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Friday, August 31, 2018
Former Vice President Joe Biden speaks at Sen. John McCain’s memorial
Chuck Todd Says Mueller May Drop Something Big: 'I Wouldn't Miss Work Tomorrow'
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British Thai cave rescue hero sends legal letter to Elon Musk threatening to sue over paedo accusation
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Thousands line up in Arizona heat to pay respects to McCain
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Sarah Palin Reportedly Not Invited To John McCain's Funeral
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Here's Who Will Serve As Pallbearers At John McCain's Washington Memorial
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Twitter Users Blast Hypocrisy Of Donald Trump's 'Anonymous Sources' Warning
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Myanmar rejects 'false allegations' in U.N. genocide report
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How America Should Handle Iran and North Korea
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Donald Trump Stands By His Controversial Response to John McCain's Death
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UN Syria envoy floats idea of evacuating Idlib civilians
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British Thai cave rescue hero sends legal letter to Elon Musk threatening to sue over paedo accusation
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Thousands line up in Arizona heat to pay respects to McCain
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Ben Shapiro blasts media coverage of Catholic Church crisis
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Democrats And Republicans In Florida's Governor's Race Got The Opponent They Wanted
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Memorial tributes to John McCain
Former Vice President Joe Biden was due to lead mourners in saluting the late John McCain, his former Senate colleague, at a Phoenix church service on Thursday celebrating the life of the Vietnam War hero and two-time Republican presidential candidate.
The memorial service at the North Phoenix Baptist Church marks the second of five days of commemorative tributes to McCain, who died on Saturday after a nearly yearlong battle with brain cancer. He was 81.
On Wednesday, several thousand admirers stood in line for hours in the blazing Arizona sun and triple-digit heat to pay final respects to McCain, eventually filing past his flag-draped coffin as it lay in state in the Arizona Capital rotunda.
The public viewing followed a brief ceremony for family and dignitaries led by Republican Governor Doug Ducey, who has said he would appoint McCain’s immediate successor in the Senate only after McCain’s burial on Sunday. (Reuters)
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Chile's Santiago Archbishop says regrets 'tension' in the Church
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Chuck Todd Says Mueller May Drop Something Big: 'I Wouldn't Miss Work Tomorrow'
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Correction: Texas Officer-Murder Trial-Differences story
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Despite tensions, China says navy chief plans to visit U.S. next month
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US Church divided over claims that pope ignored sex abuse
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Trump's morning tweet storm
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Russia hopes West won't 'obstruct anti-terror operation' in Syria: Lavrov
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British Thai cave rescue hero sends legal letter to Elon Musk threatening to sue over paedo accusation
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Ben Shapiro blasts media coverage of Catholic Church crisis
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The Latest: Judge sets $50,000 bond in newspaper threat case
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Chuck Todd Says Mueller May Drop Something Big: 'I Wouldn't Miss Work Tomorrow'
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Chile's Santiago Archbishop says regrets 'tension' in the Church
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Gingrich: Primaries have set stage for red wave in November
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UN Syria envoy floats idea of evacuating Idlib civilians
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Twitter Users Blast Hypocrisy Of Donald Trump's 'Anonymous Sources' Warning
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Here's Who Will Serve As Pallbearers At John McCain's Washington Memorial
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Brain Implant Puts the Brakes on Epileptic Seizures in Mice
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Experiments in mice have shown that an implanted electronic device in the brain can detect -- and deliver drugs to stop -- impending epileptic seizures.
Potentially, a similar device might help people with epilepsy, Parkinson's disease and brain tumors who have failed standard treatment. So far, the technology is in the very early stages of development and its clinical applications are years away, the researchers said.
"We can envision devices that are implanted in patients suffering from severe, drug-resistant epilepsy that survey brain activity and deliver drugs to prevent a seizure before it arises," said lead researcher George Malliaras. He is a professor of technology at the University of Cambridge in England.
"This, however, will take several years to bring to the clinic, as there is still a lot of research that needs to take place before the device is safe for use in humans," he added.
The device works by detecting electrical impulses in the brain that signal that a seizure is about to occur. The device then delivers a predetermined dose of a drug that stops the seizure in its tracks.
By delivering an anti-seizure drug directly to a targeted area of the brain, the side effects that can occur when these drugs are given orally can be avoided. Moreover, for about 30 percent of patients, these drugs aren't effective in preventing all seizures, Malliaras said.
In the study, the researchers used a neurotransmitter that acts at the source of the seizure, signaling brain cells to stop firing and ending the seizure. The drug is sent to the specific part of the brain by a probe that has a tiny pump and electrodes to monitor brain activity.
When a signal of a seizure is detected by the electrodes, the pump is activated and moves the drug out of the device.
Malliaras and his colleagues found that seizures could be prevented with very low doses of the drug -- less than 1 percent of the amount of drug loaded into the device. So, the device should be able to operate for extended periods without needing to be refilled.
