Vaccines Rarely Cause Life-Threatening Allergic Reactions: CDC

THURSDAY, Oct. 15, 2015 (HealthDay News) — A U.S. government study has reassuring news for concerned parents — vaccines rarely trigger serious and potentially fatal allergic reactions.

Just 33 people had a serious, potentially life-threatening allergic reaction — also known as anaphylaxis — out of 25 million vaccines given, according to research from the U.S. Centers for Disease Control and Prevention. That’s 1.3 people in every million who gets a vaccine.

“Vaccination is one of the best ways parents can protect infants, children and teens from 16 potentially harmful diseases. This is a good time to remind parents that vaccines are safe and effective — the odds of having an anaphylaxis-related reaction following the administration of a vaccine are very slim,” said study author Dr. Michael McNeil, of the CDC.

For the study, the researchers reviewed records from more than 17 million visits and more than 25 million administered vaccines. The vaccines were given from 2009 to 2011.

The researchers identified 380 cases of anaphylaxis, possible anaphylaxis, or allergy. Only 135 of these cases involved children aged 5 years old or younger, the researchers said.

Results of the study were published recently in the Journal of Allergy and Clinical Immunology.

“We identified no cases of anaphylaxis in children less than 4 years old. The median age of our case patients was 17 years old with a range from 4 to 65 years old,” McNeil noted in a journal news release.

None of the people who had anaphylaxis died, and only one had to be hospitalized, the study found.

Pre-existing allergies, asthma or past anaphylaxis were a factor in 85 percent of these cases, the study found. The researchers pointed out that these medical issues are known risk factors for anaphylaxis.

Life-threatening reactions are rare following immunization but caregivers should always be prepared to treat symptoms of anaphylaxis. The study noted that epinephrine — the first-line treatment for anaphylaxis — was given in only 45 percent of these cases.

Only 9 percent of those who had a serious allergic reaction had a documented prescription for an epinephrine auto-injector, the study found. After the reaction occurred, only 15 percent were known to have been referred to an allergist for follow-up.

More information

The U.S. Centers for Disease Control and Prevention provides more information on vaccine safety.

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Relax, Parents, Your Teen’s Moodiness Should Subside, Study Finds

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Oct. 15, 2015 (HealthDay News) — For parents dealing with moody teens, a new study offers welcome news: Adolescents do grow out of those emotional swings.

That’s what Dutch researchers report after following nearly 500 teens for five years, starting at age 13.

“Mood swings are greatest in early adolescence,” said Dominique Maciejewski, a doctoral student at VU University Amsterdam, who led the study. “Most teens get less moody across adolescence.”

She advises parents to stay calm and patient, and not to panic. “Parents would be advised not to worry too much about their teenager’s moodiness, as these will decline in most cases,” Maciejewski said.

The study also found that although “girls show more mood swings in sadness and happiness, both boys and girls show similar changes in their mood swings across adolescence.”

The researchers followed 474 Dutch teens, 40 percent of whom were considered at high risk of aggression or delinquency at age 12.

Each year, for three weeks of the school term, the kids rated their daily moods in terms of happiness, anger, sadness and anxiety.

The researchers looked at fluctuations in day-to-day mood and developmental changes over the five-year span. The results were published Oct. 14 in the journal Child Development.

Maciejewski can’t say for sure if the findings would apply to U.S. children, but suspects they might.

Exactly what drives the ups and downs was not part of the study, but Maciejewski said a number of factors might explain them.

Hormonal or brain-related changes in early adolescence might have an influence, she said. “For instance, there are studies that indicate that cognitive control systems lag behind the development of emotional systems during that time, which makes adolescents hypervigilant to emotional cues but does not provide them with enough cognitive capacities to suppress their emotional reactions,” she said.

Also, significant social factors coincide with puberty that may induce more fluctuations in negative and positive emotions, Maciejewski said. These include the transition to high school, conflicts with parents (curfews are one example), greater peer affiliation, or first romantic relationships. “Additionally, during that time, they are still learning how to cope with their emotions,” she said.

Gilda Moreno, a clinical psychologist at Nicklaus Children’s Hospital in Miami, believes some of the moodiness is driven by a teen’s temperament. “People are born with personality and temperament,” she said, noting some teens are naturally calmer than others.

While the Dutch researchers found more variability in the happiness and sadness reported among girls than boys, that might reflect girls’ greater tendency, in general, to express their feelings, Moreno said. “Boys might have had the same ups and downs, but not talked about it as much,” she speculated.

