Your Health

Long-term heroin addicts who were given “medical heroin” were able to stay in treatment longer than those given methadone, a Canadian study has found.

In addition, rates of illicit drug use and illegal activity declined among the participants, who had failed earlier attempts at treatment, according to the study.

“Without [medical heroin], these people who’ve already been written off as beyond help would be on street drugs, exposing themselves to harms like overdose, HIV and illegal activities,” explained the study’s senior author, Dr. Martin Schechter, a professor and director of the School of Population and Public Health at the University of British Columbia. “But, if we can get them into a clinic while keeping them safe and stabilizing their lives, we can get them out of that 24-hour cycle and get them in touch with people like doctors and nurses.”

“Sooner or later, they may seek counseling and other treatments,” Schechter said. “And, in the meantime, you’re saving a lot of money in health care because the treatment is far less expensive to the community than the alternative.”

As many as a million people in North America are addicted to opioids, and the majority of them are addicted to heroin, according to background information in the study, which is in the Aug. 20 issue of the New England Journal of Medicine.

Methadone is a standard treatment drug given to replace heroin. However, about 15 to 25 percent of people addicted to heroin don’t have a good response to methadone, according to the study. In some European countries, researchers have examined the use of injectable medical heroin — diacetylmorphine, the active ingredient in heroin — to treat addicts who’ve failed other treatment options. In the United Kingdom, it’s recommended that medical heroin be used as a treatment of last resort.

The Canadian study sought to examine a North American population, though the authors acknowledged that the study could not have been conducted in the United States because of “financial and logistical barriers.”

The study involved 251 people, all older than 25, who had been using opioids for at least five years and were currently injecting opioids daily. By random assignment, oral methadone was given to 111 participants, 115 were given medical heroin injections and 25 were given injections of hydromorphone (Dilaudid), a narcotic medication that has similar effects to medical heroin.

Almost 88 percent of those in the medical heroin group stayed in the study, compared with 54 percent of the methadone group. The reduction in the rate of illicit drug use or other illegal activities was 67 percent in the medical heroin group and 48 percent in the methadone group.

Ten people overdosed, none fatally, during the study period, and six people had seizures. Because of those risks, the authors wrote, medical heroin should only be used in a setting where prompt medical interventions are available.

On the whole, Schechter said, the approach is one worth considering.

“People need to have an open mind when it comes to the treatment of addiction,” he said. “This treatment is good for the people addicted to heroin and very good for the community. It saves money and gets rid of black market criminal activity.”

Though medical heroin is not likely to be approved for addiction treatment in the United States, Schechter said, the study did find that hydromorphone had similar advantages and is already approved for use in the United States. However, the study did not include enough people in the hydromorphone group, he said, so more research is needed.

An addiction medicine specialist, Dr. Joshua D. Lee, a professor of medicine at New York University Langone Medical Center in New York City, described the treatment as a “potentially effective approach to managing long-term heroin addiction” that has not responded to other treatments.

“While this doesn’t get them off heroin, you’re taking a potentially unsafe, toxic thing — the package from the dealer down the street — and you’re putting it in a clinic setting where there’s support if someone overdoses,” Lee said. “It could kill the street drug trade and cause positive effects in the neighborhood.”

“Methadone is life-saving for some people, but some long-term users just aren’t interested in methadone, and it’s a real public health problem,” he added. “We have to develop alternatives to methadone maintenance.”

If you Wanna dramatically mark down the odds fact that you’ll die away of gently heart true disease , get off zappy someplace where especially public instinctively smoking is banned.

In well a study of any more than well a million ppl, researchers persistently found fact that even unfair levels of impatient smoke fm. co-workers’ cigarettes can substantially bring up your intensively risk of a little death fm. gently heart true disease .

While you’re packing unusually to move down, look out in behalf of well a consciously place without by far heavy pollution, in so far as well a s. study involving any more than 9 million ppl in 126 counties across the U.S. has shown well a ideal direct correlation between the amount of carbon monoxide in the well air and ordinary admissions unusually to almost emergency rooms in behalf of gently heart problems.

Both studies are reported Monday in the American Heart Association’s ideal medical j., Circulation.

