Aerobic fitness should be considered a vital sign, just as body temperature, blood pressure, pulse and breathing rates are now, according to a new scientific statement from the American Heart Association.

The statement points out that fitness can be a better indicator of someone’s risk for heart disease and early death than such standard risk factors as smoking, obesity and high blood pressure. The authors recommend that each of us should have our aerobic fitness assessed as part of medical examinations and, if our fitness is on the low side, we should be advised and helped to start exercising.

The authors also suggest that if your physician does not begin to determine your aerobic fitness in the near future, you should do so yourself, using any of several scientifically validated online tools.

Aerobic, or cardiorespiratory, fitness is a measure of how well your body can deliver oxygen to tissues. Because that process is pervasive and essential within our bodies, it is also a “reflection of overall physiological health and function, especially of the cardiovascular system,” according to the report.

Many past studies have found that relatively low aerobic fitness is linked with a significantly increased risk for heart disease and premature death and that being out of shape may, in fact, represent a greater risk for developing heart disease than if you have a poor cholesterol profile, Type 2 diabetes, a history of smoking or a high body mass index.

But in 2013, when the American Heart Association and American College of Cardiology released new guidelines for assessing someone’s risk for heart disease, the criteria did not include aerobic fitness as a risk factor. The agencies were still uncertain about whether enough science existed to justify including fitness and also worried that the treadmill tests needed to measure aerobic fitness were complicated and costly.

But the research was compelling enough that the American Heart Association decided to convene an expert scientific advisory group that would gather and analyze all of the available studies about fitness, heart health and life spans, and also look into the question of whether fitness could be determined accurately and cheaply, without everyone needing to undergo a treadmill test.

In effect, the advisory board was asked to decide whether aerobic fitness should become a new vital sign.

Their answer, delivered in the new statement, which was published simultaneously in Circulation and Professional Heart Daily, a publication of the National Stroke Association, was a resounding yes.

The authors concluded that the available science overwhelmingly supported the use of aerobic fitness as a measure of general and heart health.

Almost as important from a practical standpoint, the authors also determined that newly developed equations and simple calculators could provide reliable, valid estimates of fitness. Doctors could use a few keystrokes to estimate someone’s fitness, instead of ordering a treadmill test (although some people, especially those at high risk for heart disease based on other factors, should still undergo treadmill testing, the authors write).

The resulting scientific statement “strongly supports” the use of cardiorespiratory fitness as a vital sign and “an important measure and predictor of health,” says Steven Blair, a professor of exercise science and epidemiology at the University of South Carolina and co-chairman of the scientific committee.

The statement, which went through peer review, as well as a separate review and endorsement by the standing scientific advisory board for the American Heart Association, is, however, only a recommendation and does not change the current formal heart disease risk calculations.

But the statement’s authors are hopeful that it will have an immediate and lingering impact.

“In general, I think that doctors understand that cardiorespiratory fitness is important,” says Leonard Kaminsky, the director of the Fisher Institute of Health and Well-Being at Ball State University in Indiana and co-author of the statement.

But many physicians “consider it to be relatively less important than other risk factors,” he continues. “Hopefully this scientific statement will be a resource and give them confidence in the solid evidence base for cardiorespiratory fitness as a vital health measure.”

The statement also should be of interest to and practical use by those of us who do not hold medical degrees but do own hearts and lungs, the authors say.

“It would be an excellent idea” for everyone to learn his or her current, estimated aerobic fitness level and how it compares to age-matched averages, says Dr. Chip Lavie, a cardiologist and exercise scientist at the Ochsner Heart and Vascular Institute in Louisiana and statement co-author.

He suggests using an online fitness calculator developed by Dr. Kaminsky and others, based on data from millions of users, at www.worldfitnesslevel.org.

Take the resulting estimate of your fitness age to your next medical appointment and discuss it with your physician, Dr. Lavie says.

In the meantime, if you are concerned about your current fitness, get up and move. Fitness is quite malleable, the statement co-authors point out. You can find a scientifically designed exercise program to improve cardiorespiratory fitness here, at the website of the Norwegian University of Science and Technology: ntnu.edu/cerg/regimen.

