Hip-Fracture Surgery Risk Not Just Due to Age, Study Finds

By Amy Norton
HealthDay Reporter

TUESDAY, Sept. 15, 2015 (HealthDay News) — People who need surgery for a broken hip face a higher risk of serious complications and death than those who undergo an elective hip replacement — and the disparity is not explained by fracture sufferers’ older age or poorer health, a new study finds.

Doctors have long known that hip-fracture surgery is a riskier procedure than elective hip replacements, which are done to treat severe arthritis.

“Everyone has recognized that hip-fracture patients are having bad outcomes,” said Dr. P.J. Devereaux, the senior researcher on the new study and a professor at McMaster University in Hamilton, Canada. “It’s been assumed that it’s because they’re older and sicker.”

But his team’s study, published in the Sept. 15 issue of the Journal of the American Medical Association, suggests that is not the whole story.

“This raises the hope that we don’t have to just accept those poor outcomes,” Devereaux said. “It’s likely there are factors we can modify.”

For the study, the researchers analyzed records from more than 690,000 French patients aged 45 and older who underwent either hip-fracture surgery or a total hip replacement between 2010 and 2013.

The investigators found that almost 3.5 percent of fracture patients died in the hospital, versus less than 0.2 percent of hip replacement patients. And a large disparity remained even when they compared the ages and similar rates of medical conditions of both groups.

Fracture patients were still almost six times more likely to die in the hospital, the study found. They also had more than double the risk of post-surgery complications, such as heart attack, stroke and blood infection.

What explains the higher risks? It’s not clear from the study, but Devereaux speculated on some reasons.

For one, the fracture itself creates inflammation, a stress response from the nervous system, and a tendency for blood cells to form clots. On top of that, Devereaux said, hip-fracture patients are immobile and not eating ahead of surgery, which quickly causes muscle breakdown and “deconditioning.”

A potential way to address those issues, Devereaux said, is through quicker surgery.

In Canada and the United States, he said, hip-fracture surgery is typically done 24 to 48 hours after the injury. Doing surgery sooner, and getting patients on their feet within eight hours of the procedure, might be a better tactic, according to Devereaux.

A clinical trial to test that theory is already under way, he noted.

In the United States, at least 258,000 people aged 65 and older are hospitalized for a hip fracture each year, according to the U.S. Centers for Disease Control and Prevention. Nearly all of those injuries are caused by falls.

After surgery, many patients need nursing home care, and about 20 percent of all hip-fracture patients die within a year, according to the CDC.

Fracture surgery typically involves fixing the injury with screws — and it’s actually less complicated than hip replacement, Devereaux said.

On the other hand, hip replacement is planned in advance, said Dr. Douglas Lundy, a spokesman for the American Academy of Orthopaedic Surgeons, who was not involved in the study.

So people undergoing a hip replacement have time to get chronic health conditions — such as high blood pressure and heart disease — under the best control possible ahead of surgery.

That’s not the case for fracture patients, Lundy pointed out.

He said he thinks that the basic difference between the two procedures — one is elective, one is an emergency — helps explain the disparities in patients’ outcomes.

For the general public, Lundy said the findings underscore the importance of prevention.

“A lot of these fractures are preventable,” he said. “It’s important for adults, and especially women, to protect their bone health with regular exercise, a healthy diet, and calcium and vitamin D.”

People who already have the bone-thinning disease osteoporosis can still curb their risk of fractures, Lundy said — though they may need the added help of a prescription medication.

Preventing falls is also key, he stressed.

To curb the risk of falls, the CDC recommends that older adults remove tripping hazards and improve lighting in the home, install grab bars in the bathroom, and have their vision checked regularly.

More information

The U.S. Centers for Disease Control and Prevention has more on hip fractures.

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Watch This Baby Prank Her Dad in the Most Adorable Way

 

Clipping your newborn’s nails can be terrifying, especially for the first time. What if they start squirming, and suddenly you snag skin instead of the nail? This baby from Sao Bernardo do Campo, Brazil, clearly saw the fear in her dad’s eyes when he approached with nail scissors in hand, so the baby genius decided to play a little trick on him.

As he zeros in for a nail trim, she starts fake crying out in pain, so her dad recoils. But she can’t keep the charade going for too long, and adorably starts laughing, dissolving her dad into deep belly laughs along with her.

The baby Einstein’s mom, Marcelinha Dos Santos Iwama, posted the video to her Facebook page on Sept. 5^th, where it’s now racked up close to 27 million views.