Parents can employ a number of strategies to stay sane through the ups and downs of adolescence, Moreno said. For instance, if your teen is rude and disrespectful, she advised stepping away and avoiding conversation, explaining why. Say something like: “I can’t talk to you right now. You are being disrespectful,” she said.

Once everyone has calmed down, you can have a productive conversation, Moreno said. If moodiness centers on sadness or depression, parents should listen and gauge how seriously upset the teen is.

Maciejewski agreed. “It is best to listen carefully to their expressions of anger, fear and disappointment,” she said. “Staying in touch by exchanging and discussing experiences will help their teen not to drift away from contact with the parent, and at the same time help the teen to quietly think about the reasons and solutions for their mood changes.”

Sometimes it helps to offer alternative interpretations of events, “but only if the teen wants to listen to these,” Maciejewski said. “Only when mood swings stay high in late adolescence, professional help may be needed,” she said.

More information

For more on coping with teen moodiness, visit the University of Alabama.

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I Tried the Goth Answer to SoulCycle and Learned to Love Exercise

My “health goth” gear all ready to go. Photo: Lauren Oster

Working out doesn’t have to be a nightmare—but if you’re lucky, it can be.

Let me explain: Group fitness and perkiness tend to go hand-in-hand. Many gyms play inspirational pop music, and commemorative race tees are often neon-bright. And as much as I appreciate the benefits of exercise, the pep and positivity that surround it have always felt saccharine to me. I am not the sort of person who visualizes myself opening like a flower as I stretch before a workout, and under no circumstances do I salute the sun. I am also not particularly motivated by Taylor Swift songs, or so-called spiritual spin instructors.

Truth be told, I sort of hate plastering on a smile and working out with other people, despite knowing how effective it can be.

That’s why I much prefer the snark of tools like Zombies, Run!, an app that turns your daily jog into an adrenaline-charged escape from the undead (even though all real horror buffs know classic zombies are shamblers; you could outrun them with some vigorous Prancercise). Because at least with tools like that, it feels honest. Running really is horrifying sometimes.

It’s also why I snapped to attention when the term “health goth” started clawing its way into the mainstream. Goth culture’s darkly elegant fashion, dolorous music, and mythical imagery had been touchstones for me when I was a teen; if “health goth” caught on, would I be able to wear my Siouxsie and the Banshees tees to the gym without getting side-eye? Might I find a Power Pilates class where I’d be instructed to climb H.P. Lovecraft’s Mountains of Madness? Well, yes and no; “health goth” can be anything from a fashion statement to an actual fitness brand, depending on whom you ask. I have no allegiance to either of those groups, really. For me it seemed like, finally, I might find my fitness tribe.

RELATED: 10 Exercise Cheats That Blow Your Calorie Burn

Photo: The Monster Cycle

Enter The Monster Cycle, a New York City spin and yoga studio discovered by my like-minded friend Dave. Neither of us is a fan of most group classes, but Dave discovered Monster by way of instructor Erika Neola, creator of #gothrunners. (Her motto: “Fitness can be goth, you just need the right outfit”). Her “witch on the run” aesthetic appealed to me, as did the studio’s. So I signed up for an evening class of Erika’s, pulled out and donned the black gear I usually sprinkle among separate outfits so as not to unnerve the elderly folks in my apartment building’s exercise room, and strolled out into the night.

A magnificent mural of B-movie monsters from a classic fairground dark ride crawls up the southern wall of Monster Cycle’s foyer, and a neon pentagram chandelier holds court in front of the reception desk. “Do you like it?” asked Michael Macneal, one of the studio’s owners, as he gestured at the wall. “We had it done for our anniversary a little while ago. I always dreamed of having my own haunted house.”

RELATED: 10 Habits of People Who Love to Work Out

Photo: Lauren Oster

I did like it—and the balaclavas with a third bloodshot eye sold in the back of the studio, the spin bike hanging from the ceiling customized with designer  Zana Bayne’s S&M-inspired leatherwork, and the neon pink eyes watching over the basement changing rooms.

The gym can be a creepy place anyway, after all—why not acknowledge that and have fun with it? Down in the black-walled classroom, I climbed on my bike and clicked into my pedals, the lights dropped, and we were off.

