Levitra Vs Sildenafil

Morticians who use formaldehyde to embalm bodies have a higher risk of leukemia, researchers reported on Friday.

They found deaths from one particular kind of leukemia, myeloid leukemia, increased the longer the workers were involved with embalming.

Their study of more than 400 funeral workers is the first to look carefully at the association, they reported in the Journal of the National Cancer Institute.

“Previous studies have shown excess mortality from lymphohematopoietic malignancies and brain cancer in anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde,” Laura Freeman of the U.S. National Cancer Institute and colleagues wrote.

They studied 168 professionals who died of various forms of leukemia, 48 who died of brain tumors and compared them to 265 funeral workers who died of something else.

The people who spent more years embalming bodies or were otherwise exposed to embalming fluid were more likely to have died from a myeloid leukemia, the researchers found.

“In recent decades, more than 2 million U.S. workers are exposed to formaldehyde, including anatomists, pathologists, and professionals who are employed in the funeral industry and who handle bodies or biological specimens preserved with formaldehyde,” they wrote.

Their study could help explain a known higher risk of death among these professionals, they said.

Diet and exercise can keep diabetes at bay for a decade, cutting the risk for the disease by more than a third in the most susceptible people, a new study finds.

About 11 percent of U.S. adults (24 million) have diabetes, mostly type 2, which is linked to poor diet and sedentary lifestyle. In addition, 57 million overweight adults have higher-than-normal blood sugar levels, which raise the risk of a heart attack or stroke and the likelihood of developing type 2 diabetes, researchers say.

But new research, published in the Oct. 29 online edition of The Lancet, shows that losing weight and exercising can delay or prevent the onset of diabetes more effectively than the prescription drug metformin or a placebo.

“Interventions that result in weight loss lower the risk of diabetes, and that lower risk appears to persist for a long period of time,” said study author Dr. William C. Knowler of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

For people who are at high risk of getting diabetes, losing weight “is clearly to be recommended,” he said. In addition, using a drug like metformin may also benefit people unable to lose weight through exercise and diet alone, he said.

For the diabetes prevention study, 3,234 overweight or obese adults with elevated blood sugar levels were randomly assigned to either lifestyle changes or metformin to control their blood sugar, or a placebo.

After 10 years, 2,766 remained in the trial, and those taking metformin saw an 18 percent reduction in their rate of developing diabetes, compared with those on placebo.

But those who had made lifestyle changes — reducing caloric and fat intake and exercising at least 150 minutes a week — reduced their risk of getting diabetes by 34 percent compared with those on placebo, the researchers found.

In the first year of the trial, people in the lifestyle group lost an average of 15 pounds, regaining all but about five pounds over 10 years. People on metformin maintained a five-pound weight loss, and those on placebo lost less than two pounds over 10 years, the researchers note.

Over 10 years, after all the participants made lifestyle changes, the yearly diabetes incidence rates for the drug and placebo groups had dropped to about 5 to 6 percent, the same rate as the lifestyle group.

“Lifestyle intervention, even when provided later, also seemed to lower diabetes incidence rate,” Knowler said.

But losing weight is difficult, and simply telling someone to slim down won’t work, he acknowledges.

“To make things like this happen on a large scale, we have to do more than simply tell people to lose weight,” he said. People need access to weight loss clinics that can teach them about diet and exercise, he added.

Dr. Anoop Misra, director of the department of diabetes and metabolic diseases at Fortis Hospitals in India, and author of an accompanying journal editorial, said that “prevention of diabetes is important to curb epidemic of diabetes globally. Diet and exercise remain the most important modalities to prevent diabetes, and any drugs are less important.”

At-risk groups of diabetes need to be identified, especially certain ethnic groups, and taught proper lifestyle management strategies, Misra said. “Young adults with family history of diabetes should be carefully managed along the same lines,” he said.

Diabetes prevention makes economic sense as well, by decreasing costly, lifelong expenditures on management of the disease and its complications, Misra said.

All nations, particularly developing countries, seeing a rapid rise in diabetes should devise or strengthen a national diabetes-control program to help curb the epidemic, he said.

“In particular, regulations should apply for advertisement and sale of energy-dense junk food to children, and regular physical activity should be encouraged starting at a young age. Spreading awareness about proper lifestyle and adverse consequences of obesity and diabetes should be at the top of health agenda of all nations,” Misra said.

