Women Often Miss Signs of Stroke

A new online survey of U.S. women finds only about one in four women aged 25 to 75 can name more than two primary symptoms of stroke.

This is important because researchers say it takes longer for women than men to seek medical care at the hospital after a stroke, and researchers think lack of awareness about symptoms may cause even worse delays.

The survey also found that women think that breast cancer is five times more common than stroke (women are actually twice as likely to die of stroke than breast cancer), and 40 percent of women surveyed weren't very concerned about experiencing a stroke.

In general, women surveyed weren't aware that women suffer more strokes than men, and one-quarter said they didn't believe stroke could happen at any age.

The researchers also found that black and Hispanic women knew fewer facts about stroke than white women in some specific areas of knowledge.

"If you experience any of the symptoms of a stroke, it is imperative to call 911 so you receive immediate medical attention, even if the symptoms go away," Dr. Angela Gardner, president of the American College of Emergency Physicians, said in a news release from the HealthyWomen organization. "Time equals brain; for every minute the brain is deprived of oxygen, it may lose up to 1.9 million brain cells. If you are having even one of the symptoms of stroke, come to the emergency department so we can evaluate and treat you."

The main symptoms of stroke are:
Sudden difficulty speaking, understanding speech, or confusion
Sudden numbness or weakness in the limbs, particularly on one side
Sudden facial drooping or numbness and weakness on one side of the face
Sudden balance problems, dizziness or trouble walking
Sudden difficulty seeing with one or both eyes
Sudden severe headache

The online-only survey included 2,000 women in the United States, and was undertaken on behalf of HealthyWomen in conjunction with the American College of Emergency Physicians and National Stroke Association. It was funded by the Genentech, a biotech company that develops medications.

SOURCE: HealthyWomen, news release.

More Clues Emerge on How HIV Infects Women

Researchers have identified a previously unknown way that women are infected with HIV, the virus that causes AIDS.

HIV can break down and penetrate the epithelial cell barrier (designed to keep out infection) in the intestinal and female genital tract during intercourse, according to the study published online April 8 in PLoS Pathogens.

Prior to this study, many scientists believed that HIV invaded women's reproductive tract after some sort of trauma, such as a small tear during intercourse. This is the first time researchers have pinpointed HIV itself as the possible culprit.

The breakdown in protection appears to be caused by inflammatory factors produced when HIV binds to epithelial cells. The tight junctions between the protective cells are destroyed, which gives HIV access to the inside of the body in order to infect immune cells, the Canadian study authors noted.

"This is a significant step forward in defining where prevention strategies, such as microbicides and vaccines, need to focus. Instead of trying to stop HIV from infecting the target cells underneath the [protective barrier], we need to think about ways to stop the virus from attaching to epithelial cells themselves," lead researcher Charu Kaushic, an associate professor in the Centre for Gene Therapeutics at McMaster University in Hamilton, Ontario, said in a university news release.

Women account for half of the 40 million people worldwide infected with HIV.


SOURCE: McMaster University, news release

When Sleep Suffers, So Does Decisiveness

Sleep-deprived people may put themselves and others at risk when they need to make split-second decisions, U.S. researchers have found.

The study, which included 49 U.S. military cadets, looked at how sleep deprivation affected information-integration, a process that relies heavily on instantaneous, gut-feeling decisions.

"It's important to understand this domain of procedural learning because information-integration -- the fast and accurate strategy -- is critical in situations when soldiers need to make split-second decisions based about whether a potential target is an enemy soldier, a civilian or one of their own," Todd Maddox, a psychology professor at the University of Texas at Austin, said in a university news release.

The ability to make split-second decisions is crucial in a number of other high-pressure professions, including firefighters and police officers, the study authors noted.

The cadets performed information-integration tasks twice -- once when they were well-rested and once while they were sleep-deprived. The results showed that moderate sleep deprivation can cause an overall immediate loss of information-integration thought processes.

Accuracy on the information-integration tasks declined by 2.4 percent (73.1 percent to 70.7 percent) when cadets were sleep-deprived, and improved by 4.3 percent (74 percent to 78.3 percent) when they were well-rested, the researchers found.

Laser Treatment for Vision Loss from Branch Retinal Vein Occlusion is Safer than Corticosteroid Injections and Equally Effective

Scientists have found that laser therapy is equivalent to two different dosages of corticosteroid medications for treating vision loss from the blockage of small veins in the back of the eye, a condition known as branch retinal vein occlusion (BRVO). Furthermore, laser treatment was shown to have fewer complications for patients. This research was part of the Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) Study, a phase III clinical trial conducted at 84 sites and supported by the National Eye Institute (NEI) at the National Institutes of Health. "The SCORE study is the first to demonstrate that laser treatment and injections of corticosteroid into the eye have a similar impact on vision loss for patients who have retinal swelling due to branch retinal vein occlusion," said Ingrid U. Scott, M.D., M.P.H., professor at Penn State College of Medicine and co-chair of the SCORE study. "However, the lower rate of complications with laser treatment may indicate that it is the best proven treatment option for patients at this time, and that laser represents the benchmark against which other treatments should be compared in future clinical trials." In the United States, vein occlusion is estimated to be the second most common condition affecting blood vessels in the retina. In BRVO, a blood clot slows or stops circulation in a small vein within the eye's light-sensitive retinal tissue. This may lead to new blood vessel growth and blood vessel leakage, which results in retinal tissue swelling — a common cause of vision loss from BRVO. Eye doctors typically treat BRVO with laser therapy applied to the affected retina in a grid pattern. However, some ophthalmologists have treated people who have BRVO using eye injections of an anti-inflammatory corticosteroid called triamcinolone. Because clinical observations suggested a visual benefit, the SCORE study was initiated to compare the safety and effectiveness of standard care laser treatment with two different doses of triamcinolone — 1 milligram and 4 milligrams. The results appear in the September 2009 issue of Archives of Ophthalmology, published alongside findings from a separate trial within the SCORE study, which looked at blockages in larger retinal veins (http://www.nei.nih.gov/news/pressreleases/091409a.asp). Participants in the study included 411 people with BRVO who were an average of 67 years old. Patients could receive treatment every four months for up to three years. One year after patients began the trial, equal numbers of patients experienced visual improvement in each treatment group. Twenty to 30 percent of patients in each group experienced substantial visual gains of three or more lines on a vision chart — equivalent to identifying letters that were half as small as they could read before treatment. However, patients who received either dosage of corticosteroid medication were more likely to develop a cataract or have an increase in eye pressure requiring medication than patients who received laser treatment. Between one and two years after treatment was begun, patients who received the 4 milligram dosage were also more likely to undergo cataract surgery. "These results may have a significant public health impact by providing guidance for clinicians and patients in their selection of a branch retinal vein occlusion treatment," said Frederick L. Ferris III, M.D., clinical director of the NEI. "Still, better treatments for this condition are needed. This information could guide future clinical trials of new and more effective treatments for BRVO patients."

Some Parents Aren't Giving Kids Pain Meds Post-Surgery

Twenty-five percent of children aren't getting sufficient pain medication from their parents after common surgical procedures, such as having their tonsils out, a new study finds. It's not clear at this point what the ramifications of the finding are, or the reasons for it. In a worst-case scenario, kids who don't get enough medication may not be able to swallow enough water, leading to dehydration and even hospitalization, said Dr. Kenneth Goldschneider, director of the division of pain management at Cincinnati Children's Hospital. He was not involved in the new study. Another expert, Dr. Patricia Cantwell, professor and chief of pediatric critical care medicine at the University of Miami Miller School of Medicine, agreed that many young patients at her facility end up back in the emergency room as a result of unresolved pain issues. Under-medication could affect large numbers of children. According to background information in the article, published in the October issue of Pediatrics, upwards of 5 million children in the United States undergo surgery each year, with three-quarters having significant pain afterward. Tonsillectomy and adenoidectomy (to remove the adenoids) are among the most widely performed procedures in younger people. As hospital stays get shorter and more procedures are done on an outpatient basis, medication is given more often in the home. "The typical way in which pain medicine is given, I would say, is the surgical team giving the family a prescription, then you go out the door and fill it," said Cantwell. The study authors, from the University of California, Irvine and the Children's Hospital of Orange County, Calif., looked at 261 children aged 2 to 12 who had undergone one of these two procedures. On the first day home, parents reported that 86 percent of their children were experiencing "significant overall pain." Despite that, one in four children received minimal pain medication: zero or one medication dose that day. Three days after surgery, two-thirds of the children still had significant pain, with 41 percent getting minimal medication, according to the study. The study authors speculated that under-medication could be due to parents' fears that their child will become addicted to medications such as Tylenol with codeine. Parents might also not realize how much pain their children are in, especially if the child is too young to communicate verbally. "There's a lot of nervousness on using pain medications," Goldschneider said. The study also found that parents with less education and with children who were "more reactive" were less likely to give pain medications, while parents with impulsive children were more likely to follow dosing instructions. Children may also just have trouble swallowing the pills, raising the issue of whether other "delivery systems," such as a patch, might be more useful, Cantwell said. "We need to educate parents on how to use these medications," Goldschneider said. A second study in the same issue of the journal found a 70 percent jump in venous thromboembolisms (VTEs) -- blood clots that usually occur in the veins of the legs -- diagnosed at children's hospitals between 2001 and 2007. In 2007, 58 cases of VTE per 10,000 hospital admissions were recorded, versus 34 per 10,000 in 2001. Almost two-thirds of the children had underlying medical conditions, most commonly cancer, the study found. The authors, from the University of Pennsylvania and the Children's Hospital of Philadelphia, could not say if the increase was the result of more actual cases or better detection.

Combo Therapies to Lower Cholesterol Don't Work

Despite their popularity, so-called "combination therapies" may not be the most effective treatment for high cholesterol, Canadian researchers report. In their review, the scientists analyzed data from 102 studies that tested combination therapies involving ezetimibe, niacin, bile acid sequestrants and omega-3 fatty acids. They concluded that there is little evidence to support the widespread use of combination therapies to lower cholesterol. The results of this comprehensive review of clinical studies are important, as lowering cholesterol has been shown to decrease the risk of heart attack and stroke, and more than 35 million Canadians and Americans are prescribed cholesterol-lowering drugs each year, according to a news release from the Ottawa Hospital Research Institute. In the new study, stroke specialist Dr. Mukul Sharma and colleagues from the Ottawa Hospital Research Institute and the University of Ottawa looked for evidence that supported the use of combination therapies vs. high-dose statin therapy. Although statins are the most commonly used class of cholesterol-lowering drugs, some people don't respond to the standard dose. For these people, statins are increasingly being prescribed at higher doses or in combination with other types of drugs, according to the report published online Sept. 1 in the Annals of Internal Medicine. "Our review shows that so far, there is not enough evidence to support the widespread use of combination therapies over high-dose statin therapy," Sharma said in the news release. "For most patients who don't respond to a low dose of statin, it would make sense to try a higher dose of statin before trying a combination therapy. If the high-dose statin does not work or is not well-tolerated, or if there are other special circumstances, a combination therapy may be a good option, but until more research is done, this is not recommended for most patients."

Pfizer to Pay Record Fine in Fraud Probe

In what it calls the largest health-care fraud settlement in U.S. history, the Justice Department said Wednesday that pharmaceutical giant Pfizer Inc. and a subsidiary have agreed to pay a $2.3 billion penalty for illegally promoting certain drugs. Those drugs included Bextra, part of a group of painkillers called Cox-2 inhibitors, which Pfizer pulled from the market in 2005 after reports of potential heart risks to patients. The other drugs were Geodon, an antipsychotic; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug, the Justice Department said in a news release. In each case, the Justice Department accused Pfizer of marketing the drugs for uses other than those approved by the U.S. Food and Drug Administration, a practice called "off-label" use. According to the news release, the Food, Drug and Cosmetic Act stipulates that a company must "specify the intended uses of a product in its new drug application to FDA. Once approved, the drug may not be marketed or promoted for so-called 'off-label' uses." Pfizer promoted Bextra for several uses and dosages not sanctioned by the FDA due to safety concerns, the Justice Department said. As part of the settlement, Pfizer also agreed to enter into a so-called "expansive corporate integrity agreement" with the Department of Health and Human Services' Office of Inspector General. That agreement calls for the establishment of "procedures and reviews" designed to prevent a similar occurrence, the agency said. "Today's landmark settlement is an example of the Department of Justice's ongoing and intensive efforts to protect the American public and recover funds for the federal treasury and the public from those who seek to earn a profit through fraud," Associate Attorney General Tom Perrelli said in the news release. Kathleen Sebelius, secretary of the Department of Health and Human Services, said: "The Department of Health and Human Services will continue to seek opportunities to work with its government partners to prosecute fraud wherever we can find it. But we will also look for new ways to prevent fraud before it happens. Health care is too important to let a single dollar go to waste." In a statement, Pfizer general counsel Amy W. Schulman said the agreement ends all "material pending matters" with the Justice Department. "This gives us a very important opportunity to put final closure on the universe of material open items involving our U.S.-based operations," she said, Bloomberg News reported.