Furthermore, the drug is absorbed by the brain within minutes, which should reduce side effects, the study authors said.
Study co-author Adam Williamson, from the Institut de Neurosciences des Systemes at Aix-Marseille University in France, is cautiously optimistic. The nature of the experiment was such that many obstacles have to be overcome before the device could be tried in humans, he said.
The animals in this study were anesthetized during experiments. "There is a vast difference between the awake state and the anesthetized state," Williamson explained.
In addition, the devices were implanted at the exact source of epileptic activity. "This was only possible because we defined the source experimentally," he said. Also, the researchers triggered the seizures -- they didn't occur naturally.
"In a clinical application, patients are in the awake state, and most importantly, the source of the seizure is initially unknown and must be discovered, and the onset is totally unknown," Williamson said.
The discovery and targeting of seizures will be a huge problem, he said. "These challenges will need to be individually investigated and integrated to move the technology forward. It's exciting, but I encourage cautious optimism."
The next step in this research is to repeat the experiment, but over a much longer time to see if the treatment remains effective.
Side effects of the device in humans might be very different from those in animals, said Dr. Derek Chong, director of the epilepsy program at Lenox Hill Hospital in New York City.
"A mouse can't tell you they have horrible headaches or they can't focus on the stock market," he said. "This is years away."
Other problems Chong sees are treating all the areas in the brain that might trigger seizures, preventing infections, and breaching the brain's natural defenses, which might lead to serious health issues.
This approach would probably be used in patients who fail other treatment or who cannot have the affected part of the brain surgically removed because it's too vital, Chong suggested.
Another expert sees this as another step forward in treating a variety of brain diseases beyond just giving drugs.
"The era of the device is coming," said Dr. Jacqueline French, a professor of neurology at NYU Langone Medical Center in New York City, and a spokeswoman for the American Academy of Neurology.
"Where this was a pipe dream, it's now becoming closer and closer to reality," she said.
The report was published online Aug. 29 in the journal Science Advances.
More information
For more on epilepsy, visit the U.S. National Institute of Neurological Disorders and Stroke.
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Strain of E. Coli Spread From Poultry to People, Study Suggests
THURSDAY, Aug. 30, 2018 (HealthDay News) -- An E. coli strain found in fresh chicken and turkey products can cause serious urinary tract infections (UTIs) in people, researchers say.
For the study, investigators analyzed chicken, turkey and pork purchased from every major grocery chain in Flagstaff, Ariz. They also collected and analyzed urine and blood samples taken from patients at Flagstaff Medical Center.
E. coli was found in about 80 percent of the nearly 2,500 meat samples and in 72 percent of the urine and blood samples from patients who tested positive for infection, the study authors said. E. coli ST131 was the most common type infecting people and was also present in the meat samples.
In the next phase of the research, the investigators discovered that almost all of the E. coli ST131 on the poultry products was a strain called ST131-H22, and that it carried genes that help E. coli thrive in birds. This same strain was also found to be causing UTIs in people.
The findings indicate that E. coli in fresh poultry can be passed to people, causing UTIs. While many people believe these common infections are a minor problem, invasive UTIs that involve the kidneys or blood can be life-threatening, the study authors said.
More than 80 percent of UTIs are caused by E. coli, but only a few strains cause the most serious infections. That includes E. coli ST131, which kills thousands of people in the United States each year, according to the researchers.
"In the past, we could say that E. coli from people and poultry were related to one another, but with this study, we can more confidently say that the E. coli went from poultry to people, and not vice versa," said study leader Lance Price. He is director of the Antibiotic Resistance Action Center at George Washington University in Washington, D.C.
These findings highlight the importance of cooking poultry thoroughly and handling it carefully in the kitchen, said Price, who noted that poultry products are not routinely tested for E. coli strains that can cause UTIs.
"We are now working to measure what proportion of UTIs might be caused by foodborne E. coli by looking at all E. coli strains, not only ST131," Price said in a university news release. "This is not an easy question to answer, but an extremely important one."
The study was published online Aug. 28 in the journal mBio.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on urinary tract infections.
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States Struggle With Onslaught of Opioid OD Deaths
THURSDAY, Aug. 30, 2018 (HealthDay News) -- A new report on thousands of opioid overdose deaths across 11 states finds the problem is increasingly complex, but more can be done to stop it.
The report, from the U.S. Centers for Disease Control and Prevention, looked at nearly 12,000 fatal opioid overdoses occurring between July 2016 and June 2017 in states across the Northeast, the Midwest and the West.
"Most states were simultaneously struggling with a complex mix of prescription and illicit opioid deaths," reported the team led by Christine Mattson, of the CDC's National Center for Injury Prevention and Control.
Her team found that, of the total fatal ODs, nearly six out of 10 (58.7 percent) involved illicit "street" drugs such as heroin or fentanyl. About 17 percent of the deaths involved prescription opioids such as Oxycontin, Vicodin and the like, while 18.5 percent involved a mix of prescription and illicit drugs.
