Quitting smoking may extend life 10 years - World Science

Quit­ting smok­ing early pro­longs life­span by an aver­age of about 10 years, a big­ger ben­e­fit than was pre­vi­ously un­der­stood, ac­cord­ing to a study of 1.3 mil­lion U.K. wom­en.

The sci­en­tists say that oth­er new re­search sug­gests si­m­i­lar ef­fects in men.

Brit­ish re­search­ers re­cruited 1.3 mil­lion wom­en were to a study be­tween 1996 and 2001, at ages 50 to 65 years. Par­ti­ci­pants filled out a ques­tion­naire about lifestyle, med­i­cal and so­cial fac­tors and were resur­veyed by mail three years lat­er. Wom­en were traced for an av­er­age of 12 years from when they joined. The find­ings were pub­lished in the med­i­cal jour­nal The Lan­cet on Oct. 27.

In­i­tial­ly, 20 per­cent of the study par­ti­ci­pants were smok­ers, 28 per­cent were ex-smok­ers, and 52 per­cent had nev­er smoked. Those who were still smok­ers three years lat­er were found to be nearly three times as likely as non-smok­ers to die over the next nine years, even though some re­duced their risk by stop­ping smok­ing dur­ing this pe­ri­od. 

The three­fold death rate ra­tio means that two-thirds of all deaths of smok­ers in their 50s, 60s, and 70s are caused by smok­ing, as most of the dif­fer­ence be­tween smok­ers and non-smok­ers came from smok­ing-related dis­eases such as lung can­cer, chron­ic lung dis­ease, heart dis­ease, or stroke, the re­search­ers said.

The risks among smok­ers in­creased steeply with amount smoked, al­though even for those who smoked just one cig­a­rette a day at the start of the stu­dy, mor­tal­ity rates were dou­ble those for non-smok­ers.

Both the haz­ards of smok­ing and, ac­cord­ing­ingly, the ben­e­fits of stop­ping are big­ger than pre­vi­ous stud­ies have sug­gested, the in­ves­ti­ga­tors said. Smok­ers who stopped around age 30 were found to avoid 97 per­cent of their ex­cess risk of prem­a­ture death, and al­though se­ri­ous ex­cess haz­ards re­mained for dec­ades among those who smoked un­til age 40 be­fore stop­ping, the ex­cess haz­ards among those who con­tin­ued smok­ing af­ter age 40 were ten times big­ger.

“If wom­en smoke like men, they die like men – but, wheth­er they are men or wom­en, smok­ers who stop be­fore reach­ing mid­dle age will on av­er­age gain about an ex­tra ten years of life,” said study co-author Rich­ard Pe­to, at the Uni­vers­ity of Ox­ford, UK. “Both in the UK and in the USA, wom­en born around 1940 were the first genera­t­ion in which many smoked substanti­al num­bers of cig­a­rettes through­out adult life. Hence, only in the 21st cen­tu­ry could we ob­serve di­rectly the full ef­fects of pro­longed smok­ing, and of pro­longed cessa­t­ion, on prem­a­ture mor­tal­ity among wom­en.”

The au­thors wrote that they found “the pro­por­tion­al ex­cess risk in smok­ers was more marked than in many pre­vi­ous stud­ies, but re­cently up­dat­ed anal­y­ses of 21st cen­tu­ry mor­tal­ity in six smaller co­horts of U.S. smok­ers now sug­gest, in ag­gre­gate, si­m­i­lar haz­ards from smok­ing and ben­e­fits of stop­ping, as does a re­cent study in Jap­a­nese men and wom­en.”

As for their own stu­dy, Pe­to and col­leagues wrote fur­ther that “al­though the rel­a­tive risks for the ef­fects of pro­longed smok­ing on par­tic­u­lar dis­eases can­not be gen­er­al­ised ex­actly to popula­t­ions with very dif­fer­ent back­ground rates of those dis­eases, they should be ap­prox­i­mately gen­er­al­isable to many (though not all) coun­tries where wom­en smoke.”

The re­search was pub­lished to mark the 100th an­ni­ver­sa­ry of the birth of Sir Rich­ard Doll, one of the first peo­ple to iden­ti­fy the link be­tween lung can­cer and smok­ing.

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Smokers Who Survive Stroke At Increased Risk Of Another Stroke, Heart Attack, Death

Those who quit smoking before their stroke also had less risk of poorer outcomes than current smokers, researchers found.

