study suggests millions of people need to rethink their use of aspirin
to prevent a heart attack. (AP Photo/Patrick Sison)
Washington (AP) — Millions of people who
take aspirin to prevent a heart attack may need to rethink the
pill-popping, Harvard researchers have reported.
A daily low-dose aspirin is recommended for people
who have already had a heart attack or stroke and for those diagnosed
with heart disease.
But for the otherwise healthy, that advice has been
overturned. Guidelines released this year ruled out routine aspirin use
for many older adults who don’t already have heart disease — and said
it’s only for certain younger people under doctor’s orders.
How many people need to get that message?
In the United States, some 29 million people 40 and
older were taking an aspirin a day despite having no known heart disease
in 2017, the latest data available, according to a new study from
Harvard and Beth Israel Deaconess Medical Center. About 6.6 million of
them were doing so on their own — a doctor never recommended it.
And nearly half of people over 70 who don’t have
heart disease — estimated at about 10 million — were taking daily
aspirin for prevention, the researchers reported in Annals of Internal
“Many patients are confused about this,” said Dr.
Colin O’Brien, a senior internal medicine resident at Beth Israel who
led the study.
After all, for years doctors urged people to
leverage aspirin’s blood-thinning properties to lower the chances of a
first heart attack or stroke. Then last year, three surprising new
studies challenged that dogma. Those studies were some of the largest
and longest to test aspirin in people at low and moderate risk of a
heart attack, and found only marginal benefit if any, especially for
older adults. Yet the aspirin users experienced markedly more
digestive-tract bleeding, along with some other side effects. .
In March, those findings prompted a change in
guidelines from the American Heart Association and American College of
—People over 70 who don’t have heart disease — or
are younger but at increased risk of bleeding — should avoid daily
aspirin for prevention.
—Only certain 40- to 70-year-olds who don’t already
have heart disease are at high enough risk to warrant 75 to 100
milligrams of aspirin daily, and that’s for a doctor to decide.
Nothing has changed for heart attack survivors:
Aspirin still is recommended for them.
But there’s no way to know how many otherwise
healthy people got the word about the changed recommendations.
“We hope that more primary care doctors will talk
to their patients about aspirin use, and more patients will raise this
with their doctors,” O’Brien said.
A child receives treatment for dengue fever infection at Dhaka
Shishu Hospital in Dhaka, Bangladesh, Wednesday, July 31, 2019.
(AP Photo/Mahmud Hossain Opu)
Abdur Rahman Jahangir
Dhaka, Bangladesh (AP) — Bangladesh
is facing its worst-ever dengue fever outbreak as hospitals are
flooded with patients, putting a severe strain on the country's
already overwhelmed medical system.
The mosquito-borne viral infection has
spread across the country, with 61 out of 64 districts reporting
The government has confirmed 15,369 dengue
cases since Jan. 1. Of those, 9,683 patients were diagnosed
between July 1 and July 30. About 4,400 patients, including many
children, are undergoing hospital treatment. There have been 14
Officials from Dhaka, the overcrowded
capital and the epicenter of the outbreak, have struggled to
contain it, drawing criticism and spreading panic among some
Dengue is found in tropical areas around
the world and is spread by a type of mosquito that mainly lives
in urban areas. The virus causes severe flu-like symptoms, and
while there is no specific treatment for the illness, medical
care to maintain a person's fluid levels is seen as critical.
There are fears that the situation in the
countryside will worsen as many residents of the city travel to
villages to celebrate Eid-ul-Adha this month. Infected humans
can serve as a source of the virus for uninfected mosquitoes.
Ayesha Akhter, assistant director at the
Directorate General of Health Services under the Ministry of
Health, said an outbreak of dengue has accompanied every monsoon
since 2000, but this year's situation is the worst.
A DGHS study identified a six-fold increase
in the Aedes aegypti mosquito population in four months in Dhaka
as the primary cause of the larger-than-average outbreak.
Earlier last month, the World Health
Organization said the dengue situation in Bangladesh was
"alarming but not out of control."
Other countries in Asia are also facing a
surge in dengue cases this year, including Thailand, where
53,699 cases and 65 deaths were reported as of July 23.
Nevertheless, with dengue cases soaring in
recent weeks, Dhaka hospitals have been running out of room and
manpower to treat new patients.
Prof. Abul Kalam Azad, director general of
DGHS, said they had asked the hospitals to increase beds for
dengue patients and to open dengue wards. The government also
halved the charges for diagnosing dengue and directed public and
private hospitals, clinics and diagnostic centers to do the
Dhaka Medical College Hospital, the largest
hospital in the country, opened a special ward for dengue
patients, said A.K.M. Nasir Uddin, its director general.
Prof. Uttam Kumar Barua, director of
Shaheed Suhrawardy Medical College and Hospital, another major
public hospital in Dhaka, said they were relying on senior
medical students to assist doctors in the face of so many
"We don't have manpower, logistic support
and technicians as much as needed. That's why we are having too
much pressure. We have three times more patients than our bed
capacity," Barua said.
He said they were admitting every dengue
patient who entered the hospital but could not provide beds or
even seats for everyone, adding that many had been asked to wait
in hospital corridors and verandas.
Champa Begum took her 8-month-old to
Shaheed hospital recently.
"I have other kids. I go to work leaving
this one to another child. I have no way but to work," she said.
"I can't take care of this child properly. This child is laid
down anywhere. My home is above dirty water. That’s how this one
was bitten and got dengue."
Bangladeshi Prime Minister Sheikh Hasina
has called for concerted efforts to fight the illness.