Sometimes, non-opioids entered the mix, and the resulting combinations were often deadly, Mattson's group noted.
For example, half of all the "prescription only" overdose deaths also involved a benzodiazepine such as Xanax or Valium.
"Benzos" are "known to depress the central nervous system and increase the risk of overdose and death," the CDC authors noted. The researchers believe interventions that help stop getting this drug mix into the hands of users might go a long way to curbing fatal ODs.
Another potentially deadly combo: Opioids used with the anti-seizure medication gabapentin. Recent reports are suggesting that "combined use of gabapentin and opioids might be an indicator of high-risk opioid misuse," Mattson's team said.
But there were other risk factors raising the odds of a deadly overdose. The study found that in one of every 10 cases, the deceased had been released from jail, prison or other detention facility in the past month.
Here, too, is another key area where preventive measures might save lives, the CDC report said. The researchers pointed to the case of Rhode Island, which recently expanded enrollment in a medication-assisted treatment program for incarcerated persons. After that move, Rhode Island saw "a 60 percent decrease in post-incarceration overdose deaths," according to the report.
Finally, even though bystanders were nearby in 44 percent of opioid overdose deaths, the "rescue" medication naloxone (Narcan) was only used in 4 percent of deaths linked to illicit drugs, and less than 1 percent of incidents involving prescription opioids.
That's a red flag for New York City emergency room physician Dr. Robert Glatter, who's seen the ravages of the opioid addiction epidemic firsthand.
"The use of naloxone is an essential element of care after an opiate overdose that is proven to save lives," he said. "It reverses the effects of the opiate and its effects on breathing. It's easy to administer and can even be delivered intranasally."
He said states need to do all they can to make naloxone more available.
"It's critical to have Narcan available in the home or rehab setting for anyone who was recently treated for an opiate overdose, or who may be at risk of an overdose," he said.
He also applauded programs like the one used in Rhode Island -- either before or after an overdose.
"Medication-assisted treatment is a validated and effective approach to improve long-term outcomes after nonfatal overdose," Glatter said. The intervention "reliably treats withdrawal symptoms, which includes follow-up care in a 'bridging' clinic, to monitor ongoing care."
Dr. Harshal Kirane directs addiction services at Staten Island University Hospital in New York City. He agreed with Glatter that the CDC report "reveals two key areas of pressing concern: limited access to addiction care and limited community engagement in overdose education and naloxone distribution."
"Expanding access to effective addiction treatment and resources for naloxone distribution are vitally important," he said.
The report was published Aug. 31 in the CDC's Morbidity and Mortality Weekly Report.
More information
For more on opioids, visit the U.S. National Institute on Drug Abuse.
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Gene 'Editing' in Dog Study Shows Promise for Kids With Muscular Dystrophy
THURSDAY, Aug. 30, 2018 (HealthDay News) -- For the first time, scientists report using gene-editing technology to halt the progression of muscular dystrophy in dogs -- suggesting a possible breakthrough for children with a form of the disease.
Reporting in the current issue of Science, researchers describe how they used CRISPR technology to edit a naturally occurring genetic flaw that causes a version of Duchenne muscular dystrophy in dogs. CRISPR is an acronym for a family of DNA sequences.
The gene correction, in turn, triggered what the scientists call an "unprecedented" improvement in the animals' muscle fibers.
The discovery might hold the key to helping children with Duchenne MD, the most common form of muscular dystrophy. MD is a group of incurable genetic disorders that cause progressive muscle degeneration.
Duchenne MD primarily affects boys and usually arises in early childhood. Historically, most boys did not survive beyond their teens, but more are living into their 30s these days, according to the Muscular Dystrophy Association.
Duchenne is caused by a mutation in a gene that produces a critical protein called dystrophin. Without it, muscles throughout the body -- including the heart and diaphragm -- break down over time.
"The only real way to correct this disorder is to get the body to produce functional dystrophin," said Eric Olson, lead researcher on the new study. He's professor and director of University of Texas Southwestern Medical Center's Hamon Center for Regenerative Science.
To do that, researchers have been studying gene therapy. But with Duchenne MD, Olson said, there is a hurdle to replacing the defective gene with a functioning one: its size.
"It's simply too massive to replace," he explained.
So Olson and his team took a different approach. They used CRISPR gene-editing technology to fix the gene defect.
The researchers treated four dogs that carried the most common mutation seen in people with Duchenne MD -- affecting a location on the dystrophin gene called exon 51. They used a harmless virus to deliver CRISPR components to the exon -- which the technology then "edited."
Within weeks, the researchers reported, the missing dystrophin protein was restored in muscle throughout the animals' bodies.
The effects were not uniform. In some muscle, dystrophin was produced at 3 percent of its normal level. But in the heart and diaphragm, the protein was restored to 92 percent and 58 percent of normal, respectively.
The researchers also found evidence of improved integrity in the animals' muscle fibers.