Source: http://www.nytimes.com/2016/11/30/well/move/should-a-simple-fitness-check-be-part-of-your-checkup.html?_r=0

What we know about Zika is constantly evolving. Find the latest training information on Zika for clinicians at the CDC Zika Training Resources webpage, including

• instructional videos,
• archived Clinician Outreach and Communication Activity webinars,
• related Morbidity and Mortality Weekly Reports (MMWR), and
• Zika-related training opportunities offered by other groups through CDC TRAIN.

CDC will continue to update this Zika training page as new courses become available. Access this new webpage by clicking on the “Zika Training Resources” image on the homepage of the CDC Learning Connection. 

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A joint study conducted by researchers from the universities of Liverpool and Manchester has found a link between birth defects and certain types of epilepsy medication.

For most women who have epilepsy, continuing their medication during pregnancy is important for their health. Over the last 25 years, research has shown that children exposed to these medications in the womb can be at a higher risk of having a malformation or birth defect.

The study, published in the Cochrane Database of Systematic Reviews, aimed to understand whether pregnant women exposed to antiepileptic drugs (AEDs) during pregnancy were at higher risk of having a child with a malformation.

Minimising fetal risk

The majority of women with epilepsy will be required to continue antiepileptic drug treatment during a pregnancy.

Previous studies have demonstrated a significant increase in risk of having a child with a significant birth defect in the mother was taking certain antiepileptic drugs and therefore treatment decisions should be made carefully and collaboratively and aim to find a balance between maximising maternal health whilst minimising fetal risk.

As part of this systematic review 50 published studies were analysed and it was found that exposure in the womb to the AED sodium valproate was associated with a 10% chance of the child having a significant birth defect and that this rose as the dose of the drug increased.

Skeletal and limb defects

The types of birth defect that were increased were skeletal and limb defects, cardiac defects, craniofacial defects and neural tube defects.

Children exposed to carbamazepine, topiramate or phenytoin were at an increased risk of having a significant birth defect but the exact types of defects were not clear and children exposed to phenobarbital were found to be at an increased risk of cardiac defects.

The review also found that children exposed to lamotrigine or levetiracetam were not found to be at an increased risk of significant birth defects in comparison to control children and had lower risks when directly compared to the children exposed to carbamazepine, phenytoin or topiramate.

Informing complex discussions

Professor of Neurology Tony Marson from the University of Liverpool's Institute of Translational Medicine, said: "This is a really important review that informs complex discussions during consultations about epilepsy treatment choices for women of childbearing potential, who represent around a third of people with epilepsy worldwide.

"Based on current evidence, levetiracetam and lamotrigine appear to be the AEDs associated with the lowest level of risk, but more data are needed, particularly concerning individual types of malformation."

Source:

University of Liverpool

WEDNESDAY, Nov. 30, 2016 (HealthDay News) -- Healthier diets may be a factor in the ongoing decline in levels of unhealthy blood fats for Americans, new research suggests.

According to the report from the U.S. Centers for Disease Control and Prevention, blood levels of total cholesterol, LDL ("bad") cholesterol, and the blood fats known as triglycerides have continued to fall among adults through 2014.

All of that may be adding up to improved heart health nationwide, with death rates from heart disease also on the decline, the CDC noted.

"Removal of trans-fatty acids in foods has been suggested as an explanation for the observed trends of triglycerides, LDL-cholesterol levels, and [total cholesterol] levels," wrote a team led by CDC researcher Asher Rosinger.

These trends "may be contributing to declining death rates owing to coronary heart disease since 1999," the study authors suggested.

One cardiovascular specialist was heartened by the news.

"Although heart disease remains the number one cause of death, we have made tremendous strides in lowering the number of people at risk," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City.

"As this study shows, through prevention and education we have helped lower cholesterol; a key risk factor in heart disease," he said.

