Lift Ban on CDC Research Into Gun Violence, Doctors’ Group Says

TUESDAY, June 14, 2016 (HealthDay News) — On the heels of yet another senseless gun massacre in the United States, the nation’s leading physicians’ organization is urging more research into gun violence.

Specifically, the American Medical Association (AMA) said Tuesday that a long-standing ban on federal government research into gun violence must be lifted to better understand and tackle the problem.

The AMA is now pledging to lobby Congress to overturn 20-year-old legislation that has prohibited the Centers for Disease Control and Prevention from researching the issue.

“Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence,” AMA President Dr. Steven Stack said in a news release from the group.

Such research would also help “determine how to reduce the high rate of firearm-related deaths and injuries,” he said.

The newly adopted policy was announced in the wake of the worst mass shooting in U.S. history — at the Pulse Nightclub in Orlando, Fla. — on Sunday that left 49 people dead and 53 wounded.

The AMA also noted that more than 6,000 people in the United States have died in gun violence so far this year.

The groups’ new policy coincided with the release of new research into the toll gun violence takes in hospital emergency rooms every day.

A study of 29,000 Denver area ER patients treated for gunshot wounds between 2000 and 2013 found that the fatality rate has increased significantly during that time.

Guns are “becoming progressively more dangerous,” said study lead author Dr. Angela Sauaia. Her team published their findings June 14 in the Journal of the American Medical Association.

The AMA’s Stack agreed.

“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” he said.

He believes that lifting the CDC research ban is “vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”

The AMA also has a number of policies in place that urge improved firearm safety and reduction and prevention of gun violence.

Currently the group supports a waiting period before someone can purchase any form of firearm, background checks for all handgun purchasers, stricter enforcement of present federal and state gun safety legislation, and mandated penalties for crimes committed with the use of a firearm, including the illegal possession of a firearm.

According to the AMA, “uncontrolled ownership and use of firearms, especially handguns, is a serious threat to the public’s health inasmuch as the weapons are one of the main causes of intentional and unintentional injuries and deaths.”

More information

The American Psychological Association has more about gun violence.

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Gun Violence Toll Grows More Gruesome: Study

By Steven Reinberg
HealthDay Reporter

TUESDAY, June 14, 2016 (HealthDay News) — Injuries from senseless gun violence — like those witnessed in Orlando on Sunday morning — may be increasing in severity in ERs across the United States, a new study suggests.

“Americans mourn firearm-related fatalities every day,” said lead researcher Dr. Angela Sauaia, a professor of public health and surgery at the University of Colorado, in Denver. “Mass shootings are just the tip of the iceberg of the daily tragedy witnessed by trauma surgeons in emergency rooms,” she added.

Sauaia’s study was based on nearly 29,000 patients who came to the trauma center at the Denver Health Medical Center from 2000 to 2013. Just under 6 percent arrived with gunshot wounds. Among those who had been shot, the number of deaths increased significantly, as did the severity of their wounds.

While technology and education are helping to make cars and bicycles safer, “firearms are moving in the exact opposite direction,” Sauaia said. “They are becoming progressively more dangerous.”

If you are in a car crash today, you are more likely to survive than you were 10 years ago due to safer cars and improvements in trauma care, Sauaia noted.

“However, if you get shot today, you are more likely to die than if you were shot 10 years ago, despite our excellent trauma care,” she said. “Firearm injuries are becoming more lethal due to an increased number and severity of wounds they inflict.”

The data comes from only one trauma center, so the findings can’t be generalized, she said. However, according to the U.S. Centers for Disease Control and Prevention, nearly 34,000 Americans died from gunshot wounds in 2013.

Regardless of how people feel about gun control, “there are a number of things we can all agree upon,” Sauaia suggested. These include:

• Children and people who are mentally unstable should not have access to unlocked, loaded guns.
• Use technology to improve the safety of guns.
• Add counseling about firearm safety in primary care.

“We should start the discussion on these common grounds,” she said.

Of the nearly 29,000 patients included in the study, almost 6 percent had gunshot wounds and just over 6 percent had stab wounds. In addition, about 7 percent were pedestrian accidents, 9 percent were assaults, 24 percent were from falls, 26 percent from car crashes and 22 percent from other injuries. Of these, more than 5 percent died, the researchers found.

