Too much physical activity may lead to Arthritis

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 30,2009

High levels of physical activity may result in knee damage and eventually arthritis for middle-aged men and women.

MRI showed evidence of knee abnormalities, including cartilage damage and ligament lesions, in active adults with no pain or other symptoms.

Osteoarthritis affects 27 million Americans.

Middle-aged men and women who engage in high levels of physical activity may be unknowingly causing damage to their knees and increasing their risk for osteoarthritis, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

“Our data suggest that people with higher physical activity levels may be at greater risk for developing knee abnormalities and, thus, at higher risk for developing osteoarthritis,” said Christoph Stehling, M.D., research fellow in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF) and radiology resident in the Department of Clinical Radiology, University of Muenster, Germany.

Osteoarthritis is a degenerative joint disease that causes pain, swelling and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the most common form of arthritis and affects an estimated 27 million American adults.

The UCSF study involved 236 asymptomatic participants who had not reported previous knee pain and were enrolled in the National Institutes of Health Osteoarthritis Initiative. Study participants included 136 women and 100 men, age 45 to 55, within a healthy weight range. The participants were separated into low-, middle-, and high-activity groups based on their responses to the Physical Activity Scale for the Elderly (PASE) questionnaire. PASE is a standard test that scores an older individual’s physical activity level, based on the type of activity and the time spent doing it. Several factors contribute to the final PASE score, but a person whose activity level is classified as high typically might engage in several hours of walking, sports or other types of exercise per week, as well as yard work and other household chores.

Subsequent MRI analysis by two musculoskeletal radiologists indicated a relationship between physical activity levels and frequency and severity of knee damage. Specific knee abnormalities identified included meniscal lesions, cartilage lesions, bone marrow edema and ligament lesions. Abnormalities were associated solely with activity levels and were not age or gender specific.

“The prevalence of the knee abnormalities increased with the level of physical activity,” Dr. Stehling said. “In addition, cartilage defects diagnosed in active people were more severe.”

The findings also indicated that some activities carry a greater risk of knee damage over time.

“This study and previous studies by our group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health,” Dr. Stehling said. “Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease.”

Dr. Stehling noted that there is a need for prospective studies to evaluate the influence of low-impact versus high-impact physical activity on disease progression.

Coauthors of the study are Nancy E. Lane, M.D., Michael C. Nevitt, Ph.D., M.P.H., Charles E. McCulloch, Ph.D., and Thomas M. Link, M.D., Ph.D.

Source: Radiological Society of North America (RSNA)


With cold and flu season upon us, it’s more important than ever to employ good practices to control the spread of infections and avoid illness.

“We need to be proactive not only to keep ourselves healthy, but to avoid transmitting illness if we’re sick,” said Eileen Finerty, RN, MS, CIC (certified in infection-control), nursing director for infection control and occupational health at Hospital for Special Surgery (HSS) in Manhattan.

Hospital for Special Surgery has one of the lowest infection rates of any hospital in the country and was recently commended by the New York State Department of Health for its low infection rate in patients undergoing hip replacement. The overall infection rate refers to all infections acquired by patients in the hospital, not only viruses such as those that cause the flu.

Infection control in the health care setting is critical. Nationwide, hospital-acquired infections result in 100,000 deaths each year.

“We emphasize infection control as a best practice,” said Thomas P. Sculco, M.D., surgeon-in-chief at HSS, “and strive to maintain it at every level of patient care from washing hands to a clean and safe environment for our patients in the operating room and the entire hospital.”

HSS employs a combination of infection-control measures, according to Ms. Finerty. Some are highly sophisticated and others are basic good practices.

Strategies used by the hospital to keep germs in check can be adapted for use at home and in everyday life, according to Ms. Finerty. These practices include:

1 – Good hand hygiene using sanitizers.

Hospital: Hand sanitizers located all around the hospital have a sensor that dispenses foam without the need to touch it. The sensor detects hand motion and automatically releases foam.

What everyone can do: Sanitize hands frequently using an alcohol-based liquid hand cleaner. Use about a tablespoon, rub it into your hands and let it dry. Do not wipe it off. Ms. Finerty carries a hand sanitizer in her purse at all times.

2 – Frequent hand-washing.

Hospital: Hospital staff are instructed to wash their hands often. Signs around the hospital say: “Good Hand Hygiene Saves Lives.”

What everyone can do: Wash your hands for at least 15 seconds. You can sing “Happy Birthday” to get an idea of how long it should take. Work up a good lather and rub your hands together.

3 – Good ventilation.

Hospital: Clean air in operating rooms and the use of special panels to direct air flow to maintain the most sterile environment possible for the patient.