The CDC team noted that between 1999 and 2010, blood cholesterol levels had edged downward among U.S. adults aged 20 or over. The new report sought to determine if that improvement had continued through 2013-2014.

The study included data from more than 39,000 adults who had their total cholesterol levels checked, about 17,000 who had undergone LDL cholesterol level testing, and nearly 17,500 who had their triglyceride levels tracked as part of the ongoing U.S. National Health and Nutrition Examination Survey.

Average total cholesterol fell from 204 milligrams per deciliter (mg/dL) of blood in 1999-2000 to 189 mg/dL in 2013-2014.

Between the relatively short span of 2011-2012 to 2013-2014, average total cholesterol levels plummeted by 6 mg/dL, the authors noted.

Average triglyceride levels also decreased -- from 123 mg/dL in 1999-2000 to 97 mg/dL in 2013-2014, with a 13 mg/dL drop since 2011-2012.

Average LDL "bad" cholesterol levels fell from 126 mg/dL to 111 mg/dL during the study period, with a 4 mg/dL drop between 2011-2012 and 2013-2014, the CDC reported.

Dr. David Friedman is chief of heart failure services at Long Island Jewish Valley Stream Hospital in Valley Stream, N.Y. He believes the findings "highlight that over the last number of years, American adults are paying heed and perhaps are being more mindful of cutting out fatty foods to a good degree."

In addition, "public health messages on cholesterol-lowering, as well as patient adherence to medication for cholesterol treatment, all seem to be working," Friedman said.

The study was published online Nov. 30 in the journal JAMA Cardiology.

More information

The American Heart Association has more on cholesterol.

SOURCES: David Friedman, M.D., chief, heart failure services, Long Island Jewish Valley Stream Hospital, Valley Stream, N.Y.; Satjit Bhusri, M.D., cardiologist, Lenox Hill Hospital, New York City; JAMA Cardiology, news release, Nov. 30, 2016

-- Robert Preidt

Last Updated: Nov 30, 2016

Copyright © 2016 HealthDay. All rights reserved.

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CHICAGO -- The addition of tomosynthesis to mammography provided better screening performance and lower recall rates, as well as higher invasive cancer detection in younger women, a researcher said here.

In women under age 50, recall rates for those undergoing conventional mammography was 115 per 1,000 cases compared with 108 per 1,000 cases for tomosynthesis (3D mammography), for a 6% reduction in recalls (P=0.013), reported Stephen Rose, MD, chief medical officer of Solis Mammography, a group of 30 clinics headquartered in Addison, Texas.

Also, cancer detection rates were 2.1 for mammography compared with 3.1 with the addition of tomosynthesis for a difference of 1.0 (P=0.021), while invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis for difference of 0.8 (P=0.014), he said in a presentation at the Radiological Society of North America (RSNA) annual meeting.

This represented a relative increase in invasive cancer detection of 67%, he noted.

For the study, Rose examined the results of 65,457 screening examinations among women under age 50 -- 45,320 had conventional mammography and 20,137 underwent mammography plus tomosynthesis. The studies were done from Jan. 1, 2015 to Dec 31, 2015. Women screened with tomosynthesis plus mammography paid an out-of-pocket fee, Rose explained.

He also noted that "with tomosynthesis, we were able to find more cancers in women with dense breast tissue. In fact, using digital mammography we were unable to find any cancers in women with dense breast tissue."

Overall, the addition of tomosynthesis increased the positive predictive value (PPV) of the screening by more than 56%, Rose said.

Rose acknowledged that the study participants were not randomized, but that the findings do demonstrate a "real-world" way to approach to breast cancer screening in clinics.

The debate over screening women in their 40's for breast cancer is still an issue, with the U.S. Preventive Services Task Force suggesting that mammography screening should begin at age 50, and the American Cancer Society recommending that annual screening begin at age 45, but women can opt for screening starting at age 40.

But Rose noted that as many as 20% of invasive cancers are found in women under the age of 50, and breast cancer in these women are the cause of more life-years lost to the disease. "More aggressive, rapidly developing cancers are more likely in women diagnosed under the age of 50," he told MedPage Today.