RELATED: The Totally Normal Reason This Baby’s Trapped in a Tube

While this dad had trouble getting to his daughter’s tiny nails, he’s on the right track with a set of baby nail scissors. Those, which should have blunt rounded tips, along with a nail file or emery board to smooth the nails, are the best choices to trim down a baby’s finger and toenails. They also explain that, unfortunately for this dad, a baby’s fingernails grow rapidly, and need to be cut at least once a week. The toenails can wait a little longer, about twice a month, but it’s important to keep all their nails short so your baby doesn’t scratch themselves (or you, let’s be honest).

This dad should watch out though, his cute baby prankster is probably saran wrapping the toilet as we speak.

RELATED: 12 Ways to Raise a Kid Who’s Healthy for Life

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5 Tourist-Friendly Marathons Worth Traveling To

Photo: Getty Images

The best way to see a city is to run through it, and these races give you plenty for your peepers. So pack your favorite running kicks and jump on the next flight out of town. The best part, the marathon gives you the chance to work off all of those local desserts that piqued your interest. Ready? Set. Run!

Queenstown International Marathon, New Zealand
November 21, 2015
For the majority of your miles you’ll cruise along smooth, hard-packed trails against the backdrop of this region’s most breathtaking sights, including Lake Wakatipu, Queenstown Gardens and Twins River Trail.

Kilamanjaro Premium Lager Marathon, Tanzania
February 28, 2016
Set in the town of Moshi, this out and back course runs along the foothills of the famed and mighty Mt. Kilamanjaro, where you’ll make your way through villages, farms, forests and banana and coffee plantations.

Virginia Money London Marathon, England
April 24, 2016
Run this city and you’ll be treated to views of the River Thames, Buckingham Palace, Big Ben and plenty of other uniquely-London sights. Plus you’ll get to check one of the World Major marathons off your list.

Great Wall Marathon, China
May 21, 2016
If you are looking to PR, steer clear of this 26.2-mile journey; the route is paved with arduous accents and descents and even 5164 steps! On the upside, you get to run the Great Wall twice, which is nothing less than amazing.

Maratano Caixa Da Cuidad do Rio De Janeiro, Brasil
May 29, 2016
This foot race is sandwiched between the Serra do Mar mountains and Rio’s shoreline, and blessed with picturesque views which make the task at hand much more manageable. Bonus: You’ll make your way through iconic neighborhoods like Ipanema, Copacabana and Flamengo.

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The Simplest Way to Make Pour-Over Coffee

Photo: Getty Images

Have you been wondering about the pour-over offerings at Starbucks (or your local coffee house)? It costs more, it takes longer… so why would anyone order it?

Experts say this method—in which hot water is slowly poured over a single serving of freshly ground coffee—results in a better-tasting brew because, unlike standard drip, the water-to-coffee ratio is exactly right. And when done pain-stakingly right, pour-over is supposed to help extract flavor more nuances of your favorite beans.

I love a well-brewed cup of coffee, but for me, the transition to pour-over happened for a less lofty reason: I’m the only coffee drinker in my house. My 6-year-old is obviously too young to be interested, and my husband, much to my continuing dismay and disbelief, is not a coffee drinker. (It was hard to even type that sentence.) Since I drink only 1 cup a day, brewing a whole pot, or 1 cup in a large pot, didn’t make sense.

RELATED: 4 Recipes for Coffee Lovers

After much trial-and-error, I landed on pour-over, and I’ve never looked back.

True coffee purists will note my edits to this process (and probably judge me for it.) But I’ve found this is what works best for me—and I stand by it. Here’s how it’s done.

Grind the coffee

I use a hand-crank Burr grinder ($20, amazon.com) because I think the coffee comes out better, and there’s something satisfying about grinding it by hand. (Plus, I get a quick little arm and shoulder workout in, first thing—no joke.) But you can skip this step and use pre-ground or make it quicker by grinding yours in an electric grinder.

Transfer it to a filter

Because I use a porcelain Hario ceramic coffee dripper ($17, amazon.com), I use their paper filters ($7, amazon.com), too. You can buy other drippers, of course, but I prefer not to use plastic, and I think the coffee tastes cleaner with these filters than others I’ve used. Once the coffee is in the filter in the cone, give it a little shake to even out the grinds.

RELATED: Here’s How 5 Health Experts Spend Their Mornings

Heat up the water

Do this while grinding the beans. Here’s where I deviate from the die-hards. A true coffee expert would tell you to use a special kettle with a thin spout for precise pouring. I just use my regular kettle; the same one my husband uses for (gasp!) tea.

I also skip the step of warming up the cup.