What everyone can do: Open the windows and let in some fresh air to ensure adequate ventilation. A stagnant, stuffy environment causes germs to re-circulate around the house.

4 – Controlling the spread of germs.

Hospital: The entire staff is trained in infection-control measures, such as coughing into a tissue and not into one’s hand. Boxes of tissues are located throughout the hospital. Staff are encouraged to stay home if they have a contagious illness.

What everyone can do: Carry tissues and dispose of them properly and immediately after coughing or sneezing. Then wash your hands or use a hand sanitizer. You can also cough into your sleeve to avoid getting germs on your hand that can later be spread.

In general, when you’re outside or at work, or if you have come in contact with a sick person, avoid touching your face. Germs on your hand get you sick when they enter your body through your eyes, nose or mouth, or through a break in the skin. Don’t go to work if you’re sick.

5 – Cleaning and disinfecting.

Hospital: HSS housekeeping staff is especially diligent about cleaning. The routine entails mopping, cleaning, and disinfecting surfaces, getting into cracks and crevices where bacteria can grow.

What everyone can do: Make it a habit to clean and disinfect surfaces, especially in the kitchen and bathroom. Be especially wary about kitchen sponges, which can harbor large amounts of bacteria. “When in doubt, throw it out,” Ms. Finerty advises.

If someone in the household is sick, disinfect high touch personal items like phones and other equipment around the house.

6 – Flu shots.

Hospital: All staff are encouraged to get a flu shot, and the hospital has a high rate of compliance.

What everyone can do: Get a flu shot to lower the possibility of getting sick. It protects you and those around you.

7 – A separate room.

Hospital: Patients who have a contagious infection are given a private room.

What everyone can do: When a family member is sick, keep his belongings separate, give him a separate trash bag for his tissues and dispose of them properly, and maintain a sanitary environment.

If you’re outside and notice someone who looks ill, try to stay at least three feet away from him. An uncovered cough can spray droplets and germs three feet or more into the air.

8 – Diligence and good habits.

Hospital: Signs, staff training and hand sanitizers around the facility remind HSS employees of the importance of proper hygiene.

What everyone can do: Remember to maintain good practices and develop beneficial habits that will help keep you and those around you healthy.

Source: Hospital for Special Surgery


Why some vaccines may require a booster

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 28,2009

Preventing disease is the goal of every health care provider and fortunately every year, new vaccines are being added to assist in disease prevention. But do all vaccines boost immunity for the same period of time? And, if not, when are additional ‘booster shots’ needed to keep immunity strong?

In this month’s issue of Pediatrics, the Journal of the American Academy of Pediatrics, Michael Pichichero MD, Director of the Rochester General Research Institute, based at Rochester General Hospital in Rochester NY, studies the medical necessity for occasional booster shots to sustain immunity.

It is a well known medical fact that a booster shot for tetanus is needed every 10 years to maintain your immunity. But, what happens if you fail to get that booster? “Fortunately, a patient has a window of opportunity to get a booster shot even after getting a dirty wound,” said Dr. Pichichero. “In this case, the booster shot will take hold before the tetanus infection can establish itself. The problem is that this scenario is not true for all diseases.”

In his published study, Dr. Pichichero, an international authority on vaccines and vaccine-induced memory, discusses the effectiveness of booster vaccinations and disease progression. “We found that for slow moving infections like hepatitis, immune memory is activated within plenty of time to prevent the disease after a person has been vaccinated and booster vaccines are not needed” said Dr. Pichichero. “Other examples of vaccines that do not appear to require boosters because the pace of disease progression is slow include: polio, measles, mumps, and German measles.”

Dr. Pichichero Study

The study found, however, that there are several newer vaccines that may require booster shots to remain effective during a lifetime, including vaccines for diphtheria, all three types of spinal meningitis caused by bacteria, and the new vaccine to prevent cervical cancer. “Booster shots are needed in these cases because the disease progression is too fast for the memory response to occur in time,” said Dr. Pichichero.

The study offers several important findings. “Pediatricians and family doctors must begin to anticipate the need to provide booster vaccinations for several of the newer vaccines introduced in recent years,” said Dr. Pichichero. “And, public health agencies, such as the Centers for Disease Control, must begin to consider the cost of booster shots as they calculate the cost-benefit of vaccines. Up to now, cost calculations for the introduction and public payment of meningitis vaccines and the cervical cancer vaccine have not included the need (and cost) of periodic boosters, nor the consequences of missed boosters with disease development later in life.”

