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Monthly Archives: January 2017

Walking Can Helps Your Heart and Brain

Regular aerobic exercise such as walking may protect the memory center in the brain, while stretching exercise may cause the center — called the hippocampus — to shrink, researchers reported.

In a randomized study involving men and women in their mid-60s, walking three times a week for a year led to increases in the volume of the hippocampus, which plays an important role in memory, according to Dr. Arthur Kramer, of the University of Illinois Urbana-Champaign in Urbana, Ill., and colleagues.

On the other hand, control participants who took stretching classes saw drops in the volume of the hippocampus, Kramer and colleagues reported online in theProceedings of the National Academy of Sciences.

The findings suggest that it’s possible to overcome the age-related decline in hippocampal volume with only moderate exercise, Kramer told MedPage Today, leading to better fitness and perhaps to better spatial memory. “I don’t see a down side to it,” he said.

The volume of the hippocampus is known to fall with age by between 1 percent and 2 percent a year, the researchers noted, leading to impaired memory and increased risk for dementia.

But animal research suggests that exercise reduces the loss of volume and preserves memory, they added.

To test the effect on humans, they enrolled 120 men and women in their mid-sixties and randomly assigned 60 of them to a program of aerobic walking three times a week for a year. The remaining 60 were given stretch classes three times a week and served as a control group.

Their fitness and memory were tested before the intervention, again after six months, and for a last time after a year. Magnetic resonance images of their brains were taken at the same times in order to measure the effect on the hippocampal volume.

The study showed that overall the walkers had a 2 percent increase in the volume of the hippocampus, compared with an average loss of about 1.4% in the control participants.

The researchers also found, improvements in fitness, measured by exercise testing on a treadmill, were significantly associated with increases in the volume of the hippocampus.

On the other hand, the study fell short of demonstrating a group effect on memory – both groups showed significant improvements both in accuracy and speed on a standard test. The apparent lack of effect, Kramer told MedPage Today, is probably a statistical artifact that results from large individual differences within the groups.

Analyses showed that that higher aerobic fitness levels at baseline and after the one-year intervention were associated with better spatial memory performance, the researchers reported.

But change in aerobic fitness was not related to improvements in memory for either the entire sample or either group separately, they found.

On the other hand, larger hippocampi at baseline and after the intervention were associated with better memory performance, they reported.

The results “clearly indicate that aerobic exercise is neuroprotective and that starting an exercise regimen later in life is not futile for either enhancing cognition or augmenting brain volume,” the researchers argued.

The study was supported by the National Institute on Aging, the Pittsburgh Claude D. Pepper Older Americans Independence Center, and the University of Pittsburgh Alzheimer’s Disease Research Center. The authors said they had no conflicts.

Imported Jewelry Can Pose Danger

Foreign-made jewelry is a potential source of lead exposure, according to public health officials.

A 1-year-old boy living in New York City had a rapid increase in blood lead levels, and the likely source of the exposure was traced to a Cambodian amulet made from knotted string and metallic beads, according to researchers from the NYC Department of Health and Mental Hygiene and the CDC.

Testing revealed that the beads contained 45 percent lead, the researchers reported in Jan. 28 issue of Morbidity and Mortality Weekly Report.

The boy had worn the amulet — “something to protect him,” his father said — since he was 3 months old, and had been seen putting it in his mouth.

“Healthcare providers and public health workers should consider traditional customs when seeking sources of lead exposure in Southeast Asian populations,” the authors wrote.

Healthcare professionals should ask parents — particularly from Southeast Asian families — about the use of amulets, they added, noting that educational efforts about the risk of lead poisoning from jewelry are needed for immigrant families.

An accompanying editorial note pointed out that the CDC recommends blood lead testing for internationally adopted and refugee children and that the New York City health department recommends testing all children with recent travel to foreign countries.

Although the most common source of lead exposure in young children is paint, other sources have been increasingly identified.

That is particularly true in immigrant communities because of the use of lead-containing products from their country of origin, such as spices, food, candy, cosmetics, health remedies, ceramics or pottery, and jewelry.

For the case of the 1-year-old boy, routine lead testing showed an elevated blood lead level of 10 micrograms/dL.

According to the National Institutes of Health lead concentrations in blood should be less than 10 micrograms/dL in children and less than 20 micrograms/dL in adults.

Because he lived in a household with a cousin who had had lead poisoning, he had also been tested at 6 months. His blood lead level was just 1 microgram/dL then.

A risk assessor from the Environmental Protection Agency visited the home to look for potential sources of the lead exposure. The boy’s father denied using any imported products, and the assessor failed to find any potential sources of exposure.

Three months later, the boy’s blood level doubled to 20 micrograms/dL.

The boy’s father again denied that the child wore jewelry or charms, but eventually admitted that the child had worn an amulet acquired at a Cambodian market since he was 3 months old.

A second home inspection identified one area of paint with an elevated lead level, as well as imported spices and rice. Testing revealed that the food products did not have elevated lead content.

Within eight days of the amulet being removed from the home, the boy’s blood lead level decreased to 14 micrograms/dL.

About five weeks later — after the lead paint was reported to be removed — the boy’s blood lead level was 10 micrograms/dL, and five months after the amulet was removed, the level was down to 5 micrograms/dL.

“Although other factors might have contributed to the child’s overall lead burden,” the researchers wrote, “the most likely source identified was the amulet, based on its high lead content, statements that the child had been observed mouthing it, and the rapid decrease in the child’s blood lead level after its removal.”