Olson put the increases in dystrophin levels in perspective: There is a drug for Duchenne MD -- called Exondys 51, and approved in the United States in 2016 -- that can be used in a minority of patients who have a mutation in exon 51.
It has been shown to restore less than 1 percent of dystrophin in skeletal muscle after one year, Olson pointed out.
"Here, we saw really dramatic changes -- beyond what we'd hoped for," he said.
The findings are "very encouraging," said Dr. Sajel Lala Kana, a clinical geneticist at Nicklaus Children's Hospital in Miami.
But they are also very early, she pointed out. "This study shows what happens in these animals in the short term," said Kana, who was not involved in the research. "But will this be sustainable over a long period of time?"
Olson agreed that that is a critical question. And then there's the issue of whether the gene editing could have unintended adverse effects.
There are two main theoretical safety concerns, according to Olson: "Are there any off-target effects?" he said. "That is, could this accidentally affect the expression of other genes?"
Another question, Olson said, is whether the immune system will react to the enzyme CRISPR uses to make its gene fixes. So far, there have been no signs of that, the researchers said.
While animal studies frequently don't produce the same results in humans, Olson said these findings can be seen as a promising early step.
"We're working hard on trying to treat the cause of this disease," he said. "With further study in animals, in a few years we may be able to move into human trials."
Kana agreed. "There's a lot of research going on this field," she said. "This is how we'll move toward a cure someday."
In the United States, Duchenne MD affects one in every 3,500 to 6,000 boys born each year, according to the National Institutes of Health. Often, the agency says, there is no family history of the disease; instead, mutations spontaneously occur in the dystrophin gene.
More information
The Muscular Dystrophy Association has more on Duchenne muscular dystrophy.
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Later Breakfast, Earlier Dinner Might Help You Shed Body Fat
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Could the timing of your breakfast and dinner help you eat less and lose body fat?
A small, preliminary study suggests it's possible.
People cut their daily calorie intake by about 25 percent when they held off on breakfast for 90 minutes and then had dinner 90 minutes earlier than usual, said senior researcher Jonathan Johnston. He is a reader in chronobiology and integrative physiology with the University of Surrey in England.
These people also lost more than twice as much body fat, on average, than a control group with unrestricted eating times, Johnston added.
"Meal timing is important, in addition to meal content," Johnston said. "Meal timing research is still quite new, but has a lot of promise to help people improve health with relatively minor changes to behavior."
There's strong evidence in animals that restricting the number of hours of food availability each day can help boost metabolism, Johnston said.
But the researchers weren't sure whether humans would see the same benefit, since so many factors go into when people eat meals and snacks, Johnston added.
To find out, nine people were recruited to take part in a "time-restricted feeding" pilot study, in which they delayed breakfast and moved up dinner by an hour and a half. During that window, they could eat as often as they liked.
"We deliberately designed our study to have a fairly minor reduction in daily eating duration," Johnston said.
Another seven people served as a control group by eating meals as they normally would.
Participants provided blood samples and completed diet diaries before and during the study period.
After 10 weeks, the people with a shorter meal window had reduced their body fat by about 2 percent, compared with under 1 percent lost by those in the control group, the researchers said.
Participants also cut their average energy intake from roughly 2,091 to 1,553 calories per day, the findings showed.
People said they tended to eat less because they had reduced appetite, decreased opportunities to eat, or a cutback in their snacking habits, according to a questionnaire they filled out afterward.
There are a couple of possible reasons why changing meal times might alter a person's calorie intake and help them lose body fat, Johnston said.
Restricted feeding could lead you to eat food at times best suited for your body's daily metabolic rhythms, he suggested. It also could be that a shorter meal window increases the length of the daily fasting period.
"In reality, my guess would be a combination of both these options," Johnston said.
However, these changes to meal timing may not be sustainable for many.
About 57 percent of participants told researchers they could not have maintained the new meal times long-term, because they were incompatible with family and social life.
But 43 percent said they would consider continuing a time-restricted diet if eating times were more flexible.
"This is really important as it emphasizes how important it is for dietary changes to fit with people's lives in the real world," Johnston said. "An important question for future research is to evaluate whether a shortened daily duration of feeding will be effective if started at different times of day."
The meal schedule in this study is a form of intermittent fasting, said Grace Fjeldberg, a registered dietitian nutritionist with the Mayo Clinic Health System. This "has become an increasingly popular trend to support weight loss," she said.
"Everyone is looking for quick ways to support weight loss and improve overall health, and eating fewer times throughout the day often produces a deficit in calories and ultimately weight loss," Fjeldberg explained.
But Fjeldberg warned that quick weight loss through fasting might not necessarily lead to better health and long-term reduced weight.
"Hunger and stress hormones can spike with prolonged periods of fasting, and for some this may mean increased portions in the few meals that are eaten throughout the day and potentially higher calories," Fjeldberg said.
Eating behavior expert Susan Carnell agreed with Fjeldberg that further research is needed.