While the article has a strong and clear scientific basis, Dr. Pichichero acknowledges that only continued monitoring will determine whether he is correct in his assessment of the need for booster shots for certain diseases. “We do not want to face a diphtheria epidemic in the U.S. as occurred in Russia a decade ago due to lack of boostering of adults,” said Dr. Pichichero.

Dr. Pichichero was a member of the discovery team of the first bacterial spinal meningitis vaccine against Haemophilus influenzae type b, commonly called Hib; and participated in the foundational studies of the second spinal meningitis vaccine against pneumococci called Prevnar; and the third spinal meningitis vaccine against meningococcus called Menactra. He was an early champion for the introduction of safer whooping cough vaccines, called acellular vaccines. He has ongoing support from the National Institutes of Health to study the prospects of an ear, sinus and bronchitis vaccine. He has also received financial support for his research from vaccine companies including GlaxoSmithKline, MedImmune, Sanofipasteur and Wyeth (now Pfizer).

Source: Rochester General Health System


Findings Underscore Urgent Need to Reform CBO Scoring of Preventive Care

The diabetes population in the United States will almost double over the next 25 years and annual medical spending on the disease is projected to hit $336 billion, up from $113 billion today, according to a study published in the December issue of Diabetes Care. The National Changing Diabetes® Program (NCDP), a program of Novo Nordisk, commissioned the analysis by a team from the University of Chicago.

According to the forecast, the number of Americans living with diabetes will rise from 23.7 million in 2009 to 44.1 million in 2034. For the Medicare program, the increases over the next 25 years are even more dramatic: the number of Americans living with diabetes and covered by Medicare will rise from 6.5 million to 14.1 million, and Medicare spending on diabetes will almost quadruple, skyrocketing from $45 billion this year to $171 billion in 2034. Based on this projection, “Medicare spending alone will represent just over 50% of direct spending on diabetes in 2034,” the authors concluded.

Unlike past efforts to predict trends in diabetes, the model developed by the University of Chicago team considers the natural progression of the disease, effects of treatment and obesity rates in the United States, which are “factors that are currently not used by government budget analysts,” according to the authors.

“Obesity is a significant driver of future increases in the number of Americans with diabetes,” said Michael O’Grady, Ph.D., one of the study authors and a senior fellow at the National Opinion Research Center at the University of Chicago. “While our modeling, as well as that done by the Centers for Disease Control and Prevention, project obesity rates leveling off, neither model has obesity rates lowering substantially. High obesity rates among the American population over an extended period of time substantially increases the probability of developing type 2 diabetes.”

This forecasting model, which the authors contend improves the rigor of the estimates of health care spending for diabetes, was designed to inform policymakers as they explore ways to control spiraling health care costs. Currently, official government estimates of the potential costs and cost offsets associated with proposed preventive health legislation do not consider savings that may occur more than 10 years out, thus providing an incomplete view of preventive health measures as an investment.

“The size of the current diabetes population exceeds many prior forecasts and we expect that the future growth of population and its associated costs will be explosive. Finding ways to reduce the number of people who develop diabetes is both a national public health priority and a fiscal imperative,” said Dr. Elbert Huang, the lead author of the paper and an assistant professor of medicine in the Department of Medicine at the University of Chicago. “The best way to stem the dramatic rise in diabetes is to implement proven preventive care programs on a national level. This will require that policymakers understand that diabetes prevention is a long-term investment that will only reap benefits over decades, not years.”

The Congressional Budget Office (CBO), which assesses the cost of proposed legislation, does not typically consider any cost savings beyond 10 years. Because diabetes develops over a long period of time, with the highest costs coming later in life of the disease, savings are far more apparent at 25 years than at 10 years. For this reason, policymakers need a long-term analysis of costs in order to make accurate decisions that reflect the true impact of prevention programs.

“Managing diabetes means preventing the pain and expense of diabetes complications, including heart disease, amputation, kidney disease, and blindness,” said Michael Mawby, Chief Government Affairs Officer and director of the NCDP, a diabetes leadership initiative established by Novo Nordisk to drive health systems change at the national and local level, which funded the research. “Therefore, it is critical that lawmakers see the long-term projections of the impact of diabetes interventions.”

Legislation introduced earlier this year is designed to lead to a more accurate assessment of the costs and benefits of preventive health, including preventing complications and delaying progression of chronic diseases such as diabetes. The bipartisan Preventive Health Savings Act of 2009 (HR 3148), calls on the CBO to weigh clinical or observational studies when modeling projected costs and savings related to preventive health, and in certain circumstances, to look beyond the traditional 10-year budget window.

Source: National Changing Diabetes Program


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