Researchers in Melbourne, Australia, tracked 1,589 patients who experienced a first or recurrent stroke in 1996-99. They followed them for 10 years, using medical records and in-person and telephone interviews, and tracked demographics, deaths, recurrent strokes and heart attacks.

Compared to those who never smoked: Those who smoked when they had a stroke were 30 percent more likely to have a poor outcome. Among those who survived the first 28 days after stroke, current smokers had a 42 percent higher risk of poorer outcomes. Ex-smokers had an 18 percent higher risk of poorer outcomes. Compared to past smokers: Among those who survived the first 28 days after stroke, current smokers had a 23 percent higher risk of poorer outcomes during the 10 years. "This research provides fresh incentive to quit smoking now or never start because it shows smokers fare far worse after strokes than non-smokers," said Amanda Thrift, Ph.D., the study's lead researcher and professor of epidemiology for the Department of Medicine in the Southern Clinical School at Monash University in Clayton, Victoria, Australia.

In the study, those living in disadvantaged areas were much more likely to smoke, with 52 percent of current smokers belonging to the most disadvantaged group, compared to 31 percent of those who never smoked.

"We also found smoking had its greatest impact on younger patients," Thrift said. "The people who smoked in our study were younger, more often male, and more often from a disadvantaged background. Although we want everyone to give up smoking, targeting this group could yield greater benefits with fewer dollars spent."

The study focused on patients who survived the most common type of stroke: an ischemic stroke (caused by blood clot). Researchers didn't link smoking to poorer long-term outcomes for patients whose stroke was caused by bleeding within the brain (intracerebral hemorrhage), possibly due to a small sample size.

Previous studies, which have been shorter, had a smaller sample size or were less comprehensive, have provided inconsistent results on smoking's role on long-term outcomes after a stroke.

Stroke is the fourth-leading cause of death and the leading cause of adult disability in the United States.

A stroke occurs about every 40 seconds in America.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our stroke section for the latest news on this subject. Co-authors are Joosup Kim, BBiomedSci; Seana Gall, Ph.D.; Helen Dewey, Ph.D.; Richard Macdonell, M.D.; and Jonathan Sturm, Ph.D. Author disclosures are on the manuscript.
The National Health and Medical Research Council, Victorian Health Promotion Foundation, Foundation for High Blood Pressure Research and the National Stroke Foundation funded the study.
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Panel: Pregnant women, get whooping cough shot - Boston.com

AP Medical Writer /  October 24, 2012

ATLANTA (AP) — An expert panel is urging every expecting mother to get a shot preventing whooping cough, preferably in the last three months of her pregnancy to help protect her baby.

The advice follows a frightening resurgence of the dreaded childhood disease. More than 32,000 cases, including 16 deaths, have been reported so far this year, and 2012 is on track to be the nation’s worst year for whooping cough since 1959.

It’s only the second time a vaccine has been advised for all women during pregnancy. Flu shots were first recommended for them in the 1990s.

The new advice was approved in a vote Wednesday by the government’s vaccine advisory panel. Federal health officials usually adopt the group’s guidance and promote it to doctors and the public.

Whooping cough, or pertussis, is a highly contagious disease. Its name comes from the sound children make as they gasp for breath.

Despite long-standing childhood immunizations, cases have been climbing in the past decade. Most are infants two months and younger — too young to be vaccinated because their immune systems are too immature.

Health officials increasingly have pushed to get older children and adults vaccinated, to reduce the number of carriers who might infect vulnerable infants. An estimated 30 to 40 percent of infected newborns got the disease from their mothers.

In recent years, a combination vaccine — that included protection against pertussis— was offered to women immediately after they gave birth. Then after a whooping cough epidemic in California, the panel last year recommended a one-time dose of a combination vaccine for expectant mothers, either before or during pregnancy.

But fewer than 3 percent of pregnant women have gotten the vaccination, according to the Centers for Disease Control and Prevention.

Worse, recent research has shown the whooping cough vaccine’s protection doesn’t last as long as previously thought. A recent study found women vaccinated within two years of their pregnancy had relatively few antibodies to pass on to their newborns. That included women vaccinated early in their pregnancy, said Dr. Mary Healy, the Baylor College of Medicine researcher who led the study. That suggests women need to be vaccinated during the third trimester for it to really have an effect, she said.

Despite the overwhelming vote tally, several members of the panel voiced uneasiness with a lack of data on how effective and safe such a recommendation will be for mothers and newborns.

CDC officials acknowledge they have data on only hundreds of women who got the shots during pregnancy. What’s more, the vaccine is only licensed to be given to adults once. Under the new recommendation, women who raise large families may be getting the vaccine three or four or more times.