Pour over

Time to brew. Pour in just enough water to wet the grounds, then let it stand for 30 seconds to a minute. This allows the grounds to “bloom,” resulting in more even coffee extraction for the rest of the brew (you’ll see the grounds kind of puff up slightly). After the bloom, continue pouring, a bit at a time (just cover the grounds, don’t fill the filter all the way), until your cup is brewed.

Then, fix it however you like, and enjoy.

RELATED: 2-Minute Morning Workout

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Long Shifts Linked to Increased Injury Risk for EMS Workers

TUESDAY, Sept. 15, 2015 (HealthDay News) — Emergency services employees (EMS) who work extended shifts are 60 percent more likely to suffer injury and illness than those who work 12 hours or less, a new observational study shows.

And the longer the extended shift, the greater the risk, the researchers found.

Working in emergency services requires that people be physically strong and able to move patients yet remain clear-headed while providing medical care in stressful and sometimes chaotic situations.

Despite such demanding job requirements, these clinicians often have to work up to 24 hours a shift. And that could increase their risk for injuries or take a toll on the quality of care they provide to patients, the researchers said.

To investigate how long hours could affect EMS workers, the researchers analyzed 1 million shift schedules completed by 4,000 employees over the course of three years. They also examined 950 occupational health records for 14 large U.S. emergency medical services agencies.

The risk of sustaining an injury or developing an illness increased as the length of EMS workers’ shifts grew, the study published online Sept. 14 in the journal Occupational & Environmental Medicine revealed.

Shifts longer than 12 hours were linked to a 50 percent greater risk for injury than shorter shifts, even after the researchers considered other factors like the time of day and how often the EMS crew worked together. Meanwhile, shifts lasting up to 24 hours had more than double the risk of injury or illness of shifts lasting eight hours or less.

These findings don’t prove long shifts cause illness or injuries, but the researchers concluded they do show a consistent trend.

“The findings are early observational evidence of a preventable exposure associated with injury and illness and should be tested further in a randomized design,” the study authors wrote.

More information

The American College of Emergency Physicians provides more on emergency medical shift work.

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Air Pollution Exposure May Boost Risk of Early Death

TUESDAY, Sept. 15, 2015 (HealthDay News) — Breathing in tiny particles of toxic chemicals from the air could lead to an increased risk of premature death, a large new study suggests.

“Our data add to a growing body of evidence that particulate matter is really harmful to health, increasing overall mortality, mostly deaths from cardiovascular disease, as well as deaths from respiratory disease in nonsmokers,” the study’s lead investigator, George Thurston, said in a news release from NYU Langone Medical Center. Thurston is a professor of population health and environmental medicine at NYU Langone in New York City.

The data used in this study came from government and independent sources, Thurston added.

However, this study was only able to show an association between an increased risk of early death and air pollution; it cannot prove a cause-and-effect relationship.

Fine particles are often made up of toxic chemicals, such as arsenic and mercury. The chemical particles polluting the air are microscopic. That means they’re too small to see with the naked eye.

Their tiny size allows the particles to get past the body’s defenses. They can be absorbed deep into the lungs and bloodstream, increasing the risk for serious heart and lung diseases, the researchers said. These particles can also carry gaseous pollutants, including sulfur and nitrogen oxides, into the lungs. Unlike larger natural substances, these tiny particles can’t be coughed up or sneezed out, the researchers explained.

The investigators cautioned that even small increases in this type of air pollution can increase the risk of dying from any cause by 3 percent.

An increase in the amount of fine particles in the air increased the risk of death from heart disease by about 10 percent, the study found. And nonsmokers in the study had a 27 percent increased risk of death from lung disease when exposed to increased levels of chemical particles.

The study included information from more than 560,000 men and women. The participants completed health and diet surveys conducted by the U.S. National Institutes of Health and AARP (formerly known as the American Association of Retired Persons). The study volunteers were between 50 and 71, and came from eight U.S. states.

The researchers also collected information on the amount and type of air pollution where the participants lived. This information came from the U.S. Environmental Protection Agency’s Air Quality System and other databases.

After accounting for other factors that could impact health and longevity, the investigators found gender, age and education didn’t alter the effects of exposure to fine particulate matter.

The study authors plan to continue their research, investigating which components of particulate matter are most toxic. They also hope to determine the source of these pollutants.

“We need to better inform policymakers about the types and sources of particulate pollution so they know where to focus regulations,” the study’s senior investigator, Richard Hayes, a professor of population health and environmental medicine at NYU Langone, said in the news release.

“It is especially important to continue monitoring health risks as national standards for air pollution are strengthened,” he added.