Over that time, the number of deaths from gunshot wounds increased significantly, while deaths from other types of trauma either remained stable or decreased, the findings showed.

The report was published June 14 in the Journal of the American Medical Association.

Dr. Robert Glatter is an emergency physician at Lenox Hill Hospital in New York City. He said, “While this is only a single-center study, it is a continuing reminder that we need to focus our efforts to find practical approaches — through policy and other grassroots efforts — to reduce gun violence in our communities.”

Even if you survive a gunshot wound, the suffering may continue, he added.

“After gunshot wounds inflict their immediate damage, long-term effects may include poorly healing fractures, injuries to nerves and blood vessels, as well as the potential for infections that may lead to chronic disability and require long-term care,” Glatter explained.

These injuries and deaths are largely preventable, he noted.

“Our society should not continue to fall victim to a method of violence that we have the ability to set clear public policy to control,” Glatter said.

More information

Visit the Brady Campaign to Prevent Gun Violence for more on gun violence.

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Spare the Meat, Skip the Type 2 Diabetes?

TUESDAY, June 14, 2016 (HealthDay News) — Eating a mainly plant-based diet — especially one with lots of healthy veggies, fruit and whole grains — may significantly lower your risk of type 2 diabetes, a new study suggests.

“This study highlights that even moderate dietary changes in the direction of a healthful plant-based diet can play a significant role in the prevention of type 2 diabetes,” said study lead author Ambika Satija, a postdoctoral fellow at the Harvard School of Public Health in Boston.

“These findings provide further evidence to support current dietary recommendations for chronic disease prevention,” Satija added in a school news release.

The study included information from more than 200,000 Americans. They all completed a series of questionnaires about their diet, lifestyle, medical history and current health. The information was collected over 20 years.

People who closely followed a plant-based diet low in animal-based foods had a 20 percent reduced risk of type 2 diabetes than those who didn’t. However, the research didn’t establish a firm cause-and-effect relationship; it only showed a link.

The researchers also found that the healthier the foods, the lower the risk seemed to be.

A healthy version of a plant-based diet lowered the risk of type 2 diabetes by 34 percent. A healthy diet included foods such as whole grains, fruits, vegetables, nuts and legumes, the study noted.

But, people who opted for less healthy foods — though they still ate many plant-based foods — had a 16 percent increased risk of type 2 diabetes, the study revealed. The less healthy diet included foods such as refined grains, potatoes and sugar-sweetened beverages.

The researchers also found that even a modest reduction in animal-based food consumption was linked to a lower type 2 diabetes risk. The reduced risk was seen with as little a change as going from five to six servings of animal-based foods per day to about four servings per day, the study said.

“A shift to a dietary pattern higher in healthful plant-based foods — such as vegetables, fruits, whole grains, legumes, nuts and seeds — and lower in animal-based foods, especially red and processed meats, can confer substantial health benefits in reducing risk of type 2 diabetes,” study senior author Frank Hu said. He’s a professor of nutrition and epidemiology at Harvard.

The study was published online June 14 in the journal PLoS Medicine. Funding was provided by the U.S. National Institutes of Health.

In related news, another study found that eating three or more servings of whole grains a day lowered the risk of premature death by 20 percent compared to eating fewer or no servings of whole grains daily. This study was published June 13 in Circulation.

More information

The American Diabetes has more on diabetes prevention.

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Impotence Drugs Won’t Raise Melanoma Risk, Study Suggests

TUESDAY, June 14, 2016 (HealthDay News) — Three widely used erectile dysfunction drugs — Cialis, Levitra and Viagra — aren’t likely to boost the risk of melanoma skin cancer, a new study reports.

Why the concern in the first place? Laboratory tests suggested that lower levels of an enzyme that’s inhibited by certain erectile dysfunction drugs might increase the growth of melanoma cells. Melanoma is the most deadly type of skin cancer.

But studies examining melanoma risk among men who take these drugs have had conflicting results, the researchers said.