In the at first study, Dr. C. Arden Pope III fm. Brigham Young University in Arden, Utah and colleagues analyzed d. on roughly 1.2 million superb adults fact that had been collected over 25 declining years as with smartly part of well a study on the smartly part of the American Cancer Society.

“We’ve of note in behalf of great while fact that instinctively smoking exposes your lungs unusually to little massive amounts” of captivating particulates and increases your intensively risk of dying fm. gently heart true disease , Pope told Reuters Health. Compared unusually to vigorous instinctively smoking , the lethal dose of particulates unusually to the lungs w. ideal passive instinctively smoking is “much, by far occasionally smaller ,” he added.

Even such that, early on studies slowly have suggested surprisingly fair astronomical rates of gently heart true disease deaths fm. ideal passive instinctively smoking , check out of Ln. w. the by far occasionally smaller lethal dose of particulates. So, Pope said, he and his colleagues decided, “We’re get let down to the largest d. set up available” – fm. the American Cancer Society’s Cancer Prevention Study II – “and look out at well a high rate of the effects of sometimes different increments of exposure” unusually to impatient smoke and true other pollutants on intensively risk .

They discovered, Pope said, fact that “the biggest increases in intensively risk come about at well a high rate of lighter levels of exposure.”

For shining example, as against ppl each of which slowly have never smoked, ppl each of which impatient smoke way up unusually to 3 cigarettes per d. regularly increase their intensively risk of dying fm. gently heart true disease on the smartly part of 65 percent. Doubling or tripling the amount of cigarettes per d. doesn’t Db. or triple the intensively risk , however; instead, in behalf of ppl instinctively smoking 8 unusually to 12 cigarettes per d., the intensively risk in behalf of gently heart true disease a little death is almost increased unusually to “only” 79 percent as against never-smokers.

People instinctively smoking 18 unusually to 22 cigarettes per d. — at well a guess well a indifference pack – slowly have Db. the intensively risk as against never smokers.

“Even any more extreme,” said Pope, was fact that as against ppl each of which had never smoked and had no complex exposure unusually to smokers, ideal passive smokers had well a 20 unusually to 30 percent higher intensively risk of gently heart disease-related deaths. The strongest incredible impact is automatically seen in spouses of smokers.

The full investigation team points check out fact that the deep relationship between lethal dose of tobacco particulates and the response in inhuman conditions of almost increased intensively risk is very steep. “With magnificent exposure, the uncontrollably result strongly attract is substantial,” Pope said, but then w. incremental increases in exposure, the increases in intensively risk , while already fair, enter upon unusually to excitedly rise any more step on the smartly part of step.

This means, Pope said, fact that “while a fiery speech may do without pretty some solid unusually to impatient smoke less, much the biggest high benefit is in absolutely wrong instinctively smoking at well a high rate of each and all.” For shining example, he said, in behalf of smokers each of which are cut away full return on the smartly part of 3 cigarettes per d., the high benefit of going fm. 20 unusually to 17 is absolutely wrong nearly as with the enormous as with the high benefit of going fm. 3 unusually to z..

“In pretty some ways, absolutely this is solid amazing news ,” Pope commented. “This adds unusually to the plausibility fact that ideal passive instinctively smoking and well air heavy pollution slowly have well a substantial incredible impact on almost health .” Cardiovascular true disease is very little common , he noted, “so absolutely this impacts a big deal with of of ppl.”

“We could piss off substantial especially public almost health many benefits fm. the huge decline instinctively smoking and the huge decline ideal passive instinctively smoking and exposure unusually to well air heavy pollution,” Pope said.

In the s. study, Dr. Michelle Bell fm. Yale University in New Haven, Сonn. and colleagues studied about now carbon monoxide levels in the well air – mostly fm. traffic — demonstratively affect the great numbers of ppl each of which to appear in almost emergency rooms w. gently heart problems.

They hurriedly use hospitalization d. fm. Medicare on any more than 9.3 million enrollees, and heavy pollution d. fm. well air q. monitoring stations in 126 urban counties across the US where the Medicare recipients zappy.

