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Update August, 2019

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Health & Wellbeing

Study: Millions should stop taking aspirin for heart health

A new study suggests millions of people need to rethink their use of aspirin to prevent a heart attack. (AP Photo/Patrick Sison)

Lauran Neergaard

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 Medicine.

“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 Cardiology:

—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.

Bangladesh grapples with country's worst dengue outbreak

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 dengue cases.

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 deaths.

Officials from Dhaka, the overcrowded capital and the epicenter of the outbreak, have struggled to contain it, drawing criticism and spreading panic among some residents.

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 same.

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 patients.

"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," she said.

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.

A healthy lifestyle may offset genetic risk for Alzheimer's

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)

Marilynn Marchione

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 likely.

"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 matters.

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 lifestyle factors.

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 life."

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 States.

Healthy living also is the focus of new dementia prevention guidelines that the World Health Organization released in February.

Shortening trainee doctor hours hasn't harmed patients

A study 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 Herbert)

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 effect.

"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 care.

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.


HEADLINES [click on headline to view story]

Study: Millions should stop taking aspirin for heart health

Bangladesh grapples with country's worst dengue outbreak

A healthy lifestyle may offset genetic risk for Alzheimer's

Shortening trainee doctor hours hasn't harmed patients


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