American Veterans Three Times More Likely to Have Diabetes
The Department of Health and Human Services (DHHS) and the Department of Veterans Affairs (VA) recently announced statistics regarding our retired servicemen and women related to their likelihood of developing diabetes. According to the National Institute of Diabetes and Digestive and Kidney Disease (part of the National Institutes of Health), 7% of the US population has diabetes. For veterans receiving VA healthcare, the rate is 20%. "Inactive lifestyles and unhealthy eating habits can cause needless suffering for America's veterans," says VA Secretary R. James Nicholson.
Because of these high rates, the DHHS and VA have announced a coordinated effort to educate veterans and their families on ways to combat these health issues. DHHS Secretary Mike Leavitt reported that the goal is to control the cost of healthcare, along with promoting wellness and a healthier lifestyle. Educating the veterans in making wise choices will improve their fitness and health, according to Leavitt.
The campaign "HealthierUS Veterans" is a multipronged educational effort to encourage healthy eating and physical activity among veterans, families, and members of their communities. VA medical centers will serve as the core of the program and will promote proper nutrition and exercise. "Our service men and women are known for their extraordinarily high levels of fitness," said Dr. Jonathan B. Perlin, Under Secretary for Health in the VA, and "we want our veterans to be identified the same way."
Overweight patients who come to the centers may participate in weight loss programs that will be tailored to their needs. Once enrolled in this program, the participant may also receive pedometers, diet advisories, and prescriptions that will suggest how much to walk, or in the case of wheelchair users, how much to roll.
MOVE!! is a weight management program developed by the VA National Center for Health Promotion and Disease Prevention (NCP) that addresses overweight and obesity among veterans receiving VA healthcare. The program is evidence based; offers stepped services from minimal to intensive intervention; involves a multidisciplinary team; and is based in primary and ambulatory care settings. It features a computerized patient assessment, treatment planning, and a comprehensive focus on behavior, nutrition, and physical activity. The Web site to access this program is http://www.move.va.gov, and primary care providers outside of the VA can have access to these materials. Included in this information is a 30-page letter outlining the weight management program; the letter is available for download.
The campaigns have been scheduled for kickoff in the spring of this year in four cities where VA medical centers are located. Local celebrities and members of veterans' service organizations have been invited to participate.
SOURCES
U.S. Department of Health and Human Services, http://www.hhs.gov/news
U.S. Department of Veterans Affairs, http://myhealth.va.gov
Veterans Health Administration, http://move.va.gov
FDA Releases Hold on Clinical Studies of Tysabri
The Food and Drug Administration (FDA) announced recently it has removed the clinical hold on Biogen-IDEC's studies of Tysabri (natalizumab) for patients with multiple sclerosis. In February 2005, Biogen-IDEC announced suspension of any marketing and clinical trials after three patients experienced progressive multifocal leukoencephalopathy (PML). Two of the three cases were fatal. PML is a serious, progressive neurologic disorder caused by infection of the central nervous system by JC virus, a member of the papovavirus family. JC virus is carried in a latent form by 70% to 75% of the general population but generally does not cause symptoms. There were approximately 1,100 patients with MS who were receiving Tysabri for a period of 1 year or more.
With the ban lifted on the studies, patients who were previously treated with the drug will be able to resume treatment in an investigational study following discussion with their physicians about the potential risks and benefits of treatment. Prior treatment with the drug has been shown to have benefited patients with relapsing-remitting MS.
The drug will not be placed back on the market at this time, according to the FDA. An Advisory Committee Meeting has been scheduled to discuss an application for Tysabri for use in treating patients with relapsing forms of multiple sclerosis. These discussions will include risks associated with the drug, its efficacy in the treatment of multiple sclerosis relapses and disability, its possible return to the marketplace, and its proposed risk management plan(s). Additional information can be found at http://www.fda.gov/cder/drug/infopage/natalizumab/defult.htm.
New Publication for Long-Distance Caregivers
Need information to provide to your patient's family and/or caregivers living far away and who want to be actively involved in caring for their loved ones? The National Institute on Aging (NIA) has just released its latest free publication. The booklet is So Far Away: Twenty Questions for Long-distance Caregivers. Information contained in the publication is organized in a question-and-answer format and includes 20 commonly asked questions involving such issues as money management to finding caregivers. NIA developed the booklet to help make long-distance caregiving more manageable and rewarding. According to the NIA's Web site, there are more than 7 million adults who can be labeled as long-distance caregivers. These caregivers live 1 hour or more away, and surprisingly, 40% of them are men.