"The government is working to tackle
dengue," she told an emergency meeting of her ruling Awami
League party. "I urge everyone to keep their houses and
surrounding areas clean. That will save us from the disease,"
The country's opposition parties and urban
planning experts blamed the central and local government's lack
of preparedness for the rise in dengue cases. People have taken
to Facebook to vent their anger about city authorities' failure
to control dengue-carrying mosquitoes.
Research released on
Sunday, July 14, 2019 suggests that a healthy lifestyle can cut the risk
of developing Alzheimer's even if you've inherited genes that raise your
risk for the mind-destroying disease. (AP Photo/Francisco Seco, File)
Los Angeles (AP) — A healthy lifestyle can
cut your risk of developing Alzheimer's or other forms of dementia even
if you have genes that raise your risk for these mind-destroying
diseases, a large study has found.
People with high genetic risk and poor health
habits were about three times more likely to develop dementia versus
those with low genetic risk and good habits, researchers reported
Sunday. Regardless of how much genetic risk someone had, a good diet,
adequate exercise, limiting alcohol and not smoking made dementia less
"I consider that good news," said John Haaga of the
U.S. National Institute on Aging, one of the study's many sponsors. "No
one can guarantee you'll escape this awful disease" but you can tip the
odds in your favor with clean living, he said.
Results were discussed at the Alzheimer's
Association International Conference in Los Angeles and published online
by the Journal of the American Medical Association.
About 50 million people have dementia, and
Alzheimer's disease is the most common type. Genes and lifestyle
contribute to many diseases, but researchers only recently have had the
tools and information to do large studies to see how much each factor
One such study a few years ago found that healthy
living could help overcome genetic risk for heart disease. Now
researchers have shown the same to be true for dementia.
Dr. Elzbieta Kuzma and colleagues at the University
of Exeter Medical School in England used the UK Biobank to study nearly
200,000 people 60 or older with no signs or symptoms of dementia at the
start. Their genetic risk was classified as high, medium or low based on
dozens of mutations known to affect dementia. They also were grouped by
After about eight years of study, 1.8% of those
with high genetic risk and poor lifestyles had developed dementia versus
0.6% of folks with low genetic risk and healthy habits.
Among those with the highest genetic risk, just
over 1% of those with favorable lifestyles developed dementia compared
to nearly 2% of those with poor lifestyles.
One limitation: Researchers only had information on
mutations affecting people of European ancestry, so it's not known
whether the same is true for other racial or ethnic groups.
The results should give encouragement to people who
fear that gene mutations alone determine their destiny, said Dr. Rudy
Tanzi, a genetics expert at Massachusetts General Hospital. Less than 5%
of the ones tied to Alzheimer's are "fully penetrant," meaning that they
guarantee you'll get the disease, he said.
"That means that with 95% of the mutations, your
lifestyle will make a difference," Tanzi said. "Don't be too worried
about your genetics. Spend more time being mindful of living a healthy
One previous study in Sweden and Finland rigorously
tested the effect of a healthy lifestyle by assigning one group to
follow one and included a comparison group that did not. It concluded
that healthy habits could help prevent mental decline. The Alzheimer's
Association is sponsoring a similar study underway now in the United
Healthy living also is the focus of new dementia
prevention guidelines that the World Health Organization released in
released on Thursday, July 11, 2019 finds no difference in hospital deaths,
readmissions or costs when comparing results from doctors trained before and
after the caps of 80 hours of duties per week took effect. (AP Photo/Gerald
Carla K. Johnson
(AP) - When reforms shortened working hours for
U.S. doctors-in-training, some worried: Was that enough time to learn the
art of medicine? Would future patients suffer?
Now a study has answers, finding no difference in
hospital deaths, readmissions or costs when comparing results from doctors
trained before and after caps limiting duties to 80 hours per week took
"Some still long for the old days of 100-hour work
weeks, but most of the world has moved on and realized there are better ways
to train residents," said Dr. Karl Bilimoria of Northwestern University
Feinberg School of Medicine, who was not involved in the research published
Thursday in the journal BMJ.
Eliminating extra paperwork and some academic
conferences for residents, while adding nurse practitioners to the workforce
help make training more efficient, Bilimoria said.
Prior studies suggested the reforms didn't harm
residents' patients. The new study is the first to find similar reassuring
results for doctors once they hit the real world, said Dr. Mitesh Patel of
University of Pennsylvania who wasn't involved with the study.
Dr. Isaiah Cochran, 26, worked 75 hours a week,
including some 16-hour shifts, at Dayton Children's Hospital in Ohio for a
stretch during his last year of medical school. He plans to apply for a
family medicine residency next year.
"It's doable. It's not insane," said Cochran, president
of the American Medical Student Association, which supports keeping the
80-hour cap and other measures aimed at adequate sleep for doctors.
For the study, researchers analyzed data from more than
400,000 hospitalizations of Medicare patients. Using billing codes, they
assigned each case to a key doctor who dealt most with each patient.
Then researchers compared cases from two six-year time
periods: before and after 2006, when the first new doctors who were fully
affected by the reforms had finished their residencies.
This was an era of improvements in patient safety. So
researchers compared the new doctors — some affected by reforms and some not
— to trends among veteran doctors with 10 years' experience and all trained
under the old rules.
They found no difference in patient deaths,
readmissions or costs.
Patients depend on hospital teams, not just one doctor,
and that may explain why doctor training time seemed to have no effect on
Teamwork and technology have changed hospital care so
much that the impact of any one doctor is muted, said lead author Dr. Anupam
Jena of Harvard Medical School.
And more change is ahead with artificial intelligence.
With computers assuming a larger role in diagnosis and treatment, Jena said,
"it should be an open question whether 80 hours a week is the right number"
for training. Maybe it could be less.
The results apply to internal medicine doctors, not
surgeons. More research is needed on whether surgeons are getting enough
experience during training, Jena said.