"Time-restricted feeding may have benefits, but could be hard to stick to, so larger trials testing effectiveness as well as feasibility of different schedules are needed," said Carnell, who is an assistant professor of psychiatry and behavioral sciences with Johns Hopkins Medicine.
"Another point to consider might be that probably some schedules will work better for some people than others, so individual tailoring will probably be important for feasibility," she added.
The study was published Aug. 29 in the Journal of Nutritional Science.
More information
The Harvard T.H. Chan School of Public Health has more about intermittent fasting.
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FDA Warns of Common Diabetes Meds' Link to Dangerous Genital Infection
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Rare but serious genital infections, as well as one death, have been reported in some patients taking a certain class of type 2 diabetes medicine, the U.S. Food and Drug Administration says.
As a result, the FDA has ordered a new warning about this risk to be added to the prescribing information and patient medication guide of all sodium-glucose cotransporter-2 (SGLT2) inhibitors.
The bacterial infection of the genitals and area around the genitals is called necrotizing fasciitis of the perineum, also called Fournier's gangrene. The bacteria typically enter the body through a cut or break in the skin.
Between March 2013 and May 2018, the FDA identified 12 cases of Fournier's gangrene in patients taking an SGLT2 inhibitor. However, this number includes only reported cases and those found in the medical literature, so there may be more cases, the FDA said in a news release.
Fournier's gangrene developed within several months after the 12 patients starting taking an SGLT2 inhibitor, and use of the drug was stopped in most cases. All 12 patients were hospitalized and required surgery. Some patients required multiple disfiguring surgeries, some developed complications, and one patient died, according to the FDA.
A review of more than 30 years of data identified only six cases of Fournier's gangrene among patients taking other classes of diabetes drugs, the FDA said. All six of those cases occurred in men, but five of the 12 recently reported cases involved women.
In 2017, about 1.7 million U.S. patients filled prescriptions for an SGLT2 inhibitor at outpatient retail pharmacies, the FDA said.
SGLT2 inhibitors were first approved by the FDA in 2013, and include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin.
Brand names of FDA-approved SGLT2 inhibitors include Invokana, Invokamet, Invokamet XR, Farxiga, Xigduo XR, Qtern, Jardiance, Glyxambi, Synjardy, Synjardy XR, Steglatro, Segluromet and Steglujan.
Patients taking these drugs should seek medical attention immediately if they have any tenderness, redness or swelling of the genitals, or the area from the genitals back to the rectum, and have a fever above 100.4 F or a general feeling of being unwell, the FDA advised.
The agency said health care providers should assess patients for Fournier's gangrene if they have such symptoms. If Fournier's gangrene is suspected, start treatment immediately with broad-spectrum antibiotics and surgery if necessary, discontinue the SGLT2 inhibitor, closely monitor blood sugar levels, and provide appropriate alternative therapy for blood sugar control, the agency added.
More information
The National Organization for Rare Disorders has more on Fournier's gangrene.
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Monkey Trials Raise Hope for Non-Addictive Opioid Alternative
THURSDAY, Aug. 30, 2018 (HealthDay News) -- The ongoing opioid addiction crisis means the search for powerful but non-addictive painkillers is more urgent than ever before. Now, a team of scientists says it may be nearing that goal.
Research in monkeys suggests that an experimental painkiller -- called AT-121 -- is not only very effective in easing pain, but it may also blunt the addictive effects of opioids.
AT-121 provided the same level of pain relief as a typical opioid, but at a 100-times lower dose than morphine, according to the research team from Wake Forest Baptist Medical Center, in Winston-Salem, N.C.
"In our study, we found AT-121 to be safe and non-addictive, as well as an effective pain medication," said Mei-Chuan Ko, a professor of physiology and pharmacology at the hospital.
"In addition, this compound also was effective at blocking abuse potential of prescription opioids, much like buprenorphine does for heroin, so we hope it could be used to treat [both] pain and opioid abuse," Ko added in a Wake Forest news release.
The research showed that -- in monkeys, at least -- AT-121 suppressed the addictive potential of oxycodone (Oxycontin), a commonly abused opioid prescription drug.
In the experiments, monkeys were able to "self-administer" potentially addictive drugs such as cocaine or oxycodone, but when given AT-121, they were no more likely to do so than when they'd received simple saline solutions.
According to Ko's team, this suggests that AT-121 lacks the addictive potential of typical opioids.
And unlike typical opioids, withdrawal symptoms weren't observed when the monkeys ceased using AT-121 after three days, the researchers said.
AT-121 also seemed to ease pain without some of the typical side effects of opioids, such as itch, motor impairment, respiratory and other issues.
Of course, trials conducted in animals sometimes fail to pan out in people. But Ko noted that monkeys are a very close model to humans.
"The fact that this data was in non-human primates, a closely related species to humans," suggests that the findings have a good chance of being replicated in clinical trials in people, he said.
Still, further research -- including safety studies -- is needed before applying to the U.S. Food and Drug Administration for approval to conduct those clinical trials, Ko said.
The study was published Aug. 29 in the journal Science Translational Medicine.
More information
The U.S. National Institute on Drug Abuse has more about prescription opioids.
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AHA: Why More Americans Are Kicking the Smoking Habit
THURSDAY, Aug. 30, 2018 (American Heart Association) -- More and more Americans are putting out their cigarettes -- for good.
The overall cigarette smoking rate among U.S. adults has hit an all-time low, according to the U.S. Centers for Disease Control and Prevention. Preliminary data from the National Health Interview Survey showed that smoking rates declined from 15.5 percent in 2016 to 13.9 percent in 2017.
"Cigarette smoking among adults has been on a downward trajectory for decades," said Brian King, deputy director for research translation in the CDC's Office on Smoking and Health. "It's the lowest percentage we've seen since we started monitoring smoking rates in 1965." Still, the preliminary 2017 data indicates 34 million Americans still smoke, according to King. And an estimated 480,000 Americans die each year due to cigarette smoking and secondhand smoke exposure, according to the latest CDC data.
Fifty years ago, it seemed impossible to imagine a world where less than 15 percent of adults smoked. At the time, roughly 42 percent of American adults lit up, and smoking was a normal part of everyday life. You could smoke at work, in restaurants and bars, and on planes. You could buy cigarettes from vending machines. Tobacco was glamorously portrayed in the movies and on TV and advertised on billboards lining the highways.
That started to change in 1964 when the surgeon general released the first report on smoking and health. The landmark report concluded that smoking causes lung and laryngeal cancer and is a major cause of health conditions such as cardiovascular disease, ushering in policies that would change the tobacco landscape.
But the decline in smoking rates didn't happen overnight. It took time for anti-smoking campaigns and policies to unfold, said Dr. Charlie Shaeffer, a California-based cardiologist who has been active in tobacco control efforts. And quitting the highly addictive products required tools and resources that didn't yet exist.
Both King and Shaeffer credit the combination of cigarette price increases, anti-smoking campaigns, smoke-free laws, and access to cessation programs as powerful levers aided by health advocacy groups. "These interventions really de-normalize tobacco use," said King.
Higher-priced cigarettes made it more expensive to smoke, especially for teenagers -- an age when most smokers first tried smoking. Money raised from taxes funded ads that showed the adverse health impacts of tobacco, sometimes in gruesome detail. And not being able to smoke at work, bars or public places created smoke-free environments, making it easier for people to not smoke. Plus, in 2010, most commercial health insurance plans and Medicaid were required to cover smoking cessation programs, giving smokers access to the resources and tools they needed to quit.
But real strides in decreasing smoking have come from prevention efforts. Greater education, particularly aimed at children, spread the word about tobacco's effects, and health warnings on products, beginning in 1965, reiterated that message. "We're not getting an influx of new smokers on the front end. We're starting to see the impact of reducing [smoking] initiation among youth and young people in overall smoking rates," said King.
While lower smoking rates are a major public health success, experts say there's still work to do.
"The numbers have declined but seem to be plateauing," said Shaeffer. Among current smokers, the vast majority smoke daily. While they are smoking less, even just one cigarette a day increases the risk of heart disease and stroke, according to a January 2018 review published in the British Medical Journal.
Plus, the tobacco environment is diversifying thanks to the emergence of products such as e-cigarettes, the health effects of which researchers are still working to understand as their popularity among young people grows. According to the CDC, 11.7 percent of high schoolers in 2016 said they had used an e-cigarette, up from 1.5 percent in 2011. Newer approaches will be needed to prevent tobacco use and nicotine addiction in a new generation, experts say.
"There's an emerging body of novel interventions and strategies, such as increasing the age of sale of tobacco to 21, including e-cigarettes, and prohibiting the sale of flavored tobacco, which are percolating at the local level," King said.
But he is optimistic that smoking rates will continue their downward trend.
"Ultimately, it's going to take a coordinated effort at the national, state and local level," he said. "We're on track to meet the federal objective of a 12 percent smoking rate by 2020."
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Even at Low Levels, Toxic Metals Put Heart at Serious Risk: Study
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Exposure to toxic metals such as arsenic, lead, copper and cadmium is associated with an increased risk of cardiovascular and heart disease, researchers report.
Their analysis of 37 studies that included nearly 350,000 people linked arsenic exposure to a 23 percent increased risk of coronary heart disease and a 30 percent increased risk of cardiovascular disease.
Exposure to cadmium and copper was linked to an increased risk of both diseases.
Exposure to lead and cadmium was associated with an increased risk of stroke -- it was 63 percent higher for lead and 72 percent higher for cadmium, respectively.
The study findings were published Aug. 29 in the BMJ.