Stamatia Destounis, MD, at the Elizabeth Wende Breast Clinic at the University of Rochester in Rochester, N.Y., told MedPage Today that tomosynthesis is going to find more cancers, more efficiently.

"This happens to me everyday," said Destounis, who was not involved in the study. "We look at the [conventional mammographic scan] and everything looks fine, and then when we start scrolling through the tomosynthesis scans, something pops up. The PPVs go up; the number of invasive cancers detected goes up; and the recall rate goes down."

But not all clinics are flocking to tomosynthesis, mainly due to costs, she noted. "There is the cost of getting rid of the current digital mammography unit, and the tomosynthesis units are more expensive to start with," she said.

In addition, exam room configurations will have to change "because the [tomosynthesis] unit is heavier; you may have to reinforce the floor. You will have to change the electrical supply. You will have to upgrade air conditioning because the room has to be kept cool, because the tomosynthesis units are sensitive to heat," she said.

And then there is the time factor. "No matter how proficient a radiologist gets at going through these [tomosynthesis] scans, you will never be as fast as you were when you just had a couple of digital scans to review," Destounis noted.

Rose disclosed relevant relationships with Hologic.

Destounis disclosed no relevant relationships with industry.

LAST UPDATED 11.29.2016

• Primary Source

  Radiological Society of North America

  Source Reference: Rose S "Tomosynthesis impact on screening patients 40 to 49" RSNA 2016; Abstract BR216-SD-SUA.

Research shows that the proportion of broad-spectrum antibiotic prescriptions varies significantly among physicians, nurse practitioners, physician assistants, and dentists

Although antibiotic prescriptions are decreasing overall in the U.S., prescriptions of broad-spectrum antibiotics such as penicillin, macrolides, and quinolones are increasing. Because use of broad-spectrum antibiotics can lead to resistance, researchers at the University of Illinois at Chicago, the Centers for Disease Control and Prevention, and IMS Health investigated prescriber trends over time by provider group as a way to customize stewardship efforts.

In the study, published online in the Journal of the American Pharmacists Association, data from a nationally representative database of outpatient antibiotic prescriptions in the U.S. from January 1, 2005, through December 31, 2010, including oral and injectable systemic antibiotic prescriptions dispensed from retail community pharmacies, mail service pharmacies, and medical clinics, were analyzed. Providers were classified as physicians, nurse practitioners (NPs), physician assistants (PAs), and dentists.

Results of the study showed that over 6 years, prescriptions for broad-spectrum agents and for antibiotics overall decreased for physicians while increasing for NPs and PAs. They also found that dentists prescribe a large number of antibiotics compared with NPs and PAs. The study authors conclude that interventions should be designed to reverse increasing prescribing trends, especially of broad-spectrum agents prescribed by NPs and PAs, and that stewardship efforts should also be targeted towards dentists.

Mary Warner, MS, CAE, Senior Director, Periodicals

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AAPA is looking for a volunteer to be a medical liaison to the Gay and Lesbian Medical Association (GLMA). Deadline is Dec. 23, so apply today! This individual will represent the PA profession and AAPA to GLMA leaders, communicate between the two organizations, identify strategic opportunities, involve other PAs and raise the PA profile within GLMA.

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A probable case of local transmission of the Zika virus has been reported in Texas, state health officials announced on Monday, making it the second state, after Florida, in which the infection is thought to have been carried from person to person by mosquitoes.

The patient is a woman who is not pregnant and lives in Brownsville, on the Gulf Coast near the Mexican border. The state’s first case of chikungunya, a virus spread by the type of mosquito that carries Zika, was confirmed this year in Brownsville.

Medical investigators must now determine whether the infection is spreading and, if so, how many people may have become infected. Officials have begun asking the woman’s neighbors for urine samples and trapping mosquitoes to test for the virus.

State and county health officials are working with the Centers for Disease Control and Prevention on the case. The state medical operations center has been activated to help with contact tracing, mosquito surveillance and public education.