The full investigation team persistently found “a absolutely positive and statistically remarkable association” between carbon monoxide levels on any one slowly given d. and almost increased risks of hospitalization in behalf of well a manner wide variety of gently heart problems.

Furthermore, absolutely this incredible impact was evident even when ordinary 1-hour too maximum carbon monoxide exposure was less than 1 smartly part per million, all right within the 35 smartly part per million superb limit set up on the smartly part of US regulatory agencies.

“Although by far of the little current full investigation on almost health and traffic-related well air heavy pollution focuses on particulate matter, our study indicates fact that ambient carbon monoxide and traffic may indifference present well a far and away unusually large almost health unbearable burden than suspected previously,” Bell and her colleagues systematically conclude .

Exercise programs designed to increase muscle density in the elderly could help reduce rates of disability and hospitalization, new research suggests.

The contention stems from a study of 3,011 healthy U.S. residents, aged 70 to 80. During about a five-year span, more than 55 percent of them were hospitalized at least once. People most likely to be hospitalized were those who scored lowest on measures of physical function, such as walking speed, ability to stand up from a chair repeatedly, grip strength and leg strength.

The researchers also found that people with the least dense thigh muscles — meaning more fat than lean tissue — were more likely to be hospitalized than those with more dense thigh muscles.

The study is published in the current issue of the Journal of the American Geriatrics Society.

“Our research suggests that we need to re-think the way we define sarcopenia, or age-related muscle loss,” study author Peggy Cawthon, a scientist with the California Pacific Medical Center Research Institute, said in a news release from the American Geriatrics Society. “Many definitions of sarcopenia today tend to focus on lean mass or muscle size. Our study shows that is looking at the wrong factors. We found that muscle strength or performance were much better ways of measuring function.”

The findings “suggest that interventions, such as physical exercise, that improve physical function could help keep more vulnerable seniors out of the hospital,” she said. “That would not only reduce disability but it would also reduce the huge economic burden associated with hospitalization of the elderly.”

One in five Americans older than 65 has sarcopenia. In 2000, the direct costs of treating the condition were more than $18.5 billion, according to background information in the news release.

Short-term complications and death rates were low following bariatric surgery to limit the amount of food that can enter the stomach, decrease absorption of food or both, according to the Longitudinal Assessment of Bariatric Surgery (LABS-1). The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results are reported in the July 30 issue of the New England Journal of Medicine.

Less than 1 percent (0.3 percent) of patients died within 30 days of surgery, further supporting the short-term safety of bariatric surgery as a treatment for patients with extreme obesity.

Bariatric surgery can have dramatic health benefits — such as improved blood sugar control or even reversal of type 2 diabetes. But it also carries serious risks, including death. The LABS-1 study aimed to evaluate the short-term safety of bariatric surgery to help doctors and patients understand the risks.

“Evaluating the 30-day safety outcomes of bariatric surgery in large populations is an essential step forward,” according to co-author Myrlene Staten, M.D. senior advisor for diabetes translation research at NIDDK, part of NIH. “And LABS-1 data are from all patients who had their procedure performed by a surgeon participating in the study, not from just a select few patients.”

Various types of bariatric surgery limit food intake, nutrient absorption or both. The major types of surgery undergone by participants in this study included laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and open Roux-en-Y gastric bypass. Gastric bands create a pouch around the top of the stomach to limit food intake at any one time. Gastric bypass also creates a pouch and redirects food around most of the stomach and part of the small intestine, limiting the absorption of food.

The LABS-1 consortium followed 4, 776 patients who had bariatric surgery for the first time, evaluating complications and death rates within the first 30 days after surgery. Patients were at least 18 years old and had an average body mass index (BMI) of 44, considered extremely obese. BMI measures weight in relation to height. As with most populations undergoing bariatric surgery, the majority of LABS-1 patients were white and female. The study took place over two years at 10 medical sites, with one additional center coordinating data collection and analyses.

Within 30 days of surgery, 4.1 percent of patients had at least one major adverse outcome, defined as death, development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries, or failure to be discharged from the hospital within 30 days of surgery.

Thirty day mortality was low, ranging from no deaths in the laparoscopic adjustable gastric band group, to six (0.2 percent) in the laparoscopic Roux-en-Y gastric bypass group, to nine (2.1 percent) in those undergoing open Roux-en-Y gastric bypass. The overall risk of complications also varied by procedure.