The new study included more than 145,000 men who used either Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil). These impotence drugs inhibit an enzyme called phosphodiesterase type 5 (PDE5). The investigators compared the men taking the drugs to nearly 561,000 men who didn’t use them.

Although the study couldn’t prove no cause-and-effect link between the drugs and skin cancer, the researchers found only a slightly increased risk of melanoma in men who took the drugs compared to those who didn’t.

The study authors suspect there may be other factors behind the reported increases in some cases. In particular, they suggested that sun exposure may play a big role.

The study was published online June 14 in the journal PLoS Medicine.

“All of our observations pointed towards the small apparent increase in risk of melanoma in men prescribed PDE5 inhibitors being explained by greater sun exposure, rather than a side effect of the drugs themselves,” senior author Krishnan Bhaskaran, of the London School of Hygiene & Tropical Medicine in England, said in a journal news release.

More information

The U.S. National Cancer Institute has more on melanoma.

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Zika Could Spread in Southern Europe This Summer

TUESDAY, June 14, 2016 (HealthDay News) — The Zika virus could spread in southern Europe this summer if it’s introduced to the region by infected travelers, researchers warn.

Zika is transmitted by the Aedes aegypti mosquito, which is present in southern Europe. An analysis of a number of factors, including temperatures and air traveler patterns, suggests that parts of southern Europe may be at risk for Zika outbreaks between June and August.

“We know warm climates create the kind of conditions suitable for mosquito-borne illnesses to spread,” said study author Joacim Rocklov. He is a researcher in the unit for epidemiology and global health at Umea University, in Sweden.

While most people only suffer mild symptoms after being infected with the Zika virus, infection during pregnancy can cause a devastating birth defect known as microcephaly, where babies are born with abnormally small heads and brains.

The vast majority of Zika infections have occurred in Latin America, and Brazil has been the epicenter with an estimated 5,000 cases of microcephaly.

“The presence of established Aedes mosquito populations, the warmer climate and the coinciding peak flow of air travelers [from Zika-affected areas in the Americas] into Europe is a triage making southern Europe fertile ground for Zika,” Rocklov explained in a university news release.

The study was published June 10 in the journal EBioMedicine.

While Zika is typically spread via the bite of the Aedes mosquito, there is increasing evidence that the virus can also be transmitted through sex, possibly even oral sex.

In light of that, the World Health Organization advises couples who are trying to have children and live in Zika-affected areas to consider delaying pregnancy to avoid having babies born with birth defects.

The new guideline replaces an earlier one that suggested women planning to become pregnant should wait at least eight weeks before trying to conceive if they or their partner live in — or are returning from — Zika-affected regions.

There have been no reports of Zika-induced microcephaly contracted in the United States. But two babies have been born in the United States with the birth defect after their mothers contracted the virus while traveling during pregnancy in countries where Zika is active.

U.S. health officials have said they expect to see Zika infections in Gulf Coast states such as Florida, Louisiana and Texas as the summer mosquito season picks up.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on the Zika virus.

This Q&A will tell you what you need to know about Zika.

To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

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Diabetes Drug Victoza May Help the Heart: Study

TUESDAY, June 14, 2016 (HealthDay News) — The blood sugar-lowering drug Victoza (liraglutide) cuts the risk of heart attack and stroke in type 2 diabetes patients, a new study finds.

Heart disease is the leading cause of death among people with type 2 diabetes, the researchers noted.

The study was funded by the drug’s maker, Novo Nordisk, and the U.S. National Institutes of Health. It included more than 9,300 adults from 32 countries who have type 2 diabetes and a high risk of heart disease.

About half took Victoza, while the other half took an inactive placebo. Both groups also took other medications for health problems, such as high blood pressure and high cholesterol, the study authors said.

Tracking patients for three years, the researchers found that compared with patients in the placebo group, people who took Victoza had a 13 percent lower risk of heart attack or stroke. They also had a 22 percent lower risk of death from heart disease; a 15 percent lower risk of death from any cause; and a 22 percent lower risk of new evidence of advanced kidney disease.

Some patients did discontinue the drug due to “gastrointestinal events,” according to the report.