Questions addressed in the pamphlet include such areas as knowing if and when help is needed, when it's time for parents to move from their homes, and how a caregiver can help from far away. The end of the booklet includes an extensive resource list to help readers find more information on an array of various topics. NIA also has many free publications available on their Web site to include Age Pages-an informative fact sheet for older people. There are more than 40 titles, with many of them available in Spanish. Some pamphlets that are available for long-distance caregivers are:
* Home Safety for People with Alzheimer's Disease
* Good Nutrition: It's a Way of Life
* Older Drivers
To preview or order your free copy of So Far Away, log on to the NIA's Web site: http://www.nia.nih.gov/HealthInformation/Publications/LongDistanceCaregiving/.
You can also order by phone (1-800-222-2225) or e-mail ([email protected]).
Other publications are available at: http://www.nia.nih.gov/HealthInformation?publications/.
New Treatment for Candidemia
The Food and Drug Administration has approved Eraxis (anidulafungin) to treat certain infections caused by Candida. The drug is manufactured by Pfizer Inc. (New York, NY). Eraxis is used to treat candidemia, a potentially life-threatening bloodstream infection that has an associated mortality of approximately 40%.
Patients at risk for this infection include those with compromised immune systems, stem-cell and organ-transplant recipients, patients receiving chemotherapy, those with catheters, surgical patients, and those receiving long-term antibiotic therapy. In the United States alone, patients who become infected with candidemia spend (on average) an additional 10 days in the hospital, with an average increase in the hospital cost of about $39,000 per patient.
Dr. Joseph Feczko, Pfizer's chief medical officer, reported "bloodstream infections such as candidemia can spread quickly and are very dangerous, especially for patients with weakened immune systems." Physicians now have an alternative to treating their patients with the approval of Eraxis, according to Feczko. Pfizer's Diflucan (fluconazole) has been the treatment of choice for candidemia and other fungal infections.
Eraxis has never been marketed in the United States. The drug is administered intravenously and is used to treat Candida infections in the esophagus (candidiasis), bloodstream (candidemia), and other forms of Candida infections, including abdominal abscesses and peritonitis (inflammation of the lining of the abdominal cavity).
The drug was well tolerated in clinical studies, with the most commonly reported adverse events being mild diarrhea, mild elevations in laboratory results of liver enzyme tests, and headaches. A few patients taking the drug who had significant underlying medical conditions and were taking multiple concomitant medications reported serious hepatic abnormalities.
Additional information can be found at http://www.eraxisrx.com or by calling 1-800-438-1985. To read the FDA release, see http://www.fda.gov/bbs/topics/news/2006/NEW01321.HTML.
Preserving Brain Health
A report recently published online in Alzheimer's and Dementia: The Journal of the Alzheimer's Association indicates a correlation between heart health risk factors and lifestyle choices associated in maintaining brain health as we age. Three National Institute on Aging (NIA) institutes have intensified their search for ways to preserve brain health as we age. The NIA, National Institute of Mental Health (NIMH), and National Institute of Neurological Disorders and Stroke (NINDS) have banded together to establish the NIH Cognitive and Emotional Health Project. This group will be coordinating efforts regarding research leading to interventions for neurological health. NIH Director Elias A. Zerhouni, MD, states, "This report suggests a future direction of research and is a terrific example of what we can learn when scientists of diverse specialties work together on a complex health issue."
"Developing strategies to preserve cognitive and emotional health as we grow older is a major public health goal," reported Richard J. Hodes, MD, Director of the National Institute on Aging. Changes in the focus of brain research are being discussed among the panel to include a focus on what works to preserve brain health, in addition to causes of brain disease and dysfunction. NINDS Director Story C. Landis, PhD, says, "This is a new paradigm for research focused on health rather than dysfunction."
This committee reviewed data from 36 large, ongoing studies of aging and identified more than 40 separate factors that may influence cognitive and emotional health. Many of these factors can be controlled by us to some degree. Healthier living can significantly contribute to the reduction of many of these factors, according to the report.