But CDC experts repeated there’s no evidence of serious risk to either mothers or newborns. And they estimated that enacting the recommendation could reduce whooping cough cases by 33 percent, hospitalizations by 38 percent and deaths by 49 percent.

‘‘The benefits of vaccination outweigh the theoretical risks,’’ said Jennifer Liang, a CDC epidemiologist who presented the benefit estimates to the panel.

© Copyright 2012 Globe Newspaper Company.

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Spending on Medicaid Has Slowed, Survey Finds - New York Times

Medicaid provides health and long-term care coverage to more than 60 million poor people, at a combined cost to the states and federal government of more than $400 billion a year. During the recession, as Americans lost jobs and health insurance, enrollment in the program rose sharply, and states struggled under the weight of its costs. But in the fiscal year that ended for most states in June, total spending on Medicaid grew by only 2 percent — much less than the nearly 10 percent increase in 2011 and one of the lowest rates on record. The slowdown is due not only to more measured enrollment growth — 3.2 percent, compared with 4.4 percent in 2011 and 7.2 percent in 2010 — but also to continued cost-cutting by states. “Reining in costs remains the dominant theme,” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonpartisan group that conducts the survey annually with Health Management Associates, a research and consulting firm. The most typical Medicaid spending cuts were to reimbursement rates for hospitals and doctors and to optional benefits, like dental, vision and drug coverage. Forty-five states cut or froze reimbursement rates last year, according to the report, while 18 scaled back benefits. Many also expanded the use of managed care for their Medicaid populations. The national health care law has generally prohibited states from tightening eligibility for Medicaid before 2014, when the law envisions expanding the program to cover more low-income people. So the slowing of enrollment is not because fewer people are qualifying, Ms. Rowland said, but because fewer “are coming through the door.” Last year was something of an aberration, because states stopped receiving extra federal Medicaid funds that had flowed for nearly three years as part of the federal stimulus act. Without the additional help, the state share of Medicaid spending rose by 27.5 percent last year, according to the survey. That put additional pressure on states to limit costs and helps explain the modest increase in spending. Medicaid has been the subject of heated national debate in recent months, both because the Supreme Court ruled in June that states could opt out of the expansion that is a cornerstone of the health care law and because President Obama and Mitt Romney, his Republican challenger, have sharply different visions for the program’s future. Mr. Romney and Republicans in Congress want to repeal the health care law and replace the current Medicaid program with block grants, giving each state a fixed amount of federal money each year and more control over eligibility and benefits. (The federal government currently sets minimum requirements, like covering all children under the poverty level, and provides unlimited matching funds.) Medicaid spending will grow modestly again this fiscal year, the survey found, with an average increase of 3.8 percent. Enrollment will continue to increase, but by only 2.7 percent, an even slower rate than last year. More than one-third of states say they could see a Medicaid budget shortfall, but that is an improvement over last year, when more than half of states predicted a shortfall. States will also step up attempts to better coordinate care for Medicaid enrollees, especially those with expensive chronic conditions. Thirty states started or expanded such programs last year, the survey found, and 45 are doing so this fiscal year. Many such programs focus on “dual eligibles” — nine million people who qualify for both Medicare and Medicaid, are especially complicated to treat and account for a disproportionate share of spending. “Those changes are an investment up front and require a longer lead time in terms of seeing savings down the road,” Ms. Rowland said.
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323 infected in meningitis outbreak as experts study fungal culprit - CBS News

In a growing fungal meningitis outbreak, 323 Americans have been infected, the Centers for Disease Control and Prevention announced Thursday. Twenty-four people have died.

Yesterday, the agency had reported 312 cases of fungal meningitis, including 24 deaths, in patients who received contaminated epidural steroid injections made by the New England Compounding Center, mostly for back pain.

The CDC also notes five peripheral joint infections from patients who received injections in joints such as the knee, hip, shoulder or elbow, for a total of 328 cases tied to the outbreak (up from 317 yesterday).

The Food and Drug Administration confirmed the same fungus found in at least 40 people sickened with fungal meningitis was also discovered in more than 50 unopened vials from one of the recalled lots of preservative-free methylprednisolone acetate injections from the New England Compounding Center. About 97 percent of the 14,000 patients who received injections from the implicated lots of steroids have been contacted for follow-up, according to the CDC.

A preliminary investigation of the NECC's Framingham, Mass., facility found dirty floor mats, a leaky boiler and black fungus specks in steroid vials, among complaints. State officials also said their investigation found drugs were sent out before test results on their sterility could be returned. They also said the company operated as a drug manufacturer by producing drugs for broader use, rather than filling specific prescriptions like its license allowed. The state has moved to revoke the company's license given its investigation.