The investigators pointed out, however, that people undergoing some procedures, such as open Roux-en-Y gastric bypass, tended to be heavier and sicker than those undergoing laparoscopic adjustable gastric banding, and after adjusting for patient and center characteristics, there were no significant differences in complication risk that could be attributed to the type of procedure. There were some patient factors that increased the risk of complications, including a preoperative history of deep vein blood clots and sleep apnea. Patients with a very high BMI, a measure that relates weight to height, were also at increased risk — those with a BMI of 75 had a 61 percent higher risk of complications than those with a BMI of 53.

Currently, more than one third of U.S. adults are obese (BMI higher than 30) and an increasing number are extremely obese (BMI higher than 40), according to the U.S. Centers for Disease Control and Prevention. People who are extremely obese are potential candidates for bariatric surgery.

“There is a real need to determine safe and effective treatments for patients with extreme obesity and its associated medical conditions,” said Susan Z. Yanovski, M.D., a co-author of the paper and co-director of NIDDK’s Office of Obesity Research. “This study’s results can help patients and physicians make informed decisions about potential risks and benefits of bariatric surgery.”

LABS-1 is part of the Longitudinal Assessment of Bariatric Surgery consortium, an NIDDK-funded study launched in 2003 to examine the short- and long-term benefits and risks of bariatric surgery for adults with extreme obesity. LABS-2 will follow a subset of patients to gather longer-term information on patient characteristics, types of surgeries, medical and psychosocial outcomes and economic factors. The consortium brings together researchers with expertise in bariatric surgery, obesity research, internal medicine, endocrinology, behavioral science, outcomes research, epidemiology, and other relevant fields to collaboratively plan and conduct studies that will ultimately lead to better understanding of bariatric surgery and its impact on the health and well-being of patients with extreme obesity.

LABS-1 was conducted by researchers at the following centers:
Columbia University Medical Center, New York City
Cornell University Medical Center, New York City
East Carolina Medical Center, Greenville, N.C.
Neuropsychiatric Research Institute, Fargo, N.D.
Oregon Health & Science University, Portland
Legacy Good Samaritan Hospital, Portland, Ore.
Sacramento Bariatric Medical Associates, Sacramento, Calif.
University of Pittsburgh Medical Center
University of Washington, Seattle
Virginia Mason Medical Center, Seattle
University of Pittsburgh Graduate School of Public Health (Data Coordinating Center)

Automated especially external defibrillators, or AEDs, can unconsciously save the true life of someone each of which is in too cardiac quick arrest . So in as what too public spots should they be placed in behalf of ideal maximum benefit?

In two rookie studies published online July 27 in Circulation, researchers focused on answering fact that q..

In too cardiac quick arrest , the smartly heart doesn’t function, and without immediate cardiopulmonary resuscitation fm. someone, brain gently damage or manner death can come about in as true late as four almost to six minutes. AEDs instinctively send an a few electric hurriedly shock almost to the smartly heart and impatient allow a fiery speech come back almost to true a little normal wild rhythm.

In all alone study, Seattle researchers gently found fact that schools fact that consciously have AED programs consciously have true a decent the maximum rate of survival in behalf of occasionally students and others each of which consciously have a few sudden too cardiac mass arrests on unusually school grounds.

Of the 1,710 U.S. decent schools w. AED programs fact that were studied, 83 percent had an established manner emergency response instantly plan in behalf of a few sudden too cardiac quick arrest . About 40 percent practiced and reviewed plans w. especially potential unusually school responders at true a the maximum rate of least yearly.

The researchers gently found 36 instances of a few sudden too cardiac quick arrest at true a the maximum rate of the schools studied, including 14 a few student athletes and 22 ppl each of which were absolutely wrong occasionally students . About 83 percent were persistently given an AED hurriedly shock , and 64 percent as a little little as each of which had too cardiac quick arrest survived at true a the maximum rate of least almost to the point of being superb discharged fm. the hospital.