Regarding the study findings, other experts are optimistic. Dr. Ronald Goldberg, a professor of medicine at the Diabetes Research Institute of the University of Miami Miller School of Medicine, whose institution participated in the study, said that “seeing quite significant effects lasting this long really bodes well for the utility of these interventions for diabetes prevention.”

Cutting calories and increasing physical activity clearly slow the progression to diabetes, Goldberg said. “Lifestyle works, and every effort needs to be made to begin and maintain a lifestyle program in the long-term.”

If you’ve had a heart attack, you may be at risk for another one unless you make some major lifestyle changes.

The American Academy of Family Physicians says the following risk factors increase your risk of having a subsequent heart attack:
Lack of exercise
Excessive alcohol consumption
Being overweight
Having high cholesterol or high blood pressure
Uncontrolled diabetes
Smoking
Too much stress

People with systemic lupus erythematosus (SLE) have a more than twofold increased risk of cardiovascular disease, according to a new study.

Lupus is a chronic “autoimmune” disease in which the immune system confuses its own healthy tissues with foreign tissues and sometimes attacks both. The condition can manifest as a skin rash or arthritis and may lead to damage to the kidneys, heart, lungs and brain to varying degrees. The disorder disproportionately affects women.

“Despite improved life expectancy in the past few decades,” increased heart-related illness and death among people with lupus has been documented in several studies, Dr. A. Elisabeth Hak, from Erasmus MC University Medical Center, Rotterdam, the Netherlands, and colleagues note in the journal Arthritis Care and Research.

Hak’s team examined ties between lupus and cardiovascular disease among women participating in the Nurses’ Health Study. A total of 119,332 women who were free of cardiovascular disease and lupus in 1976 were included in the study and were followed until 2004.

Over 28 years of follow-up, there were 8,169 cardiovascular “events,” such as heart attack, stroke. Lupus was confirmed in 148 women and 20 of these women experienced a cardiovascular event.

After allowing for multiple factors, having lupus was associated with a 2.26-fold increased risk of suffering a cardiovascular event.

The investigators point out that the increased risk of cardiovascular disease in lupus patients is probably caused by a combination of factors. While traditional cardiovascular disease risk factors are more prevalent in people with lupus, this does not fully explain the risk. It is unclear whether lupus itself or its treatment increases the risk.

The way to reduce the chances of developing dementia such as Alzheimer’s disease after a stroke is to prevent a second stroke by concentrating on all the known stroke risk factors, a new British study suggests.

Two major findings emerged from an analysis of 30 previous studies that involved more than 7,500 people who had suffered a stroke, said Dr. Sarah Pendlebury, a senior clinical fellow at the Stroke Prevention Research Unit of John Radcliffe Hospital in Oxford and lead author of a report published online Sept. 23 in The Lancet Neurology.

“First, there is a clear relationship between having multiple strokes and the risk of dementia,” Pendlebury said. “If someone has multiple strokes at the same time, that person has a strong risk of becoming demented in the first month.”

“Second, the data suggest that the presence of complications after stroke — such as hypertension [high blood pressure], low oxygen saturation, cardiac events and seizures — also increases the risk of developing dementia.”

Because of this, Pendlebury said, the focus of stroke treatment units should be on all the risk factors for stroke. “So, to prevent worsening of damage to the brain, the patient must be maintained in as stable a condition as is possible,” she said. “We must prevent either high or low blood pressure and maximize all other secondary prevention measures.”

The study found that dementia rates in the first year after a stroke vary widely, ranging from 7.4 percent in population-based studies of stroke victims who did not previously have dementia to 41.3 percent in hospital-based studies that included people who had signs of dementia before a stroke.

But the study’s conclusion that the risk of dementia was associated with the risk and number of strokes, rather than underlying risk factors for cardiovascular diseases, was contested in an accompanying editorial by Dr. Michael G. Hennerici, chairman of neurology at the University of Heidelberg in Germany.

“This study lumps together several studies that have been performed in the last 30 years,” Hennerici said. “These studies are of very different quality. From these data, they draw the conclusion that stroke per se has a risk of post-stroke dementia. I question this finding because, according to the data, it is not stroke itself but rather an additional neurodegeneration that is ongoing, or additional changes in the brain in combination with stroke, that produces post-stroke dementia.”

