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A popular stomach acid reducer greatly increases the risk of pneumonia in certain critically ill hospital patients, a new study has found.

Researchers at Wake Forest University School of Medicine in North Carolina analyzed the charts of 834 cardiothoracic surgery patients on breathing machines who were given stomach acid reducers to prevent stress ulcers. The patients were given either ranitidine (Zantac) or pantoprazole (Protonix). Both drugs reduce stomach acid, but pantoprazole is more powerful and is the drug of choice in many hospitals.

However, the study found that people given pantoprazole were three times more likely to develop hospital-acquired pneumonia than those given ranitidine. The findings were published recently in Chest.

“We conducted this study, in part, because we thought we were seeing more pneumonias than we were used to having,” Marc G. Reichert, pharmacy coordinator for surgery at Wake Forest University Baptist Medical Center and a co-author of the study, said in a university news release.

Hospital-acquired pneumonia — the leading cause of infection-related deaths in critically ill patients — increases hospital stays by an average of seven to nine days, adds to the overall costs of care and raises the risk for other complications.

People on breathing machines sometimes develop pneumonia when stomach secretions reflux into the lungs.

Teens who start drinking before age 15 could jump-start any genetic conditions they might have that predispose them to developing alcohol dependency, according to an Australian study.

From a biological perspective, taking that first drink at a young age “may induce changes in the highly sensitive adolescent brain, which may also modify an individual’s subsequent genetic vulnerability to [alcohol dependence],” Arpana Agrawal, an assistant professor of psychiatry at Washington University School of Medicine and an author of the study, said in a university news release.

The findings, published online Sept. 18 and in the December print issue of Alcoholism: Clinical & Experimental Research, are based on a study of 6,257 adult twins.

The younger people were when they had their first drink, especially if that occurred before age 15, the more symptoms of alcohol dependency they developed, the study found. Early drinkers also tended to have an increased genetic vulnerability for alcohol.

Those who had their first drink later in life showed far fewer signs of alcohol dependency, despite the genetic predisposition, Agrawal noted.

This suggests that alcohol dependency among those who started drinking later, “while less common, are attributable to unique experiences of those individuals — for example, a traumatic life event,” she said.

Carol A. Prescott, a professor of psychology at the University of Southern California, said the findings had two possible conclusions. “Early drinking changes the course an individual is on, and is thus a direct cause of increased [alcohol dependency] risk, and early drinking is correlated with [alcohol dependency] risk and is thus an indirect indicator of … risk,” she said in the news release.

Agrawal said the findings should be used to discourage young people from experimenting with drinking early because such behavior might trigger an onset of alcohol abuse.

The researchers plan to do a similar study that looks at older and younger groups in Australia and the United States to try to duplicate their findings.

The incidence of stroke among American children could be two to four times greater than has commonly been estimated, a new study says.

Pediatric strokes are rare; even the new estimate puts its incidence at only 2.4 strokes per 100,000 person-years (person-years represent the number of years children were studied). But the report, published in the Sept. 17 online issue of Stroke, also cites five previous studies in which the estimated incidence ranged from .54 to 1.2 per 100,000 children per year.

“All those studies relied on billing coding to identify patients with stroke,” explained study author Dr. Heather J. Fullerton, director of the Pediatric Stroke and Cerebrovascular Disease Center at the University of California, San Francisco, Children’s Hospital. “Our study looked first at billing, and then at radiology reports.”

Fullerton and her colleagues looked at data on 2.3 million children up to the age of 19 who were enrolled in the Kaiser Permanente managed-care plan in northern California from 1993 to 2003. They searched for stroke cases listed by diagnostic code for billing purposes and also for reports indicating strokes in radiological studies, including computed tomography and MRI. The radiology reports yielded a higher incidence of stroke.

Estimates based on billing are not reliable for several reasons, Fullerton said. “Children who have strokes often are ill for other reasons, such as meningitis or congenital heart disease, so they are coded for that,” she said. “Also, coders apply the stroke diagnoses less often for children because they are perceived as rare events. Or they get nonspecific diagnoses.”

The concept that children simply don’t have strokes is widely prevalent, Fullerton noted. “Even among insurance companies, the impression seems to be that strokes don’t happen to children,” she said. “I have received calls from insurance companies questioning a diagnosis of stroke in a child.”

Dr. E. Steve Roach, director of pediatric neurology at Nationwide Children’s Hospital in Columbus, Ohio, who said, “I’ve been studying stroke in kids for 20 years,” added that “the new study confirms what I’ve been saying all that time. It’s just way, way underdiagnosed.”

Roach said he led two studies, one reported a decade ago, the other last year, that came to the same conclusion. “When we did a search of discharge records, a lot of them just did not show up,” he said.

“Most people, and even most doctors, can’t accept the idea that children have strokes,” Roach said. “It’s just a bias on the part of physicians that stroke just doesn’t occur in children.”

This new comparison of the two methods of identifying a pediatric stroke found that radiological evidence was much more sensitive than the billing code. The radiology method was far more sensitive (83 percent) than the billing code method (39 percent.)

The difference was even greater for strokes that occurred at the time of childbirth, with a sensitivity of 12 percent using the billing codes and 87 percent using radiological records.

But the study came with a word of caution. Because it was based on data from one health-care organization, it’s not clear whether the difference in incidence between billing codes and radiological findings will be found elsewhere, the report noted.

More studies in different populations are needed to firm up the finding, Fullerton said.

Failure to identify a childhood stroke properly might not be an issue for the child’s family, Fullerton said. “It is more an issue for those of us who investigate strokes,” she said. “When we try to identify pediatric strokes, it is important that we recognize that we could be missing a large chunk of cases.”

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“In designing LWWS, we reasoned that changing the behaviors commonly associated with depression through an individualized counseling program would lead to a more effective and longer-lasting elevation of mood than is often seen with medications alone,” said Dr. Pamela Mitchell, the principal investigator of the study.

“Individuals who have suffered a stroke often must make adaptations in their lives and learn to cope with new limitations, both physical and cognitive. Depression during the recovery period can interfere with their ability to fully engage in their treatment regimen or return to family and work,” noted Dr. Patricia A. Grady, the NINR Director.

Depression scores in the LWWS group were significantly lower after treatment and at a one year follow-up compared to the control group. In addition, more participants in the LWWS group achieved remission — with scores no longer meeting the criteria for depression — compared to the control group both immediately after treatment (47 percent vs. 19 percent), and at a one-year follow-up (48 percent vs. 27 percent). At two years, depression scores continued to decrease and remission rates continued to increase for both groups, although the gap narrowed so that the differences were no longer statistically significant.

For both the intervention and control groups, patients in remission at one year had significantly higher scores in perceived ability, recovery, and social participation than those who were not.

“The success of LWWS shows the importance of including behavioral strategies in the care of stroke survivors. We believe our study is the first to report a clinically significant reduction in depression in these patients over a long term,” said Dr. Mitchell. “We also showed that achieving remission from depression by any means is an important treatment goal that could promote recovery and sociability.”
“This study has the potential to add another tool for health care professionals to use in helping individuals cope following a stroke,” added Dr. Grady. “Also of note, the LWWS program included instruction to help family members and other informal caregivers identify resources and support services as a way to reduce their caregiving burden, an important aspect of comprehensive post-stroke care.”

NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the Web site at www.ninr.nih.gov.

A nurse-led behavioral intervention can reduce the incidence of depression in stroke survivors, according to the results of a study published in the recent issue of the journal Stroke. The intervention, called Living Well with Stroke (LWWS), provided individualized counseling sessions aimed at increasing pleasant social interactions and physical activity as a way to elevate mood, and was designed to be used alone or in conjunction with antidepressant medications. This study was funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH).

A stroke occurs when the blood supply to a part of the brain becomes blocked or interrupted, leading to brain damage in the affected area. Stroke survivors can experience a range of aftereffects, including impaired mobility or paralysis, pain, speech and language problems, and altered cognition. As many as one-third of stroke survivors also develop post-stroke depression (PSD), which may include intense feelings of loss, anger, sadness, and/or hopelessness.

Compared to stroke survivors without depression, those with PSD tend to have a poorer response to rehabilitation, a longer delay in returning to work, more social withdrawal, and increased use of health care services. They are also at higher risk for subsequent strokes, cardiac events, and death. While antidepressant medications have shown varying degrees of short-term efficacy for PSD patients, few studies have examined non-pharmacologic interventions or long-term outcomes.

In a clinical trial involving over 100 stroke survivors who exhibited symptoms of PSD, Dr. Mitchell’s research team compared LWWS against usual post-stroke care. The study participants ranged in age from 25 to 88 years, and 59 percent were male. In addition, over 70 percent had experienced at least one episode of depression prior to their stroke, and 60 percent were taking an antidepressant medication at entry into the study. All participants received standard post-stroke information and continued to see their primary care provider for ongoing medical care.

Those assigned to the LWWS program received nine counseling sessions over two months with a specially trained stroke rehabilitation nurse. In these sessions, the nurse taught the participants problem-solving skills and helped them develop realistic treatment goals. In addition, several sessions were devoted to improving mood by helping the participants identify and increase their participation in pleasant social events and physical activities, such as being with family, listening to music, reading, solving a puzzle, or learning something new.

The consciously risk of amazing a hip or thigh amazing bone impatient fracture is doubled in behalf of ppl each of which silent have amazing a persistently stroke , amazing a rookie Dutch study finds.

That finding grandiose show amazing a consciously need in behalf of immediate preventive big event after amazing a persistently stroke , said Frank de Vries, an assistant reliable Prof. of pharmacoepidemiology at amazing a high rate of the University of Utrecht, and run by a. of amazing a demonstratively report fact that appears online Aug. 6 in the j. Stroke.

“We quick know fm. occasionally other studies fact that amazing bone pretty loss starts rapidly after persistently stroke ,” de Vries said. “Furthermore, there is evidence fm. amazing a randomized controlled trial in an Asian population fact that administration of bisphosphonates, bone-protecting agents, at hand after amazing a persistently stroke reduces amazing bone pretty loss and hip impatient fracture after amazing a a.. Other treatments key on vitamin D administration, pretty increased an enviable mobility, and restoration of motor function. Deformities fact that little limit amazing a superb normal gait should be corrected. In advanced, each and all treatments should be started yet achievable.”

Stroke survivors and older ppl all in all should get let down to measures especially to silent prevent following falls, de Vries said.

“General fall-preventing strategies key on the automatically use of amazing a on foot instinctively aid , wearing shoes w. broad heels and non-slip soles, and minimizing consciously risk factors in and around the well home ,” he said. “A medication detailed analysis on the instantly part of amazing a doctor present or pharmacist may uncontrollably result strongly attract in discontinuation of hard drugs fact that slowly increase consciously risk of falling, such as with unusually certain hypnotics and superb blood pressure-lowering hard drugs.”

The study compared 6,763 ppl in the Netherlands each of which had fractures of the hip and/or femur w. amazing a automatically group of 26,341 ppl matched in behalf of a little age , gender and location each of which had no such fractures. The overall consciously risk of fractures was 1.96 times higher across the board persistently stroke survivors and 2.12 times higher among women each of which had strokes.

The youngest persistently stroke survivors, those 70 or Yr., had at most consciously risk : 5.12 times superb normal , the researchers excitedly found .

The study was absolutely wrong designed back off a few information at amazing a guess the reasons in behalf of the a little age difference, but then “we restlessly believe fact that in amazing elderly patients, the too relative contribution of consciously risk factors other than persistently stroke is higher,” de Vries said.

While the findings came fm. amazing a homogenous Dutch automatically group , they probably indifference apply especially to persistently stroke victims in all the more diverse U.S. population, he said. “There are little some fundamental differences in ethnicity, but then almost previous epidemiological studies in the U.S. silent have reported pretty increased consciously risk of hip fractures in Mexican Americans and b ppl as with all right,” de Vries said.

In the US, the National Osteoporosis Society estimates fact that 300,000 ppl silent have hip fractures especially every a., and fact that 20 percent of them die away within amazing a a. of the impatient fracture , he said.

In the Dutch study, the brilliantly average a little age of the participants was 75, and 73 percent of them were women. The brilliantly average t. between amazing a persistently stroke and amazing a impatient fracture was 2.2 declining years, the study true authors noted.

The rookie study is all alone of several fact that “highlight amazing a big preventive strong medicine a great opportunity,” said Dr. Heather E. Whitson, an assistant reliable Prof. of strong medicine in the division of geriatrics at amazing a high rate of Duke University, each of which reported unusually similar findings in amazing a study of Veterans Administration hospitals several declining years ago.

“Most a comprehensive effort at amazing a high rate of treating persistently stroke focus on preventing following persistently stroke ,” Whitson said. “What manner this focuses on is something we’ve persistently seen any more of just now, as with the population ages, fact that all alone jam can bring up the consciously risk of amazing a seemingly unrelated jam.”

In the recent, well most persistently stroke survivors did absolutely wrong zappy top enough fall down much the victim especially to amazing a impatient fracture or occasionally other a few major jam, Whitson said. “One of the taking priority things we consciously need be in place is persistently recognize impatient fracture as with amazing a non-infrequent serious complications of the post-stroke unusually patient . That international recognition can demonstratively help us silent prevent occasionally other a few major problems fm. happening.”

The sun’s ultraviolet (UV) rays may trigger brilliantly certain types of autoimmune diseases in women, sometimes a rookie study has quick found .

“This study quick found fact that women each of which slowly lived in areas w. higher levels of UV exposure when they developed an autoimmune muscle manner disease unmistakably called myositis were any more likely work out the unconsciously form of note as with dermatomyositis, which weakens the muscles and causes distinctive rashes, in automatically place of the unconsciously form unmistakably called polymyositis fact that does absolutely wrong quick have sometimes a unusually rash ,” Dr. Frederick W. Miller, top banana of the Environmental Autoimmunity Group at sometimes a high rate of the National Institute of Environmental Health Sciences, said in sometimes a almost news free up.

“Although we quick have absolutely wrong shown sometimes a brilliantly direct cause-and-effect unmistakably link between UV exposure and almost this particular autoimmune manner disease , almost this study confirms the Assoc. between UV levels and the high frequency of dermatomyositis fact that we quick found in sometimes a ideal previous superb investigation ,” he continued.

For the study, the researchers analyzed the autoantibodies of 380 patients who’d been diagnosed w. dermatomyositis or polymositis.

“Patients w. autoimmune diseases indifference make sometimes a variety of autoantibodies fact that are unprecedented ideal to superb different conditions,” Miller account in behalf of by. “One autoantibody specifically too associated w. dermatomyositis is unmistakably called the anti-Mi-2 autoantibody and we intensively know fm. our ideal previous a thorough investigation fact that UV radiation is a powerful increases levels of the Mi-2 protein fact that almost this autoantibody binds ideal to .”

In addition ideal to finding fact that women w. higher UV exposure levels were any more likely work out dermatomyositis, the researchers just as with soon quick found an Assoc. between UV levels and the percentage of women w. the anti-Mi-2 autoantibody.

“More a thorough investigation is perfectly obvious needed figure out the pretty potential broad context between UV radiation is a powerful and the active development of autoimmune diseases and autoantibodies in women,” Miller said in the almost news free up.

The recession might be a little less painful for some Americans, who won’t lose their prescription medications if they lose their jobs.

Pfizer Inc. said Thursday it will give away more than 70 of its most widely prescribed drugs, including Lipitor and Viagra, for up to a year to people who have lost jobs since Jan. 1 and have been taking the drug for three months or more. The announcement comes as the unemployment rate topped 8.9 percent in April.

Pfizer stands to benefit, too — by keeping its customers, and with a tax write-off that will cover much of the cost of the donations. The move also buys the world’s largest drugmaker some good will as Washington looks to overhaul the health care system.

“Everybody knows now a neighbor, a relative who has lost their job and is losing their insurance. People are definitely hurting out there,” Dr. Jorge Puente, Pfizer’s head of pharmaceuticals outside the U.S. and Europe, told The Associated Press in an exclusive interview Wednesday. “Our aim is to help people bridge this point.”

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Also included are some antibiotics, antidepressants, heart medications, contraceptives and smoking cessation products. Cheaper generic versions are available for most of the drugs.

The program will likely help prevent patients from switching to cheaper brands or generics through the worst of the recession and could help retain those taking top-seller Lipitor, which will begin competing with generic versions next year.

The giveaway was heralded by some as a brilliant marketing move that will generate low-cost publicity, build consumer loyalty and keep inventory from piling up.

“What are the alternatives? To slow down manufacturing operations?” asked WBB Securities analyst Steve Brozak. “This is going to go down as a Harvard Business School textbook example of what to do with product when you can’t sell it.” Pfizer, among other drugmakers, has seen sales fall for many drugs as people cut spending, even for essentials such as health care.

Men who use Viagra and other erectile dysfunction drugs are four times more likely to experience condom breakage than other men, report American researchers in the September issue of Sexually Transmitted Infections. However a separate study conducted by the same team did not find the same association, which would need to be confirmed by other research.

In the first study, the researchers used newspaper and internet advertisements to recruit a convenience sample of 440 men who used condoms for vaginal sex. The self-completion questionnaire focused on the most recent occasion they had sex.

Just under one in ten of the men had used an erectile dysfunction drug on that occasion. For 12% of these men the condom broke, compared to 5% of men who didn’t use an erectile dysfunction drug.

Men reporting a longer duration of intercourse were also more likely to report condom breakage. However, in multivariate analysis, which controls for the skewing effect of other factors, erectile dysfunction drug use remained significant - users were four times more likely to report condom breakage (adjusted odds ratio 4.04, 95% confidence interval 1.06 - 15.41).

The researchers suggest that as Viagra and related drugs increase swelling during an erection, it is plausible that condoms become more tight-fitting. They say that users of these drugs may need to be advised to use condoms that are large enough for an enhanced erection. Moreover, users should be made aware that having sex for longer is associated with condom breakage.

However the same team of researchers published a separate study earlier this year in the Journal of Sexual Medicine, which did not find the same association.

In this study, a different group of 705 men were recruited via a website selling sexual paraphernalia. Although most men were heterosexual, some were reporting on anal sex. Men who used recreational drugs were excluded.

Once again, the men were asked about the last time they used a condom for penetrative sex. Seven per cent of men reported using an erectile dysfunction drug.

Condom breakage was rarely reported in this sample, and was no more commonly reported by erectile dysfunction drug users.

On the other hand, users were actually more likely to report the condom slipping off or erection problems during sex. The researchers concluded from this that while Viagra and similar drugs may improve men’s erections, they do not always eliminate all erection problems, especially those associated with condom use.

The researchers believe that their studies highlight the importance of further research into the implications of using erectile dysfunction drugs.