The findings "reinforce the [often under-recognized] importance of environmental toxic metals in enhancing global cardiovascular risk, beyond the roles of conventional behavioral risk factors, such as smoking, poor diet and inactivity," researcher Rajiv Chowdhury and his colleagues wrote.
Chowdhury is an associate professor of global health at the University of Cambridge in England.
The study also highlights the need "to reduce human exposures even in settings where there is a relatively lower average level of exposure [such as many Western countries]," the investigators said in a journal news release.
They said more research is needed to understand the link between toxic metals and heart disease.
Maria Tellez-Plaza and colleagues at the Carlos III Health Institute in Madrid, Spain, wrote an editorial in the same issue of the journal.
They said the study is "an important call for attention to an emerging group of risk factors with a high prevalence in populations around the world."
Since toxic metals are associated with heart disease even at fairly low levels of exposure, Tellez-Plaza and her group concluded that "population-wide strategies to minimize exposure will further contribute to overall cardiovascular prevention efforts."
More information
The U.S. Centers for Disease Control and Prevention has more on heart disease risk factors.
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Low Back Pain? These Exercises May Help
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Low back pain is a common health complaint. And if it sidelines you for too long, it can lead to weight gain, a loss in your fitness level and keep you from doing things you love.
But not moving isn't the answer -- specific exercises can help you get back to everyday activities. If you're under the care of an orthopedist or physical therapist, you may be given a series of exercises to do up to three times a day.
Here are three in particular that may help.
Tummy contractions. Lie on your back with your knees bent, feet flat on the floor hip-width apart, and your hands on your tummy below your ribcage. Tighten your abs -- it should feel as though your ribcage is being pressed toward your back. Hold for five seconds, then relax. Repeat 10 times.
Knee-to-chest stretch. Begin in the same starting position, but for this exercise, place both hands on the back of your left thigh and gently pull the knee to your chest. Hold for 20 seconds, then relax. Repeat five times with the left leg, then switch to the right leg and repeat the entire sequence.
Body stretch sequence. Sit on a large exercise ball with knees bent at a 90-degree angle to the floor. Move your feet slightly out to the sides for balance. First, lift your left arm straight up over your head, then lower it and repeat with the right arm; alternate five times. Next, slowly raise and lower your left heel, then slowly raise and lower your right heel; alternate five times. Finally, raise your left arm overhead and your right heel off the floor at the same time, lower them and reverse, raising your right arm overhead and lifting your left heel off the floor; alternate five times.
Another type of exercise that may help is yoga. According to a study published in the Annals of Internal Medicine, people who took a weekly class designed for those with low back pain were helped just as much as those who did traditional physical therapy, and needed less pain medication over time.
More information
The University of California, Berkeley, has detailed information on low back pain and more exercises that can help ease it.
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Babies of Opioid-Addicted Moms May Struggle in School
THURSDAY, Aug. 30, 2018 (HealthDay News) -- The consequences of the opioid epidemic may be more far-reaching than thought. New research suggests that children who experience drug withdrawal after birth may be at risk of educational disabilities between the ages of 3 and 8.
Additionally, the Tennessee study reported that children with neonatal abstinence syndrome (NAS) were also more likely to need special education services or therapies.
"We've seen rapidly rising rates of NAS in the last decade or so. Rates have risen greater than 1,700 percent since 1999 [in Tennessee]. But there's been limited data on long-term outcomes and we wanted to try to understand the quantifiable impact," explained study author Dr. Mary-Margaret Fill, a medical epidemiologist with the Tennessee Department of Health.
Nationally, the rate of neonatal abstinence syndrome rose nearly fivefold from 2000 to 2012, according to the researchers. One infant is born every 25 minutes with NAS. Symptoms include tremors, high-pitched crying, irritability, poor feeding and vomiting and diarrhea, the researchers said.
Approximately 11.5 million people misused prescription opioids in 2016 in the United States. Almost another 1 million people used heroin, according to the U.S. Department of Health and Human Services.
And, as opioid use has risen across the nation, it has also risen in pregnant women. A U.S. Centers for Disease Control and Prevention study released earlier this week found the rate of pregnant women with an opioid use disorder quadrupled from 1999 to 2014. In 1999, 1.5 per 1,000 delivery hospitalizations involved a mother with an opioid use disorder. By 2014, that number had jumped to 6 per 1,000.
To see what impact this might have, the study team looked at data on more than 7,000 babies born in Tennessee between 2008 and 2011.
About one-third of the babies had neonatal abstinence syndrome, according to Fill. The researchers compared those babies to the ones born without NAS.
They also analyzed early education data from when the children were between 3 and 8 years old.
The study found that children with NAS were more likely to be referred for an educational disability evaluation than children who didn't have NAS -- more than 19 percent versus nearly 14 percent. They were also more likely to meet the criteria for a disability -- 15.6 percent versus 11.7 percent.
The most common education disabilities identified were developmental delay and speech or language impairment, the researchers said.
Children born with neonatal abstinence syndrome were also more likely to need classroom therapies or services compared to kids without NAS -- 15.3 percent versus 11.4 percent.