Erika kicked the class into gear with The Prodigy’s “Get Your Fight On,” a snarling electronic track that bled into a song I remembered from one of their ‘90s albums—both of which are more angry than they are gloomy, but they did remind me of an era in which I wore ripped fishnet tights without irony. She then led us into Jack White’s “Lazaretto” and its accompanying spooky video, confirming my long-held suspicion that Jack White actually is Count Dracula.

Track after track made me feel like I had to fight my way out of a horror movie, and I loved every minute.

RELATED: How to Become an Exercise Addict

Photo: Lauren Oster

And then at the end of the class something funny happened. The last track faded out and the lights flicked on, and I realized my classmates weren’t actually goths; the only person in head-to-toe black was me. The grinning, sweating, perky men and women climbing off the bikes around me looked an awful lot like the exercise-obsessed men and women I’ve always loved to hate. This lead to a series of revelations:

One: Worrying where you fit in is as silly as it was in high school. At the end of the night, if you will, my fitness tribe is the people who show up to have fun (black eyeliner and white pancake makeup or no), to support each other, and to work.

Two: Perhaps I actually can like working up a sweat—as long as there’s some imagination involved, anyway.

And finally, three: I’m going to need a third-eye balaclava to wear to my next class.

RELATED: 6 Things I Wish I Knew Before My First Fitness Class

 

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Ebola Persists for Extended Period in Survivors’ Semen: Study

By Alan Mozes
HealthDay Reporter

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — The Ebola virus is capable of hiding out in the semen of male survivors for up to nine months after symptoms appear, a new study suggests.

And a related case report illustrates why this latest discovery is so concerning: Scientists from the U.S. Army Medical Research Institute for Infectious Diseases in Maryland found evidence in blood and semen samples that a male Ebola survivor from Liberia infected his female partner a full six months after his blood tested negative for the deadly virus. His semen sample tested positive.

The first study stems from an ongoing effort to track the fallout from last year’s Ebola outbreak. According to the World Health Organization (WHO), the deadly virus has claimed the lives of more than 11,000 people, and infected an estimated 28,000 in three West African nations: Guinea, Liberia and Sierra Leone.

Researchers from the WHO, the U.S. Centers for Disease Control and Prevention, and the Sierra Leone Ministry of Health and Sanitation have spent the last year monitoring the bodily fluids of 93 male Ebola survivors whose symptoms have largely subsided.

In the Oct. 14 issue of the New England Journal of Medicine, a team led by Dr. Gibrilla Deen, from the Sierra Leone Ministry of Health, reported that more than one-quarter of the men who provided samples seven to nine months after the first sign of symptoms had semen that tested positive for Ebola. The case report appears in the same issue of the journal.

“I think this has really important implications, because we really know very little about this virus,” said Dr. William Fischer, an assistant professor of medicine at the University of North Carolina School of Medicine in Chapel Hill.

“And this demonstrates that the problems inflicted by Ebola don’t necessarily end with clearance of the virus from the blood,” added Fischer, who was not involved in the study.

The study team first looked for signs of Ebola in semen samples obtained from nine Sierra Leone patients during the three months following their onset of symptoms. Ebola was found in 100 percent of those samples.

Another 40 men were tested four to six months later, and 65 percent of those semen samples tested positive. The most recent group of 43 men were tested between seven and nine months after symptom onset, and 26 percent had Ebola in their semen, the investigators found.

“We’ve seen this sort of thing with other diseases — the compartmentalization of a virus,” Fischer said. “The virus looks for parts of the body that the patient’s immune system can’t easily get to, what we call immune-privileged sites. And when a virus can get into those areas, it can actually persist.”

Dr. Amesh Adalja, a senior associate at the Center for Health Security at the University of Pittsburgh Medical Center in Baltimore, put it this way: “These are essentially sanctuary sites, hideouts where the immune system doesn’t have the same power it has in the blood or in the gastrointestinal tract.”

Adalja, who was not a part of the latest investigation, added, “We’ve seen this happen in a patient’s eyeball. And we’ve known for a while that Ebola can hide out in semen. But until now we didn’t know that this could continue beyond six months. So, this is a very important finding. And it will have an influence on how we guide patients going forward, and how we determine when it’s appropriate to give patients the all-clear.”

But Fischer added: “It could be that what we’re seeing here are just remnants of virus with a marked decrease in infectivity. And it could be that their ability to hide out doesn’t last forever. This study does suggest that the risk that they can do this goes down with time.”

Fischer added that there is probably “some level of immune response that can attack this hidden virus over time, though it may take a while to penetrate. But at this point it’s hard to know.”

