have to be frightening,” said Gottumukkala S. Raju, M.D., professor in the Department of Gastroenterology, Hepatology and Nutrition at M. D. Anderson. “Most colon polyps are not cancer. Yet, certain kinds of polyps may make you more likely to develop colon cancer.”

The colon is part of the large intestine. A colon polyp is a growth on the inside lining of the colon. A doctor looks for polyps during a colonoscopy.

Learn your polyp type

Polyps come in different shapes and sizes. Some are:

– Raised on stems like mushrooms

– Found on the surface of the colon, like a mushroom without a stalk

– Found flat on the surface of the colon, like a pancake

When a doctor removes a polyp during a colonoscopy, he or she sends it to a pathologist for examination under a microscope. The pathologist determines if the polyp is a:

– Hyperplastic polyp, which is not cancer

– Adenomatous polyp, which is not cancer but can become cancer if it’s not removed

– Malignant polyp, which is cancer

“It’s important for you to know all about the polyps your doctor found during your last colonoscopy,” Raju said.

According to a study recently completed by an LSU group charged with conducting studies on improving hurricane crisis communication in coastal communities, many families have a well-developed hurricane response plan of their own but have little faith in the preparation developed at higher government levels.

Titled “Hurricanes, Institutional Procedures, and Information Processing, or HIPIP: Engagement with Decision-Makers and Coastal Residents,” the project contains two distinct studies on the topic, both designed to create more effective hurricane communication among forecasters, government officials, media representatives and ultimately the public.

“Clearly, the perceived inadequacy of the federal response to Katrina still lingers in the minds of many residents,” said David Brown, HPIP investigator and assistant professor in LSU’s Department of Geography and Anthropology.

The telephone survey of more than 500 southeastern Louisiana residents was conducted by LSU’s Public Policy Research Lab, or PPRL, in October and November of 2009 found 57 percent of those surveyed believe their town or parish has a well-developed plan; 62 percent believe the state does; but only 30 percent believe the federal government has one.

The good news is that a substantial number of residents, 80 percent, have a well-developed plan for hurricane season of their own.

“It is encouraging that the vast majority of respondents have some kind of hurricane plan,” said Brown. “This demonstrates recognition that hurricane preparation needs to be taken seriously at the household level.”

Sixty percent of the respondents also believe that the hurricane protection systems such as levees, warning systems and pumps are better than before Katrina, while 20 percent of the respondents have “no confidence” in them and believe they offer “no protection” to Louisiana.

Obesity and alcohol act together to increase the risk of liver disease in both men and women according to two studies published on bmj.com today. These findings have significant clinical and public health implications.

In the UK, rates of liver disease and obesity are increasing. Alcohol is a major cause of liver cirrhosis. In addition, recent evidence indicates that excess body weight may also play a role.

Researchers from the University of Oxford examined in the first study the link between body mass index (BMI) and liver cirrhosis. A total of 1.2 million middle-aged UK women took part in the Million Women Study.

Each participant was monitored for an average of 6.2 years. Risks were modified according to age, alcohol consumption, smoking, socioeconomic status and physical activity.

Women who were overweight or obese had an increased relative risk of liver cirrhosis compared to women of a healthy weight. This relative risk did not differ considerably by alcohol consumption, but the absolute risk did.

For instance, among women who reported drinking an average of about a third to half a drink a day, 0.8 in 1,000 will be admitted to hospital with, or will die from, liver cirrhosis over five years if they are of healthy weight. This compares with 1 in 1,000 women who are obese.

However, among women who reported drinking an average of two and a half drinks a day, 2.7 in 1,000 will be admitted to hospital with or will die from liver cirrhosis over five years if they are of healthy weight. This compares with 5 in 1,000 women who are obese.

Researchers from the Universities of Glasgow and Bristol investigated in the second study the joint effects of BMI and alcohol consumption on liver disease in more than 9,000 men in Scotland. Participants were monitored for an average of 29 years.