Fill said it's not clear how NAS or opioid exposure affect the fetal brain. She said some animal studies suggest that changes might occur in the brain, but more research is needed.
In the meantime, she said, this study "reinforces the need to reduce non-necessary drug use prenatally. Try to avoid opioid exposure during pregnancy, if at all possible."
Fill also pointed out that children born with NAS need quick referral for intervention services.
"There's good data to show that children enrolled in early intervention may make up for some disabilities and help children reach their full potential. But they have to be connected with those services," she said.
It's also important to note that not all children with neonatal abstinence syndrome experience educational disabilities.
Dr. Lisa Waddell from the March of Dimes said, "NAS is a difficult experience for the newborn and to watch, and now we're learning it can have more long-term consequences."
Waddell said this study shows how important it is for all women to get quality prenatal care.
"If women are using drugs, even prescription opioids, in some cases they may feel stigmatized and not come forward for care. We need to ensure that women are comfortable enough to get care so they can get into treatment as early as possible," said Waddell, who wasn't involved with the study.
She agreed with Fill that if children are born with NAS, there needs to be a system in place to identify and follow them so they get the early intervention care they need.
The findings were published Aug. 30 in the journal Pediatrics.
More information
Learn more about neonatal abstinence syndrome from the March of Dimes.
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Pediatricians Make Change to Child Car Seat Guidelines
THURSDAY, Aug. 30, 2018 (HealthDay News) -- Kids should ride in rear-facing car safety seats until they reach the highest height and weight their seat can hold, a leading pediatricians' group now says.
The previous advice from the American Academy of Pediatrics was to stop using a rear-facing seat when a child was 2 years old.
"Fortunately, car seat manufacturers have created seats that allow children to remain rear-facing until they weigh 40 pounds or more, which means most children can remain rear-facing past their second birthday," policy statement lead author Dr. Benjamin Hoffman said in an AAP news release.
"It's best to keep your child rear-facing as long as possible. This is still the safest way for children to ride," Hoffman added. He's chairman of the AAP Council on Injury, Violence and Poison Prevention.
Once kids outgrow a rear-facing seat, they should use a forward-facing safety seat with a harness until they reach its height and weight limits. Many seats can hold kids up to 65 pounds or more.
After that, children should use a belt-positioning booster seat until the vehicle's lap and shoulder belt fits properly. This is typically when they reach 4 feet 9 inches in height and are 8 to 12 years old.
Using the right seat reduces a child's risk of death or serious injury by more than 70 percent. Use it on every car ride, Hoffman said.
Car crashes are a leading cause of death for children, claiming four kids under age 14 every day during the last 10 years, he said.
"We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies," Hoffman said.
When children are old enough and big enough to use the vehicle's own restraints, they should always use lap and shoulder seat belts. For best protection, all children under age 13 should sit in the rear seat of a car.
The updated policy statement was published online Aug. 30 in the journal Pediatrics.
More information
The U.S. National Highway Traffic Safety Administration has more on child safety.
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Sleep Apnea Might Raise Odds for Painful Gout
THURSDAY, Aug. 30, 2018 (HealthDay News) -- People with sleep apnea have higher chances of developing gout, a new study suggests.
Researchers analyzed data on nearly 16,000 people with sleep apnea and more than 63,000 people without apnea who were followed for a median of nearly six years. (Half were followed longer, half for less time.)
Overall, 4.9 percent of sleep apnea patients and 2.6 percent of the others developed gout. People with sleep apnea had a 42 percent higher risk of gout, the study found.
The increased risk was highest one to two years after sleep apnea diagnosis, and was greater for patients with normal body weight than among those who were overweight or obese, the researchers said.
Of course, the study couldn't prove that apnea causes gout, just that there was an association.
Gout is a painful form of arthritis caused by a buildup of uric acid in the body. It causes swollen, red, hot and stiff joints.
The study was published Aug. 30 in the journal Arthritis & Rheumatology.
"People with sleep apnea are at an increased risk of gout in both the short and long term. Since this risk was highest in people with normal body mass index, doctors and other health professionals should consider the possibility of gout in patients with sleep apnea regardless of body mass index," study co-leader Edward Roddy said in a journal news release.
Roddy is a clinical lecturer in rheumatology at Keele University in Staffordshire, England.
It's believed that periodic low levels of oxygen caused by sleep apnea lead to overproduction of uric acid, causing gout, the researchers said.
"Sleep apnea is commonly treated with continuous positive airways pressure -- or CPAP -- therapy. Since CPAP treatment corrects low oxygen levels it might also be expected to reduce uric acid levels, which could possibly reduce the risk of developing gout or treat existing gout," said study co-leader Milica Blagojevic-Bucknall.
She said more research is needed to investigate the effect of CPAP treatment in people with gout.
Blagojevic-Bucknall is a lecturer at Keele University.
More information
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on gout.
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