Meanwhile, he said, “the concern that survivors can pass the virus on sexually is real.”

Just how real remains unclear, the research team said. The investigators acknowledged that they are not yet able to characterize the level of infection risk posed by the amount of virus they’ve spotted in semen. And in their report, they pointed out that “although cases of suspected sexual transmission of Ebola have been reported, they are rare.”

Nevertheless, as a practical matter, the WHO cautions that male survivors of the Ebola outbreak in West Africa should go in for routine viral testing and counseling, and refrain from all sexual contact, or use condoms, until their semen samples have twice come back negative for Ebola.

More information

There’s more on Ebola transmission risk at the U.S. Centers for Disease Control and Prevention.

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Vitamin D, Calcium May Not Prevent Colon Cancer After All

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — New clinical trial results negate the supposed colon cancer-preventing benefits of calcium and vitamin D supplements.

Neither calcium nor vitamin D, taken alone or together after precancerous colon polyps were removed, significantly reduced the risk of new polyps developing, researchers report.

The results contradict decades of observational studies that showed that people who take lots of calcium and vitamin D are less likely to develop colon cancer, researchers said in the Oct. 15 issue of the New England Journal of Medicine.

“It suggests that you should not think you should take calcium or vitamin D to reduce your risk of colon cancer,” said study co-author Elizabeth Barry, an assistant professor of epidemiology and community and family medicine at Dartmouth’s Geisel School of Medicine in New Hampshire.

However, Barry added that this trial focused on a relatively low dose of the two supplements taken over a 3- to 5-year time frame.

“We didn’t address whether a higher dose or a longer period of time would have been effective,” she said, noting other trials are underway that could shed additional light on the question.

For 15 to 20 years, studies have suggested that vitamin D and calcium are protective against colon cancer, said study lead author Dr. John Baron, a professor of medicine at the University of North Carolina School of Medicine. Baron himself wrote one of those reports.

“For calcium, we conducted one of the earlier trials that showed a benefit,” Baron said. “That was roughly 20 years ago. In fact, we used the same agent in the same sort of patients, in many of the same settings.”

To test this protective benefit, the researchers behind the new study randomly assigned more than 2,200 participants to take daily either 1,200 milligrams of calcium carbonate or 1,000 (International Units) IU of vitamin D separately, to take both together or to take a placebo.

All participants had recently had precancerous colon polyps, also called adenomas, removed from their colon. They were given colonoscopies to make sure they were polyp-free at the start of the study, and had a follow-up colonoscopy three to five years later to assess how well the supplements had helped prevent a recurrence.

“We studied these polyps because they’re an early stage in the cancer pathway, so it takes a shorter amount of time for vitamin D to have an effect, if it has one,” Baron said.

About 43 percent of participants had developed a recurring precancerous polyp by the time of their follow-up colonoscopy, researchers found.

But they found that vitamin D, calcium or the two combined had no effect on a person’s risk for recurring polyps, when compared to people taking a placebo.

Baron said he was particularly surprised by the results for calcium, given the large body of evidence suggesting its cancer-preventing benefits.

The changing health profile of the average American may have affected the calcium results, Baron said. For example, more of the subjects in the new trial were obese, and fewer smoked.

“We’re looking into things like that to see if they explain the differences between the earlier and the current study,” he said.

Dr. Arun Swaminath, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City, called the report an “important negative study.”

“Is this the end of the road for vitamin D in the prevention of precancerous colon polyps and, hence, colorectal cancer?” Swaminath said. “Well, the authors suggest that in today’s world, that 1,000 IU of vitamin D would be considered a quite low dose of supplementation, so maybe even higher doses would have been beneficial.”

Swaminath added that the supplements might have better protective benefits if given to patients who haven’t already had precancerous polyps.

“Is it possible that choosing higher-risk patients, ones with adenomas already detected, may be too late in the lifetime of colon health to try this supplement?” he asked. “Maybe it would have been more useful in patients who didn’t have adenomas to begin with? Of course, we don’t have the answers to that just yet.”

Barry and Baron emphasized that this study focused on supplements, and that their findings don’t negate the overall healthy benefits of a nutrient-rich diet.

More information

For more on precancerous colon polyps, visit the American Cancer Society.

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Dietary Supplements Land Thousands in the ER Each Year

By Amy Norton
HealthDay Reporter

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — Side effects from dietary supplements send more than 20,000 Americans to the emergency room each year, a new government study reveals.