Findings from the study were published Sept. 15 in Environmental Health Perspectives.

More information

The American Lung Association has more about the health effects of air pollution.

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Tight Control of Type 2 Diabetes May Help Prevent Dementia

TUESDAY, Sept. 15, 2015 (HealthDay News) — Keeping blood sugar levels in check may have a protective effect against dementia in people who have type 2 diabetes, new Swedish research suggests.

“The positive association between [average blood sugar levels] and risk of dementia in fairly young patients with type 2 diabetes indicates a potential for prevention of dementia with improved blood sugar control,” study author Dr. Aidin Rawshani, from the National Diabetes Register and Institute of Medicine in Gothenburg, Sweden, and colleagues wrote.

However, the study wasn’t able to definitively prove a cause-and-effect relationship between blood sugar levels and dementia; it was only able to show an association between these factors.

The study included almost 350,000 people with type 2 diabetes. They were all registered in the Swedish National Diabetes Registry between January 2004 and December 2012. They had no history of dementia when they were diagnosed with type 2 diabetes. The mean age was 67 years when the study began.

Study volunteers were tracked until the study ended in 2012 or they were hospitalized for dementia or died. Using a computer model, the researchers calculated the link between average blood sugar levels and dementia. Average blood sugar levels were based on the results of hemoglobin A1C tests (HbA1C). This test provides doctors with a several-month average of blood sugar levels, according to the American Diabetes Association (ADA). The ADA generally recommends an HbA1C level of 7 percent or less for people with diabetes.

Slightly more than 3 percent of those in the study — 11,035 people — were admitted to the hospital with dementia during the nearly five-year follow-up period.

After taking other variables into account, the study found that those with HbA1c levels of 10.5 percent or higher were 50 percent more likely to be diagnosed with dementia compared to people with HbA1c levels of 6.5 percent or less.

Study volunteers who’d had a previous stroke were 40 percent more likely to have declines in memory and thinking abilities, the researchers said.

The study’s findings were to be presented Sept. 14 at the annual meeting of the European Association for the Study of Diabetes, in Stockholm, Sweden. Findings presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information

The American Diabetes Association has more on blood sugar management for people with type 2 diabetes.

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Wealthy Blacks Fare Worse Than Whites After Heart Attack: Study

By Randy Dotinga
HealthDay Reporter

TUESDAY, Sept. 15, 2015 (HealthDay News) — Higher-earning black Americans seem to die sooner after a heart attack than whites, according to researchers who say they’ve uncovered a new twist on the “survival gap” theory.

Historically, income differences were considered a key reason why black cardiac patients tend to fare worse than better-off whites. But this study, based on heart attack patients in the 1990s, finds the gap between the races was widest among the richest people.

White Medicare patients in the wealthiest neighborhoods lived an average of seven years after a heart attack, while blacks in those areas lived 6.3 years. The difference between poor white patients (5.6 years) and poor black patients (5.4 years) was smaller, the study found.

“We expected to see the reverse,” said study lead author Dr. Emily Bucholz of Boston Children’s Hospital. “Instead, the greatest gap in life expectancy between black and white patients occurred in high-income patients, which was surprising to us.”

The reasons for the gap aren’t yet known, and the study doesn’t say anything about current health care since it’s based on heart attacks suffered two decades ago.

Researchers have documented differences in care between blacks and whites for decades, said cardiologist Dr. Quinn Capers IV, an associate professor of medicine at Ohio State University College of Medicine. He was not involved with the current study.

“We know that racial health care disparities exist in cancer care, diabetes care, cardiac care and many other areas, and the disparity is always in the same direction: Whites are more likely to receive high-quality care than blacks,” Capers said.

But researchers don’t know why the difference persists.

In the new study, researchers examined the records of nearly 142,000 Medicare patients aged 65 to 90 who had heart attacks between 1994 and 1996. The study followed them for the next 17 years.

The life span differences were especially significant given the ages of the patients, Bucholz said.

“In 65-year-old patients, the differences in white-black life expectancy after heart attack were 3.25 years among patients living in high-income areas and 2.15 years among patients living in low-income areas,” she said. “When one considers that the average life expectancy of a 65-year-old person is 19 years, two to three years is actually a pretty sizable difference.”

What’s going on? For one thing, blacks had more risk factors for heart disease such as smoking and diabetes, and they were less likely to be treated, the researchers found. Other research suggests that racial differences could be due to discrimination, the study pointed out.