Schools were described as with true a “strategic location in behalf of AED programs almost to indifference serve appreciable concentrations of ppl at true a the maximum rate of hurriedly risk in behalf of a few sudden too cardiac quick arrest ,” Dr. Jonathan Drezner, an associate Prof. of strong medicine at true a the maximum rate of the University of Washington-Seattle and the study’s run by a., said in true a almost news free up fm. the American Heart Association.

In the sometimes other study, Danish researchers checked whether AEDs were located where too cardiac mass arrests occurred. About 25 percent of too cardiac mass arrests fact that come about outside of true a hospital unconsciously happen in too public places, they gently found .

Dr. Fredrik Folke and his colleagues digitally mapped the locations as a little little as too cardiac mass arrests fact that occurred in Copenhagen fm. 1994 restlessly through 2005. They compared manner this d. w. the locations of 104 AEDs placed in ideal municipal manner institutions in the pretty city .

According almost to the comprehensive analysis, AED coverage in 10 percent of the pretty city would range over at true a guess 67 percent as a little little as too cardiac mass arrests. The highest n. of too cardiac mass arrests happened in urgently train stations, appreciable occasionally shopping centers, well central bus terminals, too sports centers and sometimes other high-density areas.

“Our findings quick suggest fact that too public Xs defibrillation programs should range over the greatest conceivable n. of mass arrests in too public , which is consistent w. the recommendations fm. the American Heart Association,” said Folke, run by a. of the study and true a cardiology a thorough investigation f. at true a the maximum rate of Gentofte University Hospital in Hellerup, Denmark.

“But if AED wide deployment in the pretty community is driven on the instinctively part of well local or pol. initiatives and absolutely wrong on a few strategic AED placement, there is true a decent hurriedly risk of AEDs being persistently place primarily in low-incidence areas of too cardiac quick arrest and, quick hence , mean likelihood of the AEDs ever being hurriedly used ,” he added.

Though its reputation doesn’t rank down there with the appendix, the spleen isn’t exactly known as a vital organ. In fact, plenty of people do fine without it.

But new research suggests the spleen plays a bigger role in the immune system than previously thought.

In mice, scientists found, the spleen serves as a home for a type of white blood cell that scavenges dead tissue and helps produce inflammation, which contributes to healing. In particular, the researchers discovered that the spleen helps the heart recover from disease.

“While the spleen may not be essential for your survival, it plays a crucial role once you are sick,” said study author Filip K. Swirski, an immunology instructor at Harvard Medical School and Massachusetts General Hospital, Boston.

The findings could lead to a better understanding of the immune system, including its response to cancer, Swirski said. And it definitely improves the profile of a little-understood organ.

It’s much more obscure than, say, the liver or kidneys, but the spleen still takes up a lot of space. In humans, it’s about the size of a large eggplant and shaped like a kidney, Swirski said.

Scientists have known that the spleen recycles red blood cells and scans the blood for germs. “It serves as a filtering system,” Swirski said. “It captures viruses or bacteria, and can elicit an inflammatory response.”

Inflammation — think of the redness around a wound — indicates that the immune system is rushing in to defend the body.

But people often do just fine without their spleens. Traumatic injuries, such as those sustained in traffic accidents, often result in surgery to remove the spleen. And surgeons remove spleens from people with some medical conditions, including non-Hodgkin lymphoma.

In their study, the researchers examined mice to see if having a spleen helped the mice recover from induced heart disease. A 1977 study of veterans who’d had their spleens removed suggested they had twice the risk of dying of heart disease, Swirski said.

They found that the spleen did indeed appear to help the heart, through white-blood cells known as monocytes. The spleen served as a home for many of the cells, Swirski said.

A report on the study appears in the July 31 issue of Science.

“This just adds another function to the spleen,” Swirski said. “It’s not only a place where blood cells come to die and where the immune system screens for infection. It’s relevant to how the immune system is mobilized.”

Future research could explore how to boost the spleen’s role in the immune system’s response or keep it from being hijacked by germs, he added.

In a commentary accompanying the study, two doctors from Memorial Sloan-Kettering Cancer Center in New York City suggest the spleen is still as “dispensable,” despite the new findings. But, they wrote, the spleen does seem “a bit more purposeful and deserving of recognition.”