Noteworthy Health

App for Bipolar Disorder Being Tested

MONDAY, May 12, 2014 (HealthDay News) -- A smartphone app that uses voice analysis to detect mood changes in people with bipolar disorder is being tested by researchers.

Bipolar disorder is a mental illness that causes extreme emotional highs and lows. It affects millions of people worldwide and can have serious consequences, including suicide.

The app showed promise in early tests with a small group of patients, according to a University of Michigan research team, and if further testing confirms its usefulness, the app could be used to detect subtle voice changes that give an early warning about mood changes to people with bipolar disorder and their health care providers.

The app automatically analyzes users' voices during smartphone calls and does so without infringing on anyone's privacy, according to the team.

"These pilot study results give us preliminary proof of the concept that we can detect mood states in regular phone calls by analyzing broad features and properties of speech, without violating the privacy of those conversations," study co-leader Zahi Karam, a postdoctoral fellow and specialist in machine learning and speech analysis, said in a university news release.

"As we collect more data the model will become better, and our ultimate goal is to be able to anticipate swings, so that it may be possible to intervene early," Karam added.

"The ability to predict mood changes with sufficient advance time to intervene would be an enormously valuable biomarker for bipolar disorder," study co-leader Dr. Melvin McInnis, a bipolar specialist, said in the news release.

The study, funded by the National Institute of Mental Health and facilitated by the Prechter Bipolar Research Fund at the U-M Depression Center, was scheduled to be presented at last week's International Conference on Acoustics, Speech and Signal Processing in Florence, Italy.

Other health conditions also affect patients' voices, so it may be possible to develop similar smartphone apps for disorders that range from schizophrenia and post-traumatic stress disorder to Parkinson's disease, the researchers noted.

-- Robert Preidt

MedicalNews
Copyright © 2014 HealthDay. All rights reserved.

SOURCE: University of Michigan, news release, May 8, 2014

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App for Bipolar Disorder Being Tested

Car Crash Risk May Go Up During Pregnancy

By Amy Norton
HealthDay Reporter

MONDAY, May 12, 2014 (HealthDay News) -- A woman's risk of having a serious car accident may increase in her second trimester of pregnancy, a large new Canadian study suggests.

Researchers found that compared with the few years before pregnancy, a woman's risk of a traffic accident rose by 42 percent during the second trimester. During the third trimester, the odds dropped again.

Experts said they cannot tell why the pattern exists. But the findings do suggest women should be especially mindful about safe driving when they're pregnant.

"This is not a reason to stop driving," said Dr. Donald Redelmeier, a researcher with the Institute for Clinical Evaluative Sciences in Toronto, who led the study. "It's a reason to drive more carefully," he explained.

"And it doesn't mean you should give the driving responsibilities to your husband," Redelmeier added. Even with a 42 percent increase, he noted, pregnant women's accident rate is lower than that of men their age.

The study, published online May 12 in the journal CMAJ (Canadian Medical Association Journal), is based on records for more than 500,000 Canadian women who gave birth between 2006 and 2011. The researchers looked at the women's rates of serious car accidents -- bad enough for a trip to the ER -- during pregnancy and during the three years before pregnancy.

Before pregnancy, the study found, the crash rate was about 4.5 per 1,000 women each year. The rate was similar during the first trimester of pregnancy, but then rose to almost 7.7 crashes per 1,000 women during the first month of the second trimester. During the third trimester, car accidents dipped again.

According to Redelmeier, the second-trimester jump was seen regardless of women's age or income and education levels. It was also apparent in all seasons of the year.

Still, it's hard to definitely pin the blame on pregnancy itself, according to an emergency medicine physician who was not involved in the research.

Other factors, that could not be measured in the study, might account for the connection, said Dr. Sampson Davis, of Meadowlands Hospital Medical Center in Secaucus, N.J.

It's also unclear why the risk would drop again in the third trimester, Davis added.

Despite the questions, though, he agreed that safe driving should be emphasized during pregnancy. "Normally, obstetricians don't talk to women about driving," Davis said. "I think adding that to prenatal care is important."

According to Redelmeier, there could be something about the second trimester, in particular, that makes women more vulnerable to driving errors. He said the "accumulating physiological changes" of pregnancy, plus stress, might leave women fatigued or otherwise off their driving game.

But because their bodies have not yet gone through the outward changes of later pregnancy, they may be going about all their usual activities -- without realizing their driving skills are less sharp.