The study was presented June 13 at the American Diabetes Association’s annual meeting, in New Orleans. It was also published simultaneously in the New England Journal of Medicine.

“I’ve been excited about liraglutide for a long time because I think it’s unique,” said study senior author Dr. John Buse. He directs the Diabetes Care Center at the University of North Carolina, Chapel Hill.

“This is the first diabetes drug that has shown across-the-board benefits for cardiovascular diseases, and this suggests it plays a role in treating atherosclerosis [hardening of the arteries], which is what leads to heart attacks and strokes,” Buse said in a university news release.

One diabetes expert called the study “encouraging.”

Victoza “is a relatively new medication, given by daily injection,” said Dr. Allison Reiss, who runs the inflammation laboratory at Winthrop-University Hospital in Mineola, N.Y.

Still, the long-term effectiveness of the drug is unknown, Reiss added. “It will be important to follow these patients over the next few years to see whether [Victoza] benefits continue and to investigate how it is working,” she said.

The researchers explained that Victoza is from a newer class of diabetes drugs known as GLP-1 agonists. These medications work in the pancreas to cut the production of an anti-insulin hormone called glucagon. The drugs boost insulin production and help control blood sugar levels.

As a secondary mechanism, Victoza also works on the brain to help lower appetite and boost feelings of “fullness” when eating, Buse’s team explained.

Reiss noted that because of this activity, Victoza can help spur weight loss — and that might be the prime factor driving the improvements in heart health.

Dr. Gerald Bernstein coordinates the Friedman Diabetes Program at Lenox Hill Hospital in New York City. He said that Victoza — and other drugs in its class — are being increasingly used, so “decreased cardiovascular risk is an important finding.”

Type 2 diabetes affects more than 29 million Americans, according to the U.S. Centers for Disease Control and Prevention.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about diabetes.

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Brains of Teens With Type 2 Diabetes May Have Gray Matter Differences

TUESDAY, June 14, 2016 (HealthDay News) — Teens with type 2 diabetes may have differences in gray matter in their brains, a small study found.

Researchers conducted brain scans on 20 teens with type 2 diabetes and 20 teens without the blood sugar disease. Those with diabetes had less gray matter in six regions in their brains, and more gray matter in three regions. Some of these affected regions are involved in seeing and hearing, speech, memory, emotions, decision-making and self-control, the researchers said.

Gray matter is where thinking occurs, experts noted.

The Cincinnati Children’s Hospital Medical Center team also found an association between less gray matter and the ability to pronounce and sound out unfamiliar words.

“Previous studies suggested that youth with type 2 diabetes have changes in brain structure and poorer cognitive function scores compared to their peers,” said senior study author Dr. Amy Sanghavi Shah. She is a physician-scientist in the hospital’s division of endocrinology.

“Total and regional brain volume had not been assessed comprehensively until now. We also sought to determine if the findings we found here could explain poorer cognitive scores,” Shah said in a hospital news release.

The researchers stressed that they only found an association. “Our results do not show cause and effect,” said study author Dr. Jacob Redel, a fellow in the division of endocrinology.

“We don’t know if the changes we found are the direct result of diabetes, but studies in adults with type 2 diabetes with longer duration of disease also show brain volume differences, brain vascular changes and cognitive decline,” Redel said.

“Our findings suggest that preventing type 2 diabetes in adolescents is important to prevent possible complications in the future,” he added.

The study was to be presented Tuesday at the American Diabetes Association annual meeting, in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal.

Redel and his colleagues hope to conduct a larger study to determine if the gray matter differences seen in teens with type 2 diabetes are more strongly linked with either obesity or high blood sugar, and whether other brain functions such as intellect, attention, memory and language are affected.

More information

The U.S. National Diabetes Education Program outlines how to lower teens’ risk for diabetes.

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Opioid Painkillers Raise Deadly Heart Risks for Some: Study

By Alan Mozes
HealthDay Reporter

TUESDAY, June 14, 2016 (HealthDay News) — While the dangers of overdose among patients prescribed powerful opioid painkillers such as Oxycontin and fentanyl are well known, a new study found unexpected heart risks with the medications.