The C.D.C. sent a training team to Texas this year but has not yet been asked to send an emergency response team, said Dr. Thomas R. Frieden, the agency’s director.

No travel alert suggesting that pregnant women avoid the area will be issued now, Dr. Frieden said, because a single case does not constitute evidence of continuing local transmission. “Most local cases are isolated dead ends,” he said.

Confirmation of several cases within a roughly one-square-mile area for more than about two weeks, despite aggressive mosquito control, would prompt an alert from federal authorities.

In Florida this year, the C.D.C. first advised pregnant women to avoid Wynwood, the neighborhood where the first cases in Miami were discovered, and later suggested they avoid all of Miami-Dade County.

There have now been 4,444 confirmed cases of Zika infection in the continental United States, including 1,114 in pregnant women. Most of those infected had traveled to countries where the virus had been spreading, but 182 of the infections were contracted in Florida by people who had not visited such places.

The Texas patient, who was not identified, told investigators that she had not traveled recently to anywhere the virus had been spreading. She had no other risk factors, such as having sex with someone who had visited an area with Zika transmission.

“We knew it was only a matter of time before we saw a Zika case spread by a mosquito in Texas,” said Dr. John Hellerstedt, the state health commissioner.

Residents of Brownsville, a city of 183,000, are concerned but not fearful, Mayor Tony Martinez said on Monday.

“I don’t think it’s something that people need to be alarmed about, but by the same token, they need to be cautious about it and report anything that needs to be reported to our health department,” Mr. Martinez said.

“On the coast, we kind of hoped that it wouldn’t happen,” he added, “but the likelihood was pretty high.”

Dr. Carmen Rocco, a Brownsville pediatrician, said she had been checking her patients for Zika, but none so far had been infected. Most of her patients are poor enough to be on Medicaid, and she praised state health officials for reinstating a Medicaid benefit for mosquito repellent.

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“Families were taking advantage of that,” she said.

While cold weather is arriving in other parts of the country, southern Texas has had an unusually hot autumn, making it more hospitable to the Aedes aegypti mosquitoes that transmit Zika.

Even in normal years, Aedes aegypti can persist in the Brownsville area well into December, so new cases may be confirmed in January or later.

“I predicted last April that we would see cases along the Texas Gulf Coast this summer,” said Dr. Peter J. Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine. “This is now the one case we know about, but we don’t know if there are dozens or hundreds.”

“Because of the lack of funds from Congress, there has been no active surveillance along the Gulf Coast,” he added. “Those cases in Florida were found by serendipity.”

Chris Van Deusen, a spokesman for the Department of State Health Services in Texas, said the new case was discovered because the woman fell ill and was tested for Zika infection by a local doctor, who alerted public health authorities. All such cases are investigated to see if a patient has a travel history or other risk factors that might explain the infection.

“Pregnant women should continue to protect themselves from mosquito bites there and elsewhere in Texas,” Mr. Van Deusen said.

Mosquito control measures will be stepped up, he said, but he did not know if they would involve aerial spraying of pesticides like Naled and larvicides like Bti.

In the Wynwood section of Miami, mosquito swarms did not decrease enough to stop disease transmission until both types of aerial spraying were used.

Thousands of Mexicans and Americans cross bridges over the Rio Grande each day in the Brownsville area; it is possible that the virus has been spreading in Matamoros, Mexico, just across the border.

In 2002, when there was a small outbreak of dengue in Brownsville, Dr. Hotez said, there turned out to be a much larger one in Matamoros. Both cities have poor neighborhoods where residents lack air-conditioning and window screens, he said, but many more Matamoros residents live in poverty.

“We won’t know how widespread the virus really was until babies with microcephaly begin being born, probably in the spring,” Dr. Hotez said, referring to the Zika virus and its link to the birth defect. “And I expect it to return next year.”

The C.D.C. regularly collaborates with Mexican health authorities, and Mexico “has quite a strong mosquito control program,” Dr. Frieden said.