That's speculation, though. "We can't get at the mechanisms with this study," Redelmeier said. "But just because we don't know the exact causes doesn't mean we can't prevent these accidents."

The bottom line for pregnant women, he added, is to "always obey speed limits, obey stop signs, yield the right of way, minimize distractions and wear a seatbelt."

Davis agreed, emphasizing the "don't use your cellphone" rule. "And if you're tired and not feeling well one day," he said, "don't drive."

Sometimes, Davis noted, pregnant women worry that wearing a seatbelt across the abdomen could be harmful to the baby. But that's not true, he stressed.

"Wearing a seatbelt protects you if you're in an accident," Davis said. "And that protects the baby, too."

MedicalNews
Copyright © 2014 HealthDay. All rights reserved.

SOURCES: Donald Redelmeier, M.D., researcher, Institute for Clinical Evaluative Sciences, and professor, medicine, University of Toronto, Ontario, Canada; Sampson Davis, M.D., emergency medicine physician, Meadowlands Hospital Medical Center, Secaucus, N.J.; May 12, 2014 CMAJ (Canadian Medical Association Journal), online

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Car Crash Risk May Go Up During Pregnancy

Fitness May Help Older Men With High Blood Pressure Live Longer

MONDAY, May 12, 2014 (HealthDay News) -- Getting more fit might reduce the risk of death for elderly men with high blood pressure, a new study suggests.

Compared to the least-fit men, those who had the highest levels of fitness had nearly half the risk of death. For men in the low-fitness category, the risk of dying was 18 percent lower. And, men in the moderate-fitness category had a 36 percent lower death risk, according to the study.

A moderate "level of fitness is achievable by most elderly individuals engaging in a brisk walk of 20 to 40 minutes, most days of the week," lead author Dr. Charles Faselis, a professor of medicine at George Washington University in Washington, D.C., said in a news release from the journal Hypertension.

Researchers used a standard treadmill test to assess the fitness of more than 2,100 men, 70 and older, with high blood pressure. They were classified as being least-fit, low-fit, moderately-fit or high-fit. The men were followed for an average of nine years.

"For every 100 people who died in the least-fit category, 82 died in the low-fit category, 64 died in the moderate-fit and 52 died from the high-fit category," senior author Peter Kokkinos, a professor at Veterans Affairs Medical Center, Georgetown University School of Medicine and George Washington University School of Medicine and Health Sciences, said in the news release.

"The death rate is cut in half for those in the highest fitness category," he noted.

The study was published on May 12 online in Hypertension. Although the study found an association between a reduced risk of death and greater fitness, it wasn't designed to prove that increased exercise was the definitive cause of the lower death risk.

-- Robert Preidt

MedicalNews
Copyright © 2014 HealthDay. All rights reserved.

SOURCE: Hypertension, news release, May 12, 2014

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Fitness May Help Older Men With High Blood Pressure Live Longer

Stepped-Up Screening Would Uncover More Lung Cancers

But the scans and follow-up care would be expensive

WebMD News from HealthDay

Findings suggest lung cancer develops through

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, May 14, 2014 (HealthDay News) -- New screening guidelines for lung cancer could save tens of thousands of lives, but the CT scans involved will be costly, a new study has found.

Projections show that implementing the guidelines will detect nearly 55,000 more lung cancer cases during a five-year period, most of which would be potentially curable early stage cancers.

But, the cost to Medicare for lung cancer screening and subsequent treatment would be $9.3 billion over five years, which amounts to a $3 per month premium increase for every Medicare member.

"If screening is covered, it's important for Medicare and health care systems to plan for increased demand for CT imaging and early stage treatments -- for example, thoracic surgery and radiation therapy," said study lead researcher Joshua Roth. He is a postdoctoral research fellow with the Fred Hutchinson Cancer Research Center, in Seattle.

"Additionally, Medicare should plan for increased expenditure in the budgeting process," Roth added.

These findings add fuel to an ongoing debate regarding the value of using low-dose CT screening to detect lung cancer in smokers. The study was released Wednesday ahead of the annual meeting of the American Society of Clinical Oncology (ASCO), which begins May 30 in Chicago. It will be formally presented at the meeting on June 2.

Two weeks ago, an advisory panel for the U.S. Centers for Medicare and Medicaid Services (CMS) recommended against Medicare picking up the tab for annual low-dose CT lung cancer screening of older current and former smokers.