Common Complication Delays Giffords’ Recovery

An accumulation of fluid in the brain, a condition called posttraumatic hydrocephalus, has delayed U.S. Rep. Gabrielle Giffords’ transfer to an inpatient rehabilitation facility.

Although the Arizona congresswoman was transferred last Friday to Memorial Hermann healthcare system in Houston, where she was scheduled to enter The Institute for Rehabilitation and Research (TIRR), she was admitted instead to the hospital’s neurological intensive care unit.

One of the doctors involved in her care in Houston, trauma surgeon John Holcomb, MD, said that a drain had been inserted to release a buildup of fluid. Until that drain is removed or a permanent shunt is implanted, Giffords must remain in the neuro ICU.

Reid Thompson, MD, chairman of neurological surgery at Vanderbilt University in Nashville, said in an e-mail to ABC News and MedPage Today that fluid buildup is a very common problem in neurosurgery.

“In the setting of a gunshot wound, and recent surgery, it would not be unusual to build up fluid and possibly have fluid leak out — raising the risk for an infection (meningitis),” wrote Thompson, who is not involved in Giffords’ care.

The timing of the drain placement, he said, suggests that Giffords has developed a fluid leak either from inflammation in the brain or an infection.

“This creates a plumbing problem as fluid can no longer circulate out,” he wrote.

According to a Houston Chronicle story, Holcomb said over the weekend that the fluid does not appear to be infected.

If the fluid buildup does not resolve within about two weeks, Thompson explained, the drain — a potential source of infection — would have to be replaced with a permanent shunt, which would divert spinal fluid from the ventricles of the brain to the abdomen, where it is absorbed.

“I don’t see it as a setback,” Thompson wrote in his e-mail. “Rather it is part of the process from her original injury. It will, however, keep her from progressing to a rehab environment quickly.”

Although Giffords’ transfer to the dedicated rehabilitation hospital has been delayed for an indeterminate amount of time, she will continue rehab in the ICU.

Another member of the medical team responsible for her care, neurosurgeon Dong Kim, MD, said the congresswoman “looked spectacular” when she arrived in Houston from University Medical Center in Tucson, Ariz., where she’d been cared for since being shot in the head at a public event on Jan. 8.

Kim said Giffords was alert, interactive, awake, calm, and comfortable.

He added that she had very good movement on the left side of her body and did not like it when doctors shined light in her eyes, both of which are considered good signs.

Kim noted that Giffords did not have much tone in her right arm and that over a period of about 30 minutes, she did not move it. The medical team in Tucson had reported seeing her move her right arm.

Overall, Kim said he expects Giffords to do “remarkably well,” adding that the entire process, including ICU care and inpatient and outpatient rehabilitation, will probably last four to six months, regardless of how quickly she recovers.

Although her doctors are optimistic, several physicians contacted by ABC News andMedPage Today cautioned that Giffords’ future function remains uncertain.

“Sadly, this is where the long-term reality of brain injury starts to hit home,” Gregory O’Shanick, MD, medical director of the Center for Neurorehabilitation Services in Richmond, Va., wrote in an e-mail.

“As she increases her efforts towards becoming more independent with rehabilitation,” he wrote, “the deficits will become ever more apparent and frustrating since there is no surgery, no single medication, and no artificial prosthesis to reverse the injury she sustained.”

Other physicians thought it unlikely that Giffords would recover without some physical or cognitive deficits.

“I think it would be too early to ask such a question without further testing, but the reality is, most people with this type of injury usually cannot return to their previous level of functioning, especially if it was at a high level,” wrote Inam Kureshi, MD, director of the head injury program at Hartford Hospital in Connecticut.

A statement from Memorial Hermann said the next update on Giffords’ condition will be provided when she is transferred to the rehabilitation facility.

Federal Judge Strikes Down Health Reform Law

A federal judge ruled Monday that the new U.S. health-care reform law is unconstitutional, saying the federal government has no authority to require citizens to buy health insurance.

That provision is a cornerstone of the new legislation, signed into law in March by President Barack Obama.

The judge’s decision was not unexpected, and both supports and opponents of the legislation anticipate the validity of the new health law ultimately will be decided by the U.S. Supreme Court.

The ruling was handed down by U.S. District Judge Henry E. Hudson, a Republican appointed by President George W. Bush who had seemed sympathetic to the state of Virginia’s case when oral arguments were heard in October, the Associated Press reported.

Last week, White House officials said a negative ruling would not affect the implementation of the law because its major provisions don’t take effect until 2014, the AP reported.

Virginia Attorney General Kenneth Cuccinelli, a Republican, had filed a lawsuit in defense of a new Virginia law barring the federal government from requiring state residents to buy health insurance. He argued that it is unconstitutional for the federal law to force citizens to buy health insurance and to assess a penalty if they don’t.

The U.S. Justice Department said the insurance mandate falls within the scope of the federal government’s authority under the Commerce Clause. But Cuccinelli said deciding not to buy insurance is an economic matter outside the government’s domain.

By 2019, the law will expand health insurance access to 94 percent of non-elderly Americans. Advocates say that between now and then, it will also provide Americans with many new rights and protections.

Key provisions include:

  • Health plans may no longer deny coverage to people based on pre-existing health conditions.
  • Health plans that cover dependents must permit children to stay on a parent’s family policy until age 26.
  • Insurers may no longer place lifetime dollar limits on essential benefits.
  • New health plans must offer preventive services such as mammogramsand colon cancer screenings without charging a deductible, co-payment or coinsurance. (This provision does not apply to existing plans that are “grandfathered.”)