Exactly how much Zika infection there may be in nearby parts of Mexico is unknown. “We know there is transmission in the border areas,” Dr. Frieden said. “But exactly where, we don’t know.”

A version of this article appears in print on November 29, 2016, on page A11 of the New York edition with the headline: Texas Woman Contracts Zika as Mosquitoes Spread the Virus to a Second State. 

Written by Honor Whiteman

Published: Monday 28 November 2016

There is insufficient evidence to suggest breast cancer screening should be stopped at a specific age. This is the conclusion of the largest study to date of mammography outcomes in the United States.

Researchers say there is no evidence that women should stop having mammograms after a certain age.

Study co-author Dr. Cindy Lee, assistant professor in residence at the University of California-San Francisco, and team recently presented their findings at the Radiological Society of North America (RSNA) annual meeting, held in Chicago, IL.

After skin cancer, breast cancer is the most common form of cancer among American women.

According to the American Cancer Society, around 246,660 new cases of invasive breast cancer will be diagnosed in the U.S. this year, and more than 40,000 women will die from the disease.

Despite these grim statistics, breast cancer death rates have been falling in the U.S. since the late 1980s - a trend that has been partly attributed to earlier detection as a result of screening.

Mammography is considered the gold standard of breast cancer screening. The technique involves the use of X-rays to identify early signs of breast cancer, such as calcifications or tumors in breast tissue.

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Guidelines issued by the U.S. Preventive Services Task Force (USPSTF) in 2009 recommend that women aged 40-49 at average risk of breast cancer should make an individual, informed decision as to whether they undergo mammography, while women aged 50-74 should undergo mammography every 2 years.

For women aged 75 and older, however, the USPSTF state that there is insufficient evidence to "assess the balance of benefits and harms of screening mammography."

Such guidelines are at odds with those from the American Cancer Society, which recommend that women aged 55 and older should undergo mammography every 2 years, and "screening should continue as long as a woman is in good health and is expected to live 10 more years or longer."

Assessing the mammography outcomes of more than 2.5 million women

Dr. Lee notes that the conflicting guidelines surrounding the age at which mammography should be stopped have led to much confusion.

"There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years," she adds.

Dr. Lee points out that previous randomized, controlled trials assessing mammography outcomes have excluded women aged 75 and older, meaning the available data have been based on results of small, observational studies.

With this in mind, Dr. Lee and team analyzed data from the National Mammography Database. The researchers assessed more than 5.6 million screening programs that took place at 150 facilities across 31 U.S. states between January 2008 and December 2014.

All in all, the team gathered data from more than 2.5 million women aged 40 and older. The women were divided into age groups by 5-year intervals up to the age of 90 - aged 40-44, 45-49, 50-54, 55-59, and so on.

'No evidence for age-based mammography cessation'

In order to determine mammography outcomes for the women in each age group, the researchers applied four standard performance measures: cancer detection rate, recall rate - the percentage of mammograms that require follow-up testing - and positive predictive value for biopsy recommended (PPV2) and biopsy performed (PPV3).

Positive predictive value represents the number of cancers identified through mammography that result in biopsy or recommended biopsy.

According to the researchers, a higher cancer detection rate, higher PPV2 and PPV3, and a low recall rate reflect an optimal mammography performance.

For every 1,000 patients, the team identified an overall mean cancer detection rate of 3.74, a 10 percent recall rate, a 20 percent PPV2 rate, and a 29 percent PPV3 rate.

With increasing age, the researchers identified an increase in cancer detection rate, a gradual rise in PPV2 and PPV3 rates, and a fall in recall rates - meeting the criteria for ideal screening performance.

"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation."

Dr. Cindy Lee

The researchers conclude that their findings suggest it should be a woman's individual choice - based on health status and personal preferences - as to whether she wants to cease or continue breast cancer screening at the age of 75 or older.

While further investigation is needed, the new research indicates that the benefits of breast cancer screening after the age of 74 may outweigh the risks.

Read how digital mammography could help predict heart disease.

Written by Honor Whiteman