Patients who had just been prescribed an opioid painkiller had a 64 percent higher risk of early death when compared to patients who were given an alternative pain medication. But much of that increased risk was related to the onset of breathing difficulties during sleep, followed by heart rhythm irregularities and other cardiovascular complications.

“We were not surprised by the increased risk for overdose deaths, which is well known,” noted study author Wayne Ray, from the department of health policy at Vanderbilt University School of Medicine in Nashville, Tenn.

“However, the large increase in cardiovascular death risk is a novel finding,” Ray said. “[And] it suggests being even more cautious with opioids for patients who are at high cardiovascular risk, such as those who have had a heart attack or have diabetes.”

In the study, the team analyzed data collected between 1999 and 2012 on nearly 23,000 patients, average age 48, who had just been prescribed a long-acting opioid medication. The researchers compared that to data on an equal number of patients who had been given an alternate pain medication.

The alternate medications included anticonvulsants such as Neurontin (gabapentin), Lyrica (pregabalin) and Tegretol (carbamazepine) and low-dose antidepressants. Anticonvulsants are used to control seizures, bipolar disorder and/or nerve pain.

During an average tracking period of about four to six months, there were 185 deaths in the opioid group versus 87 deaths in the alternate medication group.

In all, the opioid group was found to face a 64 percent increased risk of death due to any reason, the team found.

But the opioid patients also faced a 65 percent increased risk of death specifically related to new heart complications, the findings showed.

The study authors concluded that alternate pain medications should be favored over long-acting opioids whenever possible, particularly for those patients who have a history of heart disease, heart attack or diabetes.

“Our opinion, which is consistent with the recent guidelines from the Centers for Disease Control and Prevention, is that opioids should be used as a last resort,” said Ray. “The best way to decide if the benefits outweigh the risks is through a careful practitioner-patient discussion.”

Dr. Joseph Frank is an assistant professor of medicine in the division of general internal medicine at the University of Colorado School of Medicine. He cautioned that while “we have learned a great deal about the risks of opioid medications in recent years, [we] still have a long way to go.”

And, he added, “There may be patients for whom the improvement in function due to opioids outweighs the modest risk found in this study, but this balance is often challenging to assess and communicate to patients, particularly in busy primary care settings.”

Frank, who is also a general internist at the VA Medical Center in Denver, agreed that non-opioid pain treatment is preferable when possible.

But since the study focused exclusively on the risks faced by first-time opioid users, he stressed the need for more research to assess the risks faced by those trying to kick a long-term opioid habit, “as this transition can be very difficult, and may actually increase risk of some adverse events for some patients.”

Ray and his team published their findings June 14 in the Journal of the American Medical Association.

More information

There’s more on the potential consequences of opioid painkiller use at the U.S. National Institute on Drug Abuse.

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5 Diet Drugs: Which Ones Work?

By Amy Norton
HealthDay Reporter

TUESDAY, June 14, 2016 (HealthDay News) — Any of the prescription weight-loss drugs on the market can help obese people shed pounds, although some seem more effective than others, a new study finds.

Currently, five drugs are approved in the United States for managing obesity. But little has been known about how they stack up against one another, said Dr. Siddharth Singh, the lead researcher on the new study.

The findings — based on more than 29,000 people in total — show all five drugs can work. But people on certain drugs tended to be more successful, at least over one year.

Specifically, people using Qsymia (phentermine-topiramate) or Victoza (liraglutide) had the highest odds of shedding at least 5 percent of their initial weight. Those taking Xenical (orlistat) had the lowest odds.

However, there is no single drug that’s “best” for everyone, stressed Singh, an assistant clinical professor at the University of California, San Diego.

He cautioned that his team’s numbers are just averages across study groups. Plus, he said, the side effects of each medication vary, and that is an important factor in treatment decisions.

“Obesity treatment always needs to be personalized,” Singh said.

Nikhil Dhurandhar, a spokesman for the Obesity Society, agreed that people respond differently to any given weight-loss drug.

“In general, if you give drug ‘X,’ there will be a wide variation in patients’ responses,” said Dhurandhar, who is also a professor of nutritional sciences at Texas Tech University in Lubbock. He wasn’t involved in the study.