Both factors were related to liver disease. Significantly, the combination of high BMI and alcohol consumption was greater than the additive effect of the two separate factors.

For instance, obese men who reported drinking 15 or more units per week had the greatest risk of liver disease: almost 19 times higher than underweight or normal weight non-drinkers. The researchers observe that lower, BMI specific “safe” limits of alcohol consumption may need to be defined for people who are overweight. They explain that in addition preventive efforts are required to limit the affordability and availability of alcohol and to increase physical activity.

From a public health standpoint, both studies conclude that strategies to reduce both excessive alcohol consumption and excessive body weight should result in a decline in the prevalence of liver disease.

In an associated editorial, Professor Christopher Byrne at the University of Southampton and Dr Sarah Wild from the University of Edinburgh comment that upcoming research must center on improved diagnosis and treatment of non-alcoholic fatty liver disease. This is a build-up of fat in the liver caused by obesity, high alcohol intake and diabetes and which can lead to cirrhosis.

They write that, for now, the old proverb of “prevention is better than cure” remains relevant. “Reducing alcohol consumption and obesity are, at present, our only weapons against non-viral liver disease. The progression of non-alcoholic fatty liver disease to end stage liver disease can now be added to the list of the undesirable consequences of modern lifestyles.”

“Body mass index and risk of liver cirrhosis in middle aged women in UK: prospective study”

Daylight Savings Time can be hazardous for your health.

On average, people go to work or school on the first Monday of Daylight Savings after sleeping 40 fewer minutes than normal. And recent studies have found there’s a higher risk of heart attacks, traffic accidents and workplace injuries on the first Monday of Daylight Savings.

“Many people already are chronically sleep-deprived, and Daylight Savings Time can make them even more tired for a few days,” said Dr. Nidhi Undevia, medical director of the Sleep Program at Loyola University Health System.

Undevia offers these tips for getting enough sleep after moving the clock forward an hour:

– In the days before the time change, go to bed and wake up 10 or 15 minutes earlier each day.

– Don’t nap on the Saturday before the time change.

– To help reset your internal body clock, expose yourself to sunlight in the morning as early as you can.

Loyola offers a comprehensive and multidisciplinary program to help identify and treat sleep disorders. The sleep laboratory and sleep clinic diagnose and treat a full range of sleep disorders, including insomnia, sleep walking, obstructive sleep apnea, narcolepsy, circadian rhythm disorders, restless legs syndrome and periodic limb movement disorders.

Two articles published Online First in The Lancet report that community support groups can reduce neonatal mortality. In addition, they can lower rates of maternal depression, provided that the population coverage is wide enough and the programs are suitably designed.

In trials in Nepal, participatory women’s groups have shown promise. Neonatal mortality was reduced by about one-third. Two research teams undertook to test this approach further. They carried out cluster-randomized controlled trials that were led by Anthony Costello, University College London Centre for International Health and Development, Institute of Child Health, London, UK.

Prasanta Tripathy, Ekjut, Chakradharpur, Jharkand, India and colleagues explain their work in the first article. They assigned clusters in a population of 228,186 people in Jharkand and Orissa in eastern India to either participating in women’s groups focusing on the reduction of maternal and newborn health problems, or not. A total of 19,030 births were monitored over 3 years. They found that neonatal mortality was 32 percent lower overall. It was 45 percent lower in years 2 and 3 for women who had been living in areas where women’s groups existed than for those who had not. Moderate maternal depression had fallen by 57 percent by the third year.

The authors explain: “Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices.”

They write in conclusion: “Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.”

Professor Kishwar Azad, Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh and colleagues describe their work in a second article. They monitored neonatal mortality for 36,113 births over 3 years in a population of 503,163. As with Tripathy et al’s study, the study population was divided into clusters. Some of which were assigned to support from women’s groups. Findings indicate that the community support made no difference to neonatal mortality rates.

They comment: “For participatory women’s groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.”

They note: “Women’s groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women’s group approach requires adequate human resources support for community mobilisation and appropriate coverage.”

“Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial”