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People who are enthusiastic and content are less likely to develop heart disease than less happy people, researchers from Columbia University report.

In this prospective study of the relationship between happiness and heart disease, researchers concluded that if everyone did more of the things that made them happy, they could significantly reduce their risk of heart attack and angina.

“We were excited to discover in a large population-based sample of adults that the tendency to express positive emotion predicted fewer heart attacks across a period of 10 years,” said lead researcher Karina Davidson, director of Columbia’s Center for Behavioral Cardiovascular Health.

“The study suggests that those people who are happier have heart-protective outcomes,” she added.

Davidson speculated that several factors may combine to producing this effect. Happier people tend to sleep better and to practice more heart-healthy behaviors, she said.

“But they may also be physiologically different than those of us who are more unhappy,” Davidson said.

In addition, these people tend to have less stress in their lives and handle the stress they do have better than less happy people, she added.

The report is published in the Feb. 18 issue of the European Heart Journal.

For the study, Davidson’s team followed 1,739 men and women for 10 years. These people all participated in the 1995 Nova Scotia Health Survey. At the start of the study, everyone had their risk for heart disease assessed.

In addition, researchers looked for symptoms of depression, hostility, anxiety and the expression of positive emotions — known as “positive affect.” This is defined as the experience of pleasurable emotions, such as joy, happiness, excitement, enthusiasm and contentment, according to Davidson.

The researchers found that over the study period the happier someone was, the less likely he or she was to develop heart disease. In fact, for every point on a five-point scale that measured positive affect, the risk of heart disease dropped 22 percent.

However, unhappy people had a 22 percent increased risk of having a heart attack or chronic chest pain, compared with those who were somewhat happy. These somewhat happy people also had a 22 percent increased risk for heart problems compared with people who were moderately happy, the researchers noted.

People who were generally happy, but had a few symptoms of depression, did not see these symptoms increase their lowered risk for heart disease, Davidson added.

Davidson noted that she is involved in a clinical trial to test whether changing people’s happiness level improves their heart health.

“In the meantime, it is good for one’s quality of life and mental health to engage in happy behaviors or things that give you pleasure on a daily basis — and many of us here in North America don’t do that,” she said.

Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles and co-director of the UCLA Preventative Cardiology Program, said that “negative emotions such as depression, anxiety and anger have been shown to be associated with increased risk of cardiovascular events and mortality.”

Some, but not all previous studies, have suggested that positive affect is associated with lower risk of disease and improved clinical outcomes, he added.

“This new, large population-based study suggests that positive affect is associated with a reduced risk of coronary heart disease over 10 years independent of other cardiovascular risk factors and independent of depression and other negative affects,” Fonarow said.

“These findings are intriguing. The clinical significance will depend on whether it can be subsequently shown that interventions designed to increase positive affect can lower the risk of cardiovascular disease,” he added.

However, while maintaining a positive affect may be one factor associated with a lower risk of cardiovascular disease, regular exercise, not smoking, a healthy diet and maintaining optimal blood pressure, cholesterol levels and body weight are well-established and essential, Fonarow noted.

SOURCES: Karina Davidson, Ph.D., Herbert Irving Associate Professor of Medicine & Psychiatry, and director, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles, and director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, UCLA Preventative Cardiology Program

It takes time, but children who receive cochlear implants in both ears gradually learn to control the loudness and pitch of their voices, a new study has found.

Cochlear implants are electronic devices that provide sound to people who are deaf or severely hearing-impaired.

“Although cochlear implants do not restore sound perception as experienced by an individual with normal hearing, the implant provides the user with auditory feedback in the domains of timing, intensity and frequency of sound. These auditory feedback cues may be critical for the user to monitor his or her speech production and to make purposeful moment-to-moment adjustments in voicing,” wrote Dr. Theresa Holler and colleagues at the Hospital for Sick Children in Toronto, Canada.

The researchers conducted voice assessments of 27 children, aged 3 to 15, who received cochlear implants in both ears. They were compared to children with normal hearing.

Initially, the children with cochlear implants had poor control over the pitch and volume of their voices, compared to children with normal hearing. But voice pitch control improved over the long term as the children with cochlear implants used their hearing aids and had more exposure to hearing.

“To our knowledge, this is the first study to objectively evaluate acoustic voice outcomes in children with bilateral cochlear implants and to report the influence of overall time in sound on acoustic parameters,” the researchers wrote.

“Targeted speech therapies that assist children using cochlear implants in monitoring and modifying the pitch and loudness of their voice would be useful in this setting,” they concluded. “Future work is planned to develop and evaluate therapeutic tools that will specifically address these areas in implant recipients, with the objective of minimizing or eliminating these voice abnormalities.”

The study appears in the January issue of the journal Archives of Otolaryngology — Head & Neck Surgery.

Another paper in the same issue of the journal associated trauma to the ear area and inner ear malformation with some complications that occur in children who receive cochlear implants.

The study included 434 children in France who were followed for an average of 5.5 years after they underwent cochlear implantation. Complications were classified as early (within eight days after surgery) or delayed (more than eight days after surgery), and minor or major (requiring hospital re-admission and/or extended hospital stay).

Forty-three patients (9.9 percent) experienced complications, including 28 with delayed complications, with an average delay of 2.2 years. Of those 43 patients, 13 (30.2 percent) required cochlear re-implantation.

The study also found that 24 patients (5.5 percent) had major complications, including severe infections (15 cases), displacement of the cochlear implant magnet (three cases), meningitis (two cases), skin cyst in the middle ear (two cases), cerebrospinal fluid leak (one case), and misplacement of the cochlear implant electrode (one case).

In addition, 19 patients (4.4 percent) experienced minor complications, including vertigo (nine patients), soft-tissue infections (five patients), persistent inflammation of the middle ear (four patients), and facial paralysis (one patient).

“Trauma to the mastoid [bony projection behind the ear] area (14 patients) and inner ear malformations (51) were highly correlated with major delayed complications and early minor complications, respectively. Young age at cochlear implantation was not correlated with any type of complication,” wrote Dr. Natalie Loundon and colleagues.

They said their results show that complications associated with cochlear implants are not rare and often occur years later, which “highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family.”

SOURCE: JAMA/Archives journals, news release, Jan. 18, 2010

The diabetes drug metformin is safe for diabetes patients with advanced heart failure, say U.S. researchers.

The study included 401 patients, average age 56, with type 2 diabetes and advanced systolic heart failure who were followed for 14 years in a heart-failure management program. The results suggest that metformin is safe in patients with both advanced heart failure and diabetes, and may be associated with better heart failure survival.

Metformin previously carried a “black box” warning from the U.S. Food and Drug Administration advising against its use in treating diabetes in heart failure patients. “In fact, many medications commonly used to lower serum glucose levels have theoretic or demonstrated adverse effects on heart failure,” study senior author Dr. Tamara Horwich, an assistant professor of medicine, division of cardiology, David Geffen School of Medicine, University of California, Los Angeles, said in a news release from the school.

“As a result, many physicians have been reluctant to use metformin and other similar medications to treat this patient group. However, our analysis shows that using metformin to treat diabetes in patients with advanced, systolic heart failure is not only safe, but may also play a role in improving outcomes compared to conventional diabetes care,” Horwich said.

“There may be over 2 million individuals with heart failure and type 2 diabetes mellitus in the U.S. alone, so this important finding will have fairly broad impact,” she noted.

The study was recently published online in the Journal of Cardiac Failure.

Chemotherapy helps improve breast cancer survival in post-menopausal women, adding to a long-standing debate about how best to treat these women, U.S. researchers said Thursday.

A gene-based test called Oncotype DX made by Genomic Health Inc may help identify a small group of women who are not likely to benefit from chemotherapy, a second study found.

The main study proves that adding chemotherapy to treatment with the estrogen-blocking drug tamoxifen can help prevent cancer from coming back in women with estrogen-receptor positive breast cancers, the most common kind in which a hormone is driving the cancer.

“We have a survival benefit that lasts for a very long time … for women who got both modalities of treatment versus women who just got tamoxifen,” said Dr. Kathy Albain of Loyola University Health System in Maywood, Illinois.

She presented findings from both studies at the American Association for Cancer Research San Antonio Breast Cancer Symposium.

“It is considered a landmark study in the clinical trials literature because it is the only one really demonstrating the survival advantage of chemotherapy added to tamoxifen,” Albain said in a telephone interview.

“Up until this trial, studies adding common chemotherapy drugs to tamoxifen or tamoxifen alone were essentially negative.”

For the study, the team followed nearly 1,500 post-menopausal women with estrogen-receptor positive breast cancers that had spread to at least one lymph node.

Some of the women got both tamoxifen and a chemotherapy drug known as anthracycline, and some got tamoxifen alone.

The team found that the women who got the chemotherapy were 24 percent less likely to have their cancer come back.

They were also 17 percent less likely to die during the 10-year study period, but this finding was just shy of meeting statistical significance.

The team also found that giving tamoxifen after chemotherapy ended instead of during chemotherapy improved a woman’s survival chances.

In a second study led by Albain, published in the journal Lancet Oncology, the team evaluated whether the Oncotype DX test can predict which women would benefit from chemotherapy.

The test examines 21 genes from a tumor sample to see how active they are, and produces a score that predicts chemotherapy benefit. It is most commonly used in women with estrogen-fed tumors whose cancer has not spread to a lymph node.

But Albain’s study suggests it may also be useful in identifying women whose tumors had spread that would not benefit from chemotherapy.

Albain said a large clinical trial is getting started that will confirm whether the test is effective, but that will be expensive and take many years.

Meanwhile, she said, some doctors like herself plan to use the test on certain patients to give them more choices about their breast cancer treatment options.

Heart attack patients face a higher risk of being admitted to the hospital for bleeding when they take more blood-thinning drugs, such as warfarin and aspirin, a new study has found.

The findings, based on an analysis of more than 40,000 Danish patients, were published online Dec. 10 in the journal The Lancet.

Doctors often prescribe combinations of drugs — including aspirin, clopidogrel (Plavix) and vitamin K antagonists like warfarin (Coumadin) — after a patient experiences a heart attack. But it’s not clear whether the combinations are safe, the study authors noted.

The researchers looked at the effects of various regimens on patients who had their first heart attack between 2000 and 2005.

During an average of 16 months after their heart attack, 4.6 percent of the patients returned to the hospital because of bleeding or died with bleeding identified as the cause of death.

The annual incidence of bleeding was lowest among those who just took aspirin (2.6 percent) and highest among those who took clopidogrel plus a vitamin K antagonist (12.3 percent) or all three drugs (12 percent).

“In patients with first-time heart attack, all combinations of aspirin, clopidogrel and vitamin K antagonists are associated with increased risk of nonfatal and fatal bleeding, apart from monotherapy with a vitamin K antagonist, compared with aspirin alone,” the study authors wrote.

“Increased risk of bleeding was proportional to the number of drugs used. Nonfatal bleeding is an independent predictor associated with increased risk of recurrent heart attack or death. We propose that treatment with triple therapy or dual therapy with clopidogrel plus vitamin K antagonist should be prescribed only after thorough individual risk assessment and careful consideration of the risk-benefit ratio,” they concluded.

Binge eating disorder is characterized by consuming an excessive amount of food at one time. But unlike people with anorexia or bulimia, they don’t exercise or purge afterward, hence they are often obese, the National Women’s Health Information Center says.

The center offers this list of possible warning signs of binge eating disorder:
Eating very quickly.
Eating beyond the point of satiety to the point of uncomfortable fullness.
Eating when not hungry.
Feeling embarrassed about eating, leading the person to eat alone.
Feeling guilt, disgust or depression after eating too much.

Americans without health insurance are more likely to die after admission to the hospital with trauma injuries than those who are insured, new research suggests.

“After admission to a hospital, trauma patients can have worse outcomes based on insurance status,” the study authors wrote. “This concerning finding warrants more rigorous investigation to determine why such variation in mortality would exist in a system where equivalent care is not only expected but mandated by law.”

Dr. Heather Rosen, from Children’s Hospital Boston and Harvard Medical School, and colleagues analyzed statistics from the National Trauma Data Bank, which has tracked 2.7 million trauma patients admitted to over 900 U.S. trauma centers. The researchers looked at 687,091 adult patients admitted between 2002 and 2006.

Uninsured patients were more likely to die than insured patients even when researchers tried to adjust the statistics to eliminate the influence of factors such as gender, age and race that might throw off the results.

“Treatment often is initiated before payer status is recognized; thus, this provokes the question of whether differences exist in processes of care during the hospital stay,” the study authors wrote. “We can only speculate as to the mechanism of the disparities we have exposed; the true causes are still unclear. Although the lack of insurance may not be the only explanation for the disparity in trauma mortality, the accidental costs of being uninsured in the United States today may be too high to continue to overlook.”

The U.S. Food and Drug Administration (FDA) has new data showing that omeprazole (Prilosec/Prilosec OTC)—a medicine used to reduce stomach acid—reduces the anti-blood clotting effect of clopidogrel (Plavix) by almost half when these two medicines are taken by the same patient. Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole. This effect is called a drug interaction and it occurs because omeprazole blocks the conversion of clopidogrel into its active form.

Since clopidogrel can cause bleeding in the stomach, medications like omeprazole may be used in combination to reduce the production of stomach acid, and prevent stomach bleeding. Omeprazole is available by prescription and as an over-the-counter (OTC) medication to treat frequent heartburn

FDA wants to emphasize the following information for patients using clopidogrel:
Patients using clopidogrel should consult with their healthcare provider if they are currently taking or considering taking omeprazole, including Prilosec OTC.
Both clopidogrel and omeprazole can provide significant benefits to patients, and patients should always consult with their healthcare professional before starting or stopping any medication.
It is very important that patients talk with their healthcare professional about any over-the-counter (OTC) drugs they are taking before starting or while using clopidogrel

Patients who use clopidogrel and need a medication to reduce stomach acid can use antacids (such as Maalox or Mylanta) and most acid reducers, such as Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine) because the FDA does not believe that these medicines will interfere with the anti-clotting activity of clopidogrel. However, Tagamet and Tagamet HB (cimetidine) should not be used. Ranitidine and famotidine are available by prescription and OTC and antacids are available OTC.

The manufacturers of clopidogrel have agreed to look at other possible drug interactions with clopidogrel. In the meantime, the clopidogrel label will be updated with new warnings on omeprazole and other drugs that could interact with clopidogrel in the same way. When more information becomes available, FDA will communicate any additional recommendations or conclusions on the use of clopidogrel.

The United States is doing a poor job of reducing preterm births, according to a new report, which found Mississippi, Alabama and Louisiana have especially high numbers of early, life-threatening deliveries.

Vermont and New Hampshire were the only states with a preterm birth rate under 10 percent, while in Louisiana, Alabama and Mississippi, the premature birth rate ranged from 16.5 to 18.3 percent.

Each year, the March of Dimes ranks each state according to its rate of premature births — babies born before 37 weeks of gestation. Preterm births contribute to infant mortality and can put children at risk for lifelong problems, including cerebral palsy and developmental disabilities.

The U.S. premature birth rate was 12.7 percent in 2007 (the year the birth data was collected), nearly twice the goal of 7.6 percent set by the federal government’s Healthy People 2010 campaign.

In the March of Dimes report, states were graded on how closely they came to meeting the preterm birth objective. No state earned an “‘A” and Vermont was the only state to earn a “B” grade. All the rest earned grades ranging from “C” to “F” and the nation overall earned a “D” grade.

Still, it wasn’t all bad news. Seven states — Arizona, Indiana, Missouri, Idaho, Massachusetts, Utah and Wisconsin — improved their grade year over year. However, Ohio’s and Oklahoma’s grades dropped.

“This year, we found a slight reduction in the rate of preterm birth,” said Jennifer Howse, March of Dimes president. “Overall, that’s encouraging. But as any good epidemiologist will tell you, one year does not a trend make.”

Howse said she was concerned that the recession, including job losses and loss of medical benefits, could reverse the trend when the birth statistics from 2008 and 2009 are analyzed. “I think we’re moving in the right direction, but I am worried we are going to see slippage,” Howse said.

The states that improved did so by targeting three key risk factors for premature birth: smoking during pregnancy, lack of health insurance for pregnant women, and elective inductions or cesarean sections done during the “late pre-term,” or between 34 to 36 weeks’ gestation. The March of Dimes recommends babies not be delivered by elective C-section or induction before 39 weeks.

Lack of health insurance keeps some women from getting prenatal care, which means health conditions that could affect the pregnancy, such as underlying infections, obesity, poor nutrition, diabetes, high blood pressure and periodontal disease, are less likely to be caught and treated.

About 33 states and the District of Columbia reduced the number of women of childbearing age who smoke; 21 states and Washington, D.C. insured more women year over year; while 27 states, Washington, D.C. and Puerto Rico lowered the late pre-term birth rate.

Though the target areas are important, Howse said physicians still don’t know all of the reasons why babies are born prematurely.

“We probably understand roughly half the risks that are associated with preterm birth, but the other half are very poorly understood from a biological standpoint,” Howse said

Dr. Harold Perl, a senior neonatologist at Hackensack University Medical Center in Hackensack, N.J., said that physicians in the United States are very skilled at taking care of premature babies after they are born, but more emphasis needs to be placed on preventing premature births in the first place.

“Overall, it’s a very important point that the March of Dimes is making,” Perl said. “We have to look not only at how well we take care of our premature babies, but what we can do to prevent mothers from having premature babies.”

The report didn’t explore some significant geographic variations in causes for preterm birth factors that need to be considered when designing education or intervention programs, Perl said. New Jersey and Missouri, for example, had roughly the same rate of premature births, 12.7 percent and 12.5 respectively.

But in Missouri, about 28.4 percent of expectant mothers smoked, ranking it among the states with the highest maternal smoking rates, compared to 12.8 percent in New Jersey, ranking it among the lowest.

In New Jersey, a key reason for premature births is the number of twins, triplets and higher-order multiples being born as a result of in vitro fertilization procedures, Perl said. Twins are delivered on average, at about 35 weeks, triplets at 33 weeks, and quadruplets at 29 weeks, according to the American College of Obstetricians and Gynecologists.

Perl recommends fertility doctors follow American Society for Reproductive Medicine guidelines that call for implanting no more than two embryos at a time for women under 35, and no more than three for women with poorer chances of becoming pregnant.

About 540,000 babies are born prematurely in the United States each year, costing more than $26 billion in additional health care costs.

It’s one of the reasons that the United States is ranked 30th in infant mortality, behind most other developed nations, according to a U.S. National Center for Health Statistics report issued earlier this month. Premature births have risen 36 percent since 1984, according to the report.

The anti-clotting drug dabigatran etexilate (Pradaxa) may be more effective and safer than warfarin at preventing clots and stroke in patients with atrial fibrillation, a new Swedish study has found.

Warfarin is effective in preventing blood clots that can cause stroke in patients with atrial fibrillation (abnormal heart rhythm) and other diseases, but the drug has a narrow therapeutic range in which it prevents strokes but doesn’t cause bleeding, according to the researchers. This means that effective warfarin treatment requires regular laboratory monitoring to ensure warfarin levels remain in the range that lowers the risk of stroke without increasing the risk of bleeding.

This study included 18,113 atrial fibrillation patients in 44 countries who were randomly selected to receive either oral treatment with standard warfarin (6,022 patients) or dabigatran etexilate at either 110 milligrams (6,015 patients) or 150 milligrams (6,076 patients).

After one to three years of follow-up, 1.69 percent of patients in the warfarin group suffered a stroke or serious clot per year, compared with 1.53 percent and 1.11 percent of patients taking 110-milligram and 150-milligram doses of dabigatran etexilate, respectively, the study authors, from University Hospital in Uppsala, found.

Rates per year of major bleeding were 3.36 percent in the warfarin group and 2.71 percent and 3.11 percent for patients taking 110-milligram and 150-milligram doses of dabigatran etexilate, respectively.

The study was scheduled to be presented Sunday at the American Heart Association’s annual meeting in Orlando, Fla.

The patients in the study were an average age of 72 and included some who’d suffered a prior stroke (13 percent), patients with high blood pressure (79 percent), those who’d never taken an oral anti-clotting drug for more than two months (50.4 percent), and those who weren’t using an oral anti-clotting drug when they enrolled in the study (34 percent).

Dabigatran etexilate is approved for use in Canada and Europe but not in the United States.