"You actually had members saying the money would be better spent and you would impact more lives if you spent it on smoking cessation and smoking prevention," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

The CMS panel's decision runs counter to the judgment of the U.S. Preventive Services Task Force, which in 2013 recommended CT lung cancer screening for a very specific segment of smokers. The task force recommended annual low-dose CT scans for current and former smokers aged 55 to 79 with at least a 30 pack-year history of smoking who had their last cigarette sometime within the last 15 years. Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked.

Lung cancer is the leading cause of cancer death in the United States, usually because it has spread to other organs in the body by the time it is detected, Roth said.

The U.S. Preventive Services Task Force based its recommendation primarily on the findings from the National Lung Cancer Screening Trial, which demonstrated a 20 percent reduction of lung cancer deaths with CT screening compared to X-ray screening. CT (computed tomography) screening is an imaging procedure that uses special X-ray equipment to create a series of detailed pictures, or scans, of areas inside the body, according to the U.S. National Cancer Institute.

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Stepped-Up Screening Would Uncover More Lung Cancers, Study Says

Early Repetitive Behaviors May Signal Autism Risk

Research in siblings of children with autism may give parents a way to spot signs of the disorder earlier

WebMD News from HealthDay

Findings may help explain disorder's prevalence

By Amy Norton

HealthDay Reporter

WEDNESDAY, May 14, 2014 (HealthDay News) -- There may be a simple way to help spot signs of autism early on in siblings of children with the disorder, new research suggests.

The study, which included 184 children at high risk of autism, found that those who developed the disorder typically started showing some "red flags" as early as 12 months of age.

Specifically, they had an unusually high rate of repetitive behaviors, such as flapping their hands or arms, rocking back and forth, or focusing obsessively on one toy.

Some amount of repetitive behavior is normal for babies, said lead researcher Jason Wolff, an assistant professor of psychiatry at the University of North Carolina at Chapel Hill.

"But in typically developing children, that usually peaks around the age of 6 months," said Wolff, who is scheduled to present his findings on Saturday at the International Meeting for Autism Research, in Atlanta.

"In children who go on to develop autism, repetitive behavior is still highly prevalent, or even increasing, at the age of 12 months," Wolff said.

Wolff said an advantage of looking at repetitive behaviors is that parents can report on them with a simple "pen-and-pencil measure." And it's possible that such a tool could be used to screen for autism in average-risk children, too, he added.

More research is needed before repetitive behavior can be used as part of an early screening tool, according to Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park, N.Y.

"This is a promising observation, but it needs refinement before it can be turned into something clinically useful," said Adesman, who was not involved in the study.

Wolff agreed. For one, he said, his team wants to fine-tune the way repetitive behavior is measured. And any screening tool would have to not only reliably catch autism, but also have a low risk of "false positives."

"But this study is a good start," Wolff said.

The precise causes of autism are not clear, but genes are involved. When a child has autism, his or her siblings are at high risk themselves -- with a roughly 20 percent chance of developing the disorder, Wolff noted.

And there's a "great need" for ways to spot those children early, he said. In general, Wolff noted, the earlier that speech and behavioral therapies for autism can be started, the better children do in the long run.

But until now, researchers haven't looked at whether repetitive behavior can serve as an early red flag.

"At one time, people thought repetitive behavior didn't really show up until preschool," Wolff said. But recent research, including the current study, has shown that to be untrue.

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Early Repetitive Behaviors May Signal Autism Risk

Could Certain Antidepressants Slow Alzheimer's?

Early study suggests Celexa, and other drugs in its class, might help, but many questions remain

WebMD News from HealthDay

New guidelines address which patients might

By Randy Dotinga

HealthDay Reporter

WEDNESDAY, May 14, 2014 (HealthDay News) -- Preliminary research suggests that the commonly used antidepressant Celexa, and perhaps other drugs in its class, may temporarily lower levels of a protein that clogs the brains of people with Alzheimer's disease.

It's too early to know if the medication -- or the drugs that are similar to it -- could play a role in the prevention of the devastating brain-robbing disease. The authors of the new study only looked at the effects of a large dose of the drug for less than two days, and only healthy younger people took part in the research.

There's another important caveat: Previous efforts to reduce the levels of the protein, known as beta amyloid, haven't helped patients fend off Alzheimer's. And Celexa can cause some potentially serious side effects.