Under one theory, “a middle-class black man and a middle-class white man may both seek medical attention at the same high-quality hospital with highly trained doctors. But if the treating physician has either explicit or unconscious racial bias against the blacks, he may be less likely to offer all treatments and diagnostic tests to the black man, and may be less compassionate when treating him,” Capers said.

Also, minorities living in upper-income neighborhoods, which may have a lot of white residents, have been shown to have poorer health than those living in areas with more people of their own race, the researchers said in background notes.

So, poor blacks and poor whites may be more comfortable in the same neighborhoods, Capers said, and that could explain why there’s less difference between how they fare in terms of health. Still, “these are just theories that are difficult to prove,” he added.

Capers said it would help black patients to have a family member present as an advocate when dealing with life-threatening issues. Also, doctors should consider their potential to discriminate and take tests that aim to detect unconscious bias, he said.

The study appears in the Sept. 14 issue of Circulation.

More information

For more about racial health disparities, see the U.S. National Institutes of Health.

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Sleep Apnea Treatment May Reverse Unhealthy Brain Changes

MONDAY, Sept. 14, 2015 (HealthDay News) — Sleep apnea treatment may reverse changes in brain stem activity associated with increased risk of heart disease, a new study suggests.

The findings “highlight the effectiveness of CPAP treatment in reducing one of the most significant health issues [heart disease] associated with obstructive sleep apnea,” the researchers concluded. CPAP stands for continuous positive airway pressure.

Previous research suggests that people with obstructive sleep apnea have greater activity in nerves associated with stress response, which can lead to high blood pressure and heart problems. This increased nerve activity is due to altered brain stem function caused by sleep apnea, earlier studies have shown.

In this small study, published recently in the Journal of Neurophysiology, Australian researchers found that CPAP treatment reduced that nerve activity by restoring normal brain stem function.

The study included 13 sleep apnea patients who were assessed before and after six months of CPAP treatment.

“These data strongly suggest that functional and anatomical changes within the brain stem, which we believe underlie the elevated sympathetic activity in individuals with untreated obstructive sleep apnea, can be restored to healthy levels by CPAP treatment,” the University of Sydney researchers wrote.

In obstructive sleep apnea, muscles in the airway collapse during sleep and block breathing. A CPAP device keeps airways open by delivering a steady flow of air while patients sleep.

More information

The U.S. National Heart, Lung, and Blood Institute has more about CPAP.

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Diabetes Takes a Toll on Women’s Hearts

MONDAY, Sept. 14, 2015 (HealthDay News) — Diabetes may be harder on women’s hearts than it is on men’s.

Two new studies have found an increased risk of heart problems, such as heart attack and chest pain, in women with diabetes compared to men with the blood sugar disorder. In one of the studies — a review that included almost 11 million people — the risk was about 40 percent higher.

“We should avoid sexual prejudice in cardiovascular disease, take all necessary steps to diagnose it early, and control risk factors comprehensively to guarantee the most suitable treatments and best possible outcomes in female patients,” wrote study author Dr. Xue Dong, of the Affiliated ZhongDa Hospital of Southeast University in Nanjing, China and colleagues.

However, it’s important to note that both studies could only find an association between diabetes and a higher risk of heart disease in women than men. Neither study was designed to prove a cause-and-effect relationship.

Diabetes is a known risk factor for heart troubles. But, it hasn’t been clear if the heart risk is greater for women or men, the Chinese researchers said.

Dong and colleagues reviewed 19 previously conducted studies done between 1966 and 2014. Combined, the studies had nearly 11 million people from North America, Europe and Asia. Among these people, more than 106,000 fatal or non-fatal heart attacks or chest pain (angina) events occurred, the study said.

The researchers found that women with diabetes had a 38 percent greater risk of heart attack or angina than men with diabetes did.

The second study included data from hospitals across the Tuscan region of Italy. The information was collected between 2005 and 2012. The study included more than 3 million people, the researchers said. Forty-seven percent were male.

The Italian researchers, led by Dr. Giuseppe Seghieri of the Regional Health Agency in Florence, found that women with diabetes had a 34 percent greater risk of heart attack than men with diabetes. And, women with diabetes had a higher risk of heart attack than men regardless of age, the study found.

The study found a similar risk for congestive heart failure or stroke in people with diabetes of both sexes.

Neither group of researchers offered possible explanations as to why these gender differences might exist.

And neither study specified whether the participants had type 1 or type 2 diabetes, although the vast majority of cases are type 2.

Both studies were scheduled to be presented on Monday at the European Association for the Study of Diabetes, in Stockholm, Sweden. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

More information

Learn more about preventing diabetes complications, such as heart disease, from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

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