Some people will have “zero” weight loss — or even gain weight — while others will see the pounds drop off, Dhurandhar said.

He also stressed that there is no such thing as a magic weight-loss pill.

“These drugs can help you eat less through effects on appetite,” Dhurandhar explained. “But you have to change your diet and get regular exercise.”

“Medications are supplements, not substitutes, to your efforts,” he said.

For the study, Singh’s team analyzed findings from 28 clinical trials testing the five approved drugs for obesity: Qsymia, Victoza and Xenical, along with Belviq (lorcaserin) and Contrave (naltrexone-bupropion).

On average, the researchers found, each drug worked better than a placebo in helping obese adults lose weight over a year. But certain medications seemed more effective than others.

People on Qsymia typically lost the most weight — almost 20 pounds more, versus study patients given placebo pills. They were also nine times more likely to drop at least 5 percent of their initial weight, the researchers found.

People taking Xenical or Belviq tended to shed the fewest pounds — 6 to 7 pounds more than placebo users. Contrave and Victoza patients typically lost 11 to 12 pounds more, compared with placebo.

But not everyone benefited. In studies of all of the drugs, Singh noted, a significant number of people dropped out because of side effects.

And those dropouts were more common with certain medications, the study found. People taking Contrave or Victoza were almost three times more likely to quit a trial over side effects, compared with placebo users. According to Victoza’s maker, the drug can cause inflammation of the pancreas or kidney problems.

Just as people vary in their weight-loss success with any given drug, their risks of side effects will differ, too, Singh said.

He pointed to Contrave as an example. Because it contains the antidepressant bupropion, it carries a boxed warning about the potential risk of suicidal thoughts. So it might not be the best choice for someone with psychiatric conditions that could make them more vulnerable, Singh said.

Victoza, meanwhile, is an injection drug prescribed for controlling high blood sugar in people with type 2 diabetes. So if a patient needs medication for diabetes as well as weight loss, Victoza might be a good option, Singh said.

Most of the medications have been approved only in the past few years, so one question is whether they maintain their effects over the long run, Singh said.

“We do need more long-term data,” Dhurandhar agreed.

Still, he said, medications are an important option for managing obesity. And if one does not work, Dhurandhar added, he’d recommend trying another.

The study results were published June 14 in the Journal of the American Medical Association.

More information

The U.S. National Heart, Lung, and Blood Institute has more on obesity treatment.

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Got a Spare 15 Minutes? A Little Exercise May Boost Life Span

TUESDAY, June 14, 2016 (HealthDay News) — Just 15 minutes of exercise a day may lower older adults’ risk of early death by one-fifth, a new study suggests.

The research included more than 123,000 people, aged 60 and older. The study’s mean follow-up time was 10 years. Compared to those who were inactive, those with low levels of activity were 22 percent less likely to die during the study period, the investigators found.

In addition, for people with medium and high levels of physical activity, the risk of dying during the study was reduced by 28 percent and 35 percent, respectively, compared to people who weren’t active at all.

The findings were scheduled to be presented Tuesday at the European Society of Cardiology meeting in Sophia Antipolis, France.

The study wasn’t designed to prove a cause-and-effect relationship, but the results “show that the more physical activity older adults do, the greater the health benefit. The biggest jump in benefit was achieved at the low level of exercise, with the medium and high levels bringing smaller increments of benefit,” said Dr. David Hupin, of the University Hospital of Saint-Etienne, France.

The low level of exercise is equivalent to a 15-minute brisk walk each day, according to Hupin.

“Age is not an excuse to do no exercise,” he said in a society news release. “It is well established that regular physical activity has a better overall effect on health than any medical treatment. But less than half of older adults achieve the recommended minimum of 150 minutes moderate intensity or 75 minutes vigorous intensity exercise each week.”

Hupin said people shouldn’t make drastic changes to the amount of activity in their lives. Instead, they should progressively increase the amount of activity they’re doing, he suggested.

“Fifteen minutes a day could be a reasonable target for older adults. Small increases in physical activity may enable some older adults to incorporate more moderate activity and get closer to the recommended 150 minutes per week,” he concluded.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institute on Aging has more about exercise and physical activity.

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