Still, "this is the first step in trying to move toward a preventive treatment," said study author Dr. Yvette Sheline, a professor of psychiatry, radiology and neurology at the University of Pennsylvania Perelman School of Medicine, in Philadelphia. "Up until now, people have been focused on treating Alzheimer's disease itself, but that seems to be happening too late."

An estimated 5 million people in the United States suffer from Alzheimer's disease, and one in three seniors will die while affected by the illness or another form of dementia, according to the Alzheimer's Association.

There's no cure for Alzheimer's, and the existing treatments can only provide relief of symptoms in some cases.

The new study examines the antidepressant Celexa, known by the generic name citalopram. It's one of several antidepressants (including Paxil, Zoloft and Prozac) that are known as selective serotonin reuptake inhibitors (SSRIs).

The researchers report that they were able to use the drug to significantly lower the levels of beta amyloid in older mice that were genetically modified so they'd develop an Alzheimer's-like disease. Beta amyloid is a normal component of the brain, but its levels grow into gunk-like "plaques" in people with Alzheimer's disease.

The study researchers also gave 60-milligram (mg) doses of the drug or an inactive placebo to healthy people aged 21 to 50. They then measured levels of beta amyloid in the spinal fluid of the participants over a 37-hour period.

Production of beta amyloid slowed by 37 percent in the participants who received Celexa, the investigators found.

In the best-case scenario, the drug would reduce levels of the protein before the levels became dangerous and send patients on the road to Alzheimer's later in life, Sheline said.

But there are still many unanswered questions. For one, it's not clear if the drug would have this effect in the long term. Sheline noted that's the next step for research.

"Is that effect sustained for several weeks? We're going to be doing that research in older people aged 65 to 85," Sheline said. "If we show that the effect is maintained, that the beta amyloid stays lowered, then we'd do longer-term studies."

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Could Certain Antidepressants Slow Alzheimer's?

Treatment for atrial fibrillation, a common heart rhythm disorder, will depend on how long you've had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the treatment goals for atrial fibrillation are to:

Reset the rhythm or control the rate
Prevent blood clots

The strategy you and your doctor choose depends on many factors, including whether you have other problems with your heart and if you're able to take medications that can control your heart rhythm.

Doctors may prescribe medications to control your heart rate or to help maintain a normal heart rhythm. In some cases, if medications aren't effective, you may need a more invasive procedure to control your heart rate.

Heart rate control

You may be prescribed medications to control your heart rate and restore it to a normal rate. Heart rate control can be achieved through several medications.

The medication digoxin (Lanoxin) may control heart rate at rest, but not as well during activity. Most people require additional or alternative medications, such as calcium channel blockers or beta blockers.

Beta blockers may cause side effects such as worsening of heart failure and low blood pressure (hypotension). Calcium channel blockers also can cause side effects and may need to be avoided if you have heart failure or low blood pressure.

Maintaining a normal heart rhythm

Your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include:

Dofetilide (Tikosyn)
Flecainide
Propafenone (Rythmol)
Amiodarone (Cordarone, Pacerone)

Although these drugs may help maintain a normal heart rhythm, they can cause side effects, including:

Nausea
Dizziness
Fatigue

Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart's lower chambers. These medications may be needed indefinitely. Even with medications, the chance of another episode of atrial fibrillation is high.

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Medications to control heart rate and heart rhythm in atrial fibrillation

Working during pregnancy: Do's and don'ts

Working during pregnancy isn't always easy. Know how to battle symptoms and stay healthy while getting the job done.
By Mayo Clinic Staff

Most women can continue working during pregnancy. Being pregnant, however, might present challenges at the workplace. To stay healthy and productive on the job, understand how to alleviate common pregnancy discomforts — and know when a work task might jeopardize your pregnancy.

Easing nausea and vomiting

It's called "morning" sickness, but pregnancy queasiness can hit at any time. To ease nausea at work:

Avoid nausea triggers. That double latte you craved every morning before pregnancy or the smell of foods reheated in the break room microwave might now make your stomach flip-flop. Steer clear of anything that triggers nausea.

Snack often. Crackers and other bland foods can be lifesavers when you feel nauseated. Keep a stash at work for easy snacking. Ginger ale or ginger tea might help, too.