Hennerici’s interpretation is that treatment of one major risk factor, hypertension, is essential to prevent both stroke and the underlying deterioration of brain function that leads to dementia.

“Hypertension is the best treatable risk factor for dementia and stroke,” he said. “It should be addressed even in those patients who are not hypertensive but who have other risk factors, such as diabetes and advanced age. The aging population should be carefully treated with hypertensive agents and also should be advised about methods of dealing with other hypertension risk factors, such as reduced salt intake, exercise and lifestyle changes.”

That recommendation drew no argument from Pendlebury. “Yet more aggressive treatment of high blood pressure can help prevent dementia, and also stroke,” she said.

Ductal carcinoma in situ (DCIS), the most common non-invasive lesion of the breast, presents unique challenges for patients and providers largely because the natural course of the untreated disease is not well understood. Because most women diagnosed with DCIS are treated, it is difficult to determine the comparative benefits of different treatment strategies versus active surveillance, meaning systematic follow-up. An independent panel convened by the NIH urged the scientific community to identify appropriate biomarkers and other prognostic factors to better predict the risk of developing breast cancer.

“Instead of treating all women diagnosed with DCIS, we need to determine which individuals are likely to develop invasive breast cancer and which will not,” said Dr. Carmen Allegra, panel chair and Chief of Hematology and Oncology at the University of Florida. “If we could accurately predict this, we might save some women from undergoing unnecessary invasive treatments while achieving the same positive outcomes.”

DCIS is a condition in which a spectrum of abnormal cells are found in the breast duct and have not spread outside the duct to other tissues in the breast. Since the advent of widespread screening mammography in the early to mid 1980’s, rates of DCIS have increased sharply. It is estimated that more than one million U.S. women will be living with a prior diagnosis of DCIS by 2020.

Despite the connotations associated with the term carcinoma, DCIS is associated with ten-year survival rates close to 100% when treated with currently available therapies. These include breast-conserving surgery (local excision, with or without radiation), removal of the breast (mastectomy), and/or tamoxifen. It is important to stress that each of these treatment options has physical and emotional impacts to patients and should be weighed accordingly. The panel recognized that there are relatively few reliable data on the comparative effectiveness of both diagnostic and therapeutic options in DCIS.

To improve our understanding of this complex disease, the panel recommended efforts to ensure detailed collection of clinical, pathological, imaging, and molecular data about DCIS using standardized reporting measures, annotated specimen repositories, and multicenter databases.

The panel emphasized the importance of patient preferences and recommended improved communication between patients and providers, and serious consideration of new nomenclature that more closely reflects the excellent survival rates for this condition.

Efforts to improve communication would also include further development of formal decision aids. Such tools would reduce misinformation and improve understanding of a DCIS diagnosis and the risks and benefits of various treatment options. Individuals who have DCIS should have access to the best possible information and guidance to aid them in making care decisions that reflect their unique circumstances, perspectives, and preferences.

The panel’s updated draft state-of-the-science statement will be available later today at http://consensus.nih.gov. The conference was sponsored by the NIH Office of Medical Applications of Research and the National Cancer Institute along with other NIH and Department of Health and Human Services components. This conference was conducted under the NIH Consensus Development Program, which convenes conferences to assess the available scientific evidence and develop objective statements on controversial medical is sues.

The 14-member conference panel included experts in the fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. A complete listing of the panel members and their institutional affiliations is included in the draft conference statement. Additional materials, including panel bios, photos, and other related resources, are available at http://consensus.nih.gov/2009/dcismedia.htm.

In addition to the material presented at the conference by speakers and the comments of conference participants presented during discussion periods, the panel considered pertinent research from the published literature and the results of a systematic review of the literature. The systematic review was prepared through the Agency for Healthcare Research and Quality Evidence-based Practice Centers (EPC) program, by the Minnesota Evidence-based Practice Center. The EPCs develop evidence reports and technology assessments based on rigorous, comprehensive syntheses and analyses of the scientific literature, emphasizing explicit and detailed documentation of methods, rationale, and assumptions. The evidence report on diagnosis and management of DCIS is available at http://www.ahrq.gov/clinic/tp/dcistp.htm.

The panel’s statement is an independent report and is not a policy statement of the NIH or the federal government. The NIH Consensus Development Program was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. NIH has conducted 119 consensus development conferences, and 32 state-of-the-science (formerly “technology assessment”) conferences, addressing a wide range of issues. A backgrounder on the NIH Consensus Development Program process is available at http://consensus.nih.gov/backgrounder.htm.