Higher levels of education appear to have some relationship between good cognitive and emotional functioning, according to the literature. No rationale has been found regarding this relationship, and researchers are exploring the possibility that education may provide cognitive "reserve." Increased mental activity throughout life, such as learning new things, may also play a positive role in keeping the brain healthy and fit.
Risk factors for cardiovascular disease, including hypertension, overweight, heart disease, diabetes, and smoking, are among factors currently being studied and may prove to have a direct impact on the health of our brain. According to Dr. Hendrie, MB, ChB, DSc, Professor in the Department of Psychiatry at Indiana University School of Medicine, hypertension appears to be the strongest link for cognitive decline among all of the studies. Identification of any link between these risk factors and maintaining brain health will be an important discovery because they can be modified through lifestyle and medical interventions.
Physical activity is another area of great focus in this study. The Critical Evaluation Study Committee indicates "if physical activity were to protect against cognitive deterioration in the elderly, it would be of great public health importance because physical activity is relatively inexpensive, has few negative consequences, and is accessible to most elders." Clinical trials are currently under way testing exercise as an intervention against cognitive decline. A recent study followed up more than 1,700 normal seniors for 6 years and found that those who exercised at least three times per week were least likely to develop Alzheimer's disease. A theory that is based solely on animal research indicated that physical exercise may improve blood flow and oxygen delivery to the brain and increase substances that promote the growth of tissue and blood cells in the hippocampus, an area critical to memory.
Chronic illnesses such as arthritis, cancer, lung disease, heart disease, and diabetes have all been linked to poor emotional outcomes, specifically depression. Additional study is needed to discover whether illness causes depression or whether depression can make people more vulnerable to illness.
This information is a result of a report of the committee to the NIH's Cognitive and Emotional Health Project (CEHP). The goal of the project is to evaluate the state of research looking at what may determine or influence cognitive and emotional health in older people and the ways cognitive and emotional health may influence each other.
Details of the research papers evaluated by the panel are available online at http://www.biostat.iupui.edu/~sgao/healthybrain/hblogin.asp. Additional information on the studies can be found at http://trans.nih.gov/CEHP.
SOURCES Hendrie, H. C., et al. (2006). The NIH Cognitive and Emotional Health Project Report of the Critical Evaluation Study Committee. Available at: http://www.alzheimersanddementia.org.
National Institute on Aging, http://www.nia.nih.gov National Institute of Mental Health, http://www.nimh.nih.gov
National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov
Did You Know? Straight Facts About Calcium
The National Academy of Sciences and the National Osteoporosis Foundation recommend daily calcium intakes of 1,000 to 1,200 mg for adult men and women. Food is the best source of calcium, but most Americans do not consume enough calcium in their diets. Calcium exists in nature only in combination with other substances, called compounds. Several different calcium compounds are used in supplements, including calcium carbonate, calcium phosphate, and calcium citrate. There are different amounts of elemental calcium found in each of these compounds. Elemental calcium is the actual amount of calcium in the supplement. It is important to read the label carefully to determine how much elemental calcium is in the supplement and how many doses or pills to take.
When choosing a calcium supplement, choose well-known brands with proven reliability. Look on the labels for "purified" or products that have the USP (United States Pharmacopeia) symbol. Avoid calcium from unrefined oyster shell, bone meal, or dolomite without the USP symbol because these may contain higher lead levels or other toxic metals. Most of the brand-name products are absorbed easily in the body. If a particular product does not state that it is absorbable, you can determine whether it is by placing it in a small amount of warm water for 30 minutes and stirring it occasionally. If it has not dissolved within 30 minutes, most likely it will not dissolve in the stomach. Calcium, both from diet and supplements, is better absorbed by the body when it is taken several times during the day in amounts of 500 mg or less. Calcium carbonate is absorbed best when taken with food, and calcium citrate can be taken any time.
This information, along with facts about osteoporosis, can be found at the National Osteoporosis Foundation site (http://www.nof.org). Included at that site is information regarding eight common myths about osteoporosis, provided in a printable 3-page fact sheet.
SOURCE
National Osteoporosis Foundation 1232 22nd Street NW Washington, DC 20037 800-223-9994