Health Updates 4 September 2012

  • Rare infection prompts neti pot warning: Neti pots – those odd teapotlike vessels used to wash out the nasal passage – have won legions of fans who rely on them for relief from allergies, congestion and colds.  But now, after two cases of a deadly brain infection were linked to neti pots, government health officials have issued new warnings about using them safely.  The Food and Drug Administration last month reported on two cases in Louisiana in which patients contracted infections after using neti pots filled with tap water.  The culprit  was an amoeba called Naegleria fowleri, which is commonly found in lakes, rivers and hot springs.  This kind of infection is exceedingly rare, but it usually occurs when people get water up the nose after swimming or diving in lakes or rivers; Naegleria fowleri can travel from the nose into the brain, where it causes  primary amoebic meningoencaphalitis, a disease that destroys brain tissue and is almost always fatal.  In 123 known cases from 1962 to 2011 in the United States, only one person has survived, according to the Centers for Disease Control and Prevention.  Last year, Louisiana state health officials reported on two unrelated deaths – of a 20-year-old man and a 51-year-old woman who were believed to have been infected by tap water later found to contaminated with Naegleria fowleri.  Both had used tap water in a neti pot. (Because stomach acid kills the amoeba, drinking contaminated water does not lead to infection.)  As a result, the FDA has issued warnings reminding consumers to use distilled or filtered water in a neti pot.  They can use bottled water, or they can boil water and let it cool before using.  Doctors say the new warnings should not dissuade people from using a neti pot, which can be a safe and effective home remedy for allergies and congestion.  To use a neti pot, a person mixes water with a saline packet to create a mild saline solution.  Leaning over a sink, the user inserts the spout of the pot into a nostril, allowing the water to wash up inside the nasal passage and flow out of the other nostril.  Nasal lavage bottles can also be used, although it is important not to squeeze the bottle too hard.  ‘Initially it’s a weird sensation, but if you’re congested and it washed out some of that stuff, you’re much less miserable,’ said Dr. Rohit K. Katial, a professor of medicine and allergy specialist at National Jewish Health, a respiratory hospital based in Denver.  ‘People end up really liking it because they feel refreshed – it’s wellness with water’.” (NY Times)
  • Health law has gaps in services for men: “The federal healthcare overhaul greatly expanded women’s access to free preventive services, particularly for sexual and reproductive health.  Men didn’t fare nearly as well.  The Affordable Care Act guidelines’ promise of free contraception may have generated the most controversy, but the law also provides many other services for women, including free screening for HIV, chlamydia and gonorrhea, and pregnancy-related benefits such as screening for gestational diabetes, and breastfeeding support, supplies and counseling.  ‘Groups that were really focused on the health of women were identifying specific gaps that they wanted to make sure were covered’, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and advocacy organization.  Gaps in men’s preventive health didn’t receive the same focused attention by men’s health groups, he says.  Under the law, new health plans or those whose benefits have changed substantially are required to provide four types of preventive care without any copayments or other forms of cost-sharing: services recommended by the US Preventive Services Task Force (USPSTF), immunizations recommended by the CDC’s Advisory Committee on Immunization Practices, the preventive services and screenings for women and for children that are recommended by the Health Resources and Services Administration (HRSA)….The new law requires most health plans to begin providing free contraceptives to women when their new plan year begins this fall or next year.  It covers all FDA-approved methods, including permanent ones such as tubal ligation. But since its scope is limited to women’s services, it does not offer free coverage for vasectomies.  Men’s health specialists say both men and women could have benefited from such a requirement.  Even though they’re generally simpler and less expensive than female sterilization, cost can be a factor that deters men from getting vasectomies.  ‘Particularly for older men who are interested in playing a role in pregnancy prevention through sterilization, there are not many low-cost services available, even in a large city,’ said David Bell, MD, MPH, medical director of the Young Men’s Clinic at New York-Presbyterian Hospital‘s Family Planning Clinic.  The health law also required free coverage for screening for a number of sexually transmitted diseases in women but not in men….It’s no accident that most of the new preventive benefits are aimed at women, say experts.  ‘Women bear a disproportionate burden when it comes to sexually transmitted diseases and preventing pregnancy,” says Deborah Arrindell….As women enter their reproductive years, they typically begin to see a primary-care practitioner, often a gynecologist, for regular checkups….Although men may visit the doctor to get a physical for work, sports, or school, it’s not routine….Part of the problem in improving coverage of sexual and reproductive health for men is that research is scarce and comprehensive clinical guidelines have never been established, say experts.” (Kaiser Health News/MedPage Today)
  • Use of inhalers may affect growth: “Children who use glucocorticoid inhalers to prevent asthma attacks may be shorter as adults, researchers said on Monday.  Previous studies have shown that the drugs slow growth rate, but most experts believe that growth returns to normal after the first few years of therapy.  But the new study, published in the The New England Journal of Medicinefound that the growth deficiency persists into adulthood.  Scientists randomly assigned 943 children ages 5 to 13 to take daily doses of budesonide, nedocromil or a placebo for four to six years.  Budedonide is an inhaled glucocorticoid sold under the brand name Pulmicort; nedocromil is a nonsteroidal inhalant no longer available in the United States.  All the children were also treated with albuterol, a bronchodilator, under the guidelines of the National Asthma Education and Prevention Program.  Several of the authors have received consulting fees from pharmaceutical companies.  By the age of 25, patients in the budenoside group were on average about half an inch shorter than those who took the placebo, and the higher the dose of the drug they took, the greater the decrease in adult height.  The difference persisted after controlling for age, initial height, race or ethnicity, sex, duration and severity of asthma, and other factors.  Nedocromil had no effect on stature.  ‘There are lots of studies that show the inhalant corticosteroids produce a decrease in growth in prepubertal children’, said the lead author, H. William Kelly, referring to the class of chemicals that includes glucocorticoids.  ‘But we have the first long-term prospective study that shows that you don’t outgrow it.’  Should glucocorticoids be avoided?  No, Dr. Kelly said.  ‘Starting smaller, younger kids on lower doses may avoid much of the effect’ on growth, he said.  ‘They’re the most effective therapy in the treatment of childhood asthma, and currently the only therapy we know of that decreases the risk of dying’.” (Anahad O’Connor, NY Times)
  • A bit better walking: “Research indicates more Americans are walking.  But the Centers for Disease Control and Prevention also indicates we have miles to go.  The review of national survey data found about 62 percent of adults walked at least once for 10 minutes or more in the previous week in 2010.  That’s up from about 56 percent in 2005.  But people need to do at least 150 minutes a week of moderate intensity aerobic physical activity to get health benefits.  Researchers Dianna Carroll:  ‘In our study, we found less than half of adults get the 150 minutes of aerobic activity each week.  And this can be improved by doing activity as simply as brisk walking.’  The study is in the CDC’s Morbidity and Mortality Weekly Report.” (Ira Dreyfuss, US Dept. of Health and Human Services)

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