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The black mold creeping into the spines of hundreds of Americans who got the tainted shots marks uncharted territory for doctors, because this particular fungus has never been found to cause meningitis. The main culprit is a fungus called Exserohilum rostratum, which is commonly found in dirt and grasses. Only 33 human infections with Exserohilum rostratum have previously had been reported, and they are mostly eye or skin infections in people with weak immune systems, said Dr. Arturo Casadevall, a fungal disease specialist at New York's Albert Einstein College of Medicine.

Fungal infections don't get a lot of attention, but they afflict millions around the world, said David Perlin of the University of Medicine and Dentistry of New Jersey. Most are skin infections like athlete's foot, but fungi also can cause pneumonia, sinusitis and other problems.

Serious infections tend to strike people with immune systems weakened because of cancer, AIDS or other problems. Fungus-caused meningitis in particular is extremely rare -- especially in otherwise healthy people like in this outbreak -- and it is "very bad news," said Dr. Carol Kauffman, a professor of infectious diseases at University of Michigan in Ann Arbor, Mich. She has advised the CDC and co-authored advice in the New England Journal of Medicine on how to handle the complex medication used in treatment.

While the more common bacterial and viral forms of meningitis tend to strike quickly with obvious symptoms, fungal meningitis grows very slowly and is hard to diagnose. Few anti-fungal drugs are absorbed into the central nervous system, limiting treatment options. Plus, human cells and fungal cells have a lot of similarities, making it hard to attack the fungus without side effects, Kauffman explained.

Also, the Exserohilum rostratum fungus' brown-black color signals an armor that -- along with being injected near the spine -- allows this mold sneak past the immune defenses of otherwise healthy people, Casadevall said.

"What we're dealing with here is fundamentally different from a typical fungal infection," he said. "This is a bug that most of us don't know much about."

Here's how scientists think it's sneaking into the well-guarded spinal cord and brain of a healthy person:

-The steroid injected near the spine reduces inflammation, one of the immune system's defenses against contamination.

-The mold grows quietly until enough accumulates for it to burrow a tiny hole, or abscess, into the lining of the spinal canal, said Dr. William Schaffner of Vanderbilt University. Reaching the spinal fluid inside offers a direct pathway to the brain.

-The fungus' color signals how intractable it is. Brown-black molds produce melanin, the same chemical that helps human skin tan. It guards against the sun's mold-killing ultraviolet rays - and inside people, it fends off both antifungal drugs and other immune-system attacks, Casadevall said.

The good news: Black mold is treatable with a drug named voriconazole, with far fewer side effects than the older treatment initially recommended when the outbreak began. Kauffman cautioned doctors to carefully monitor patients because differences in metabolism can make levels surge in the bloodstream, causing hallucinations, confusion, nausea and occasionally liver damage. On the flip side, their bodies may process the drug too quickly to battle the fungus. Plus, voriconazole can interact badly with a list of other common medications.

Other bad news? It is incredibly hard to diagnose and kill, and requires at least three months of a treatment that can cause hallucinations. There is no good way to predict survival, when it's safe to stop treating or exactly how to monitor those who fear the fungus may be festering silently in their bodies.

"I don't think there is a precedent for this kind of thing," said Dr. Arjun Srinivasan of the Centers for Disease Control and Prevention.

Doctors are beginning to detail in medical journals the first deaths in this outbreak, and the grim autopsy findings make clear that treating early is crucial, before the fungus becomes entrenched. In one case, a woman died after the fungus pierced blood vessels in her brain, leading to severe damage.

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People getting treated earlier "seem to be doing OK," with fewer of the strokes that characterized the outbreak's beginning, Kauffman said,

It's not clear how long to treat but at least three months is advised, Kauffman said. It begins with intravenous infusions that are hard to administer outside of a hospital. Then once the patient is stable enough, pills can be used.

People who got contaminated steroid shots have been told to be on guard for months for meningitis symptoms. But the CDC said Wednesday that the biggest risk for getting sick seems to be within 42 days of receiving one of the implicated back injections.

With the tainted shots recalled in late September, that means the period of greatest risk is nearing an end. It should help doctors bombarded with calls from worried patients determine who most needs a spinal tap to look for the very earliest signs of infection. Still, public health officials recall a 2002 meningitis cluster linked to steroid injections contaminated with a different fungus; one of those victims got sick 152 days after the shot.

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