Handling fatigue

You might feel tired as your body works overtime to support your pregnancy — and resting during the workday can be tough. It might help to:

Eat foods rich in iron and protein. Fatigue can be a symptom of iron deficiency anemia, but adjusting your diet can help. Choose foods such as red meat, poultry, seafood, leafy green vegetables, iron-fortified whole-grain cereal and beans.

Take short, frequent breaks. Getting up and moving around for a few minutes can reinvigorate you. Spending a few minutes with the lights off, your eyes closed and your feet up also can help you recharge.

Drink plenty of fluids. Keep a water bottle at your desk or in your work area and sip throughout the day.

Cut back on activities. Scaling back can help you get more rest when your workday ends. Consider doing your shopping online or hiring someone to clean the house or take care of the yard.

Keep up your fitness routine. Although exercise might be the last thing on your mind at the end of a long day, physical activity can help boost your energy level — especially if you sit at a desk all day. Take a walk after work or join a prenatal fitness class, as long as your health care provider says it's OK.

Go to bed early. Aim for seven to nine hours of sleep every night. Resting on your left side will maximize blood flow to your baby and ease swelling. For added comfort, place pillows between your legs and under your belly.

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Working during pregnancy: Do's and don'ts

End of life: Caring for a dying loved one

Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life.
By Mayo Clinic Staff

Caring for a dying loved one isn't easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one's comfort — can help.

Choosing where to die

Your loved one might have choices for end-of-life care. Options might include:

Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well.

Inpatient care. Some people might prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility.Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments.

When you discuss the options with your loved one, consider his or her preferences as well as special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one's health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life.

Spirituality at the end of life

As your loved one approaches the end of life, he or she might talk about spirituality or the meaning of life. Don't force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences or most meaningful moments. You might want to invite a spiritual leader to visit your loved one as well.

Saying goodbye

You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This might stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone.

Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.

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End of life: Caring for a dying loved one

Hospital Workers Who Treated MERS Patient Fall Ill

Testing for the potentially fatal respiratory infection is underway, officials say

WebMD News from HealthDay

Patient had recently been in Saudi Arabia,

By Steven Reinberg and Dennis Thompson

HealthDay Reporters

TUESDAY, May 13, 2014 (HealthDay News) -- Two Florida hospital workers who helped treat a man with the second diagnosed case of MERS in the United States have developed respiratory symptoms, according to published reports.

The workers are being tested to see if they may have caught the potentially fatal virus from the man, hospital officials said.

One of the cases probably isn't MERS because the worker started experiencing symptoms just one day after treating the 44-year-old patient. The incubation period for MERS is typically five days, NBC News reported Tuesday.

"We want to be extra cautious," said Dr. Antonio Crespo, infectious disease specialist and chief quality officer for the P. Phillips Hospital in Orlando. "These two people were in contact with the patient without a mask."

One of the staffers was sent home after treatment. The other one is in a special isolation room at the hospital, as is the MERS patient, NBC News reported.

The MERS virus first surfaced in the Middle East two years ago, and the vast majority of cases have been reported in that region of the world.

News of the second U.S. case of MERS was announced Monday by federal health officials.

Like the first U.S. case identified earlier this month, the second case involved a health care provider who lived and worked in Saudi Arabia, the epicenter of the MERS outbreak. The second patient -- an unidentified man -- was being treated at the Orlando hospital and was said to be doing well.

The health risk to the general public is very low, federal officials said Monday, because the virus is only passed through close contact.

The second patient worked in a facility in Saudi Arabia that cared for MERS patients. The patient was visiting family in central Florida before entering the hospital. The patient had traveled from Saudi Arabia to London to Boston to Atlanta, before reaching Florida, officials said.

The patient felt unwell on a May 1 flight to London, but sought care in Orlando. The U.S. Centers for Disease Control and Prevention said it has notified all passengers on the affected flights to be on the lookout for symptoms.

MERS symptoms typically include shortness of breath, coughing and fever.

However, Dr. Anne Schuchat, director of the U.S. National Center for Immunization and Respiratory Diseases, said Monday that it is "likely that if you have not already developed symptoms you are not likely to."

CDC Director Dr. Tom Frieden said his agency was contacting the airlines on which the patient traveled, but the risk to people traveling with a person infected with MERS is unknown.

CDC officials cautioned that while the patient felt the symptoms of the MERS virus while traveling from Saudi Arabia, it wasn't clear if the patient was infectious at that time.

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2 Florida Hospital Workers Who Treated MERS Patient Fall Ill