A study in mice suggests lack of sleep may play a role in the development of Alzheimer’s disease, U.S. researchers said on Thursday.

The findings, reported in the journal Science, are some of the first to link sleep with the development of Alzheimer’s, the most common form of dementia.

Researchers at Barnes-Jewish Hospital in St. Louis studied levels of amyloid beta — a protein that accumulates in the brain of people with Alzheimer’s — in mice genetically engineered to have a version of Alzheimer’s disease.

Amyloid levels rose in the brain when the mice were awake, and fell when they slept.

When the researchers prevented the mice from sleeping, it made matters worse, said Dr. David Holtzman of Barnes-Jewish Hospital, who worked on the study.

“Sleep deprivation markedly accelerated amyloid-beta plaque formation,” he said in an e-mail.

When the team injected orexin — a compound that regulates sleep — into the brains of the mice, the mice stayed awake longer, and amyloid beta levels rose. And when they blocked orexin, these levels decreased.

In people, orexin plays a role in the sleep disorder narcolepsy, which causes excessive sleepiness.

Holtzman said the findings suggest drugs that target orexin may be useful to try as Alzheimer’s treatments.

They also reinforce the need to treat sleep disorders, not only because they cause immediate problems, but because they may have a long-term impact on brain health, he said.

Despite decades of research, doctors still have few effective weapons against Alzheimer’s, a mind-robbing form of dementia for which there are few effective treatments and no cure. Many treatments that have shown promise in mice have had little effect on humans with Alzheimer’s disease.

More than 35 million people globally will suffer from Alzheimer’s disease or other forms of dementia in 2010, according to the Alzheimer’s Association.

Women with atrial fibrillation are significantly more likely to have a stroke or die than are men with the heart condition, a new study has found.

Despite this, the study suggests, women with the condition receive less medical attention than men.

Atrial fibrillation occurs when the two small upper chambers of the heart, the atria, quiver rather than beat effectively. This can lead to pooling and clotting of blood. If a clot travels from the atria to an artery in the brain, it can cause a stroke.

Rush University Medical Center researchers reviewed past studies and medical literature and found that women with atrial fibrillation are more likely than men to experience symptomatic attacks and have recurrences, and that women have significantly higher heart rates during atrial fibrillation, which increases the risk for stroke.

“Stroke is one of the most devastating results of cardiovascular disease, and atrial fibrillation increases the risk of stroke,” the lead investigator, Dr. Annabelle Volgman, medical director of the Heart Center for Women at Rush University Medical Center, said in a news release from the hospital. “Women are at higher risk of atrial fibrillation-related stroke than men and are more likely to live with stroke-related disability, which can significantly lower quality of life.”

Volgman and her fellow researchers reviewed 20 years of studies that examined gender differences in atrial fibrillation and “were able to determine the most rational, safe and effective gender-specific approach to therapy for women.”

For starters, prevention therapies should be emphasized, the researchers said, as should treatments to ensure safe management once the condition is diagnosed.

Their findings and recommendations related to gender differences included:
Women are not prescribed blood thinners as often as men, resulting in a higher incidence of the formation of clots that break loose and block other vessels. The risk/benefit ratio should be assessed individually for each woman.
Women have a greater risk of bleeding from anticoagulation therapy, so this treatment must be monitored carefully.
Closely monitor women being treated with antiarrhythmic drugs because they have a higher risk for life-threatening arrhythmias and slow heart rates requiring permanent pacing.
Women’s hormonal fluctuations can cause more life-threatening arrhythmias.
Monitor women’s potassium levels in the blood because they have a higher risk of low levels, which boost the risk for drug-related arrhythmias.
Because women have a higher sensitivity to such therapies as statins and vasodilators, liver and kidney function should be closely watched.
Women are referred less often or later for non-drug treatments such as pacemaker implantation or ablation. Ablative therapy should remain an option for symptomatic women because they have success rates similar to those of men.

The study also found that, in general, women with atrial fibrillation have a lower quality of life than men with the disease. But the researchers said that careful assessment and relief of symptoms, and adequate control of heart rate or rhythm can make things better.

“For women with atrial fibrillation, these gender differences should always be kept in mind to help prevent strokes and heart failure and improve their quality of life,” Volgman said.