One expert said the report — published Oct. 15 in the New England Journal of Medicine — should quash arguments that herbal products, amino acids and other supplements are uniformly “safe” and need no tighter regulation.

“This is the most important study done on dietary supplements since DSHEA was passed,” said Dr. Pieter Cohen, an assistant professor at Harvard Medical School who studies supplement safety.

Cohen was referring to the Dietary Supplement Health and Education Act, a 1994 law that defined supplements as food rather than drugs. The upshot is that manufacturers do not have to prove their products have benefits, or are even safe.

Over the years, there have been recalls of certain supplements found to cause harm, said Dr. Andrew Geller, a researcher at the U.S. Centers for Disease Control and Prevention, who led the new study.

Often, those products were tainted with banned pharmaceutical ingredients, according to background notes in the study.

“But there’s been little data on how often supplements not involved in those recalls cause harm,” Geller said.

To get an idea, his team studied records from 63 U.S. emergency departments taking part in a national injury surveillance system project. The investigators found that between 2004 and 2013, almost 3,700 children and adults arrived at the ER with a side effect attributed to a dietary supplement.

Nationwide, that would translate to 23,000 ER visits each year, Geller’s team estimated. And roughly half of those patients would be children or young adults, Geller said.

Typically, children were taken to the ER because of accidental ingestion of a vitamin or other supplement, the study found.

But when adults in their 20s or 30s landed in the ER, it was frequently related to supplements marketed for weight loss or boosting energy, Geller said.

Those supplements — which include ingredients like caffeine, ginseng, guarana (a plant high in caffeine) and linoleic acid — were often tied to cardiac effects, such as heart palpitations and chest pain.

In fact, weight-loss products and energy boosters accounted for nearly 72 percent of heart-related problems linked to a dietary supplement, the study found.

Most often, people suffered no lasting harm. Even among those with heart-related symptoms, 90 percent were sent home from the ER, the findings showed.

“But,” Geller said, “we estimate that over 2,100 people are hospitalized each year.”

And that is likely an underestimate, he added, since many adverse reactions to supplements may go undetected.

Cohen, who wasn’t involved in the study, agreed.

“It’s well known that doctors don’t ask people about their supplement use,” Cohen said. “And it’s well known that patients don’t bring it up.”

The U.S. Food and Drug Administration has limited authority over dietary supplements. It can take action if a product on the market is found to be unsafe, for example.

But that system, Cohen said, relies on doctors and consumers to submit reports of harm from supplements.

Also, supplement labels don’t have to carry information about side effects. Nor is there any guarantee that the product contains the ingredients listed on the label — and only those ingredients, Cohen added.

In a study published this year, he and his colleagues found that nearly a dozen supplements marketed for weight loss were “spiked” with an amphetamine-like substance called BMPEA.

Cohen said he was “not surprised at all” that supplements marketed for weight loss and energy were commonly tied to ER visits in this study.

According to Geller, the findings should help zero in on the types of supplements that deserve more scrutiny.

But one of the problems, Geller said, is that many supplements contain a mix of ingredients whose actions in the body are unclear. So it can be hard to pinpoint the culprit behind any side effects.

For now, Cohen suggested that consumers avoid such combination supplements. “If you want echinacea, buy echinacea,” he said, referring to the herb that many people believe fights colds.

To find information on the science behind a product, Cohen recommended the U.S. National Institutes of Health website on dietary supplements.

More information

The U.S. National Center for Complementary and Integrative Health talks about using supplements wisely.

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Should the Annual Physical Be Scrapped?

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — Doctors continue to debate the worth of a time-honored tradition of health care — the annual physical examination.

Some want the once-a-year physical abandoned, based on a growing body of research that these exams don’t reduce your overall risk of disease or death.

But yearly checkups help build the relationship between doctor and patient, leaving both better prepared when illness does strike, other doctors respond.

In editorials in the Oct. 15 issue of the New England Journal of Medicine, Harvard professors air both sides of the debate.

The original idea behind the annual physical examination held that these visits provide doctors an opportunity to practice preventive medicine, said Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School in Boston.

Doctors would detect problems such as high blood pressure, increased cholesterol or high blood sugar, and help their patients take steps to prevent these early warning signs from developing into chronic illnesses such as diabetes or heart disease, he said.

But this idea has not withstood scientific review. “In good studies, in both randomized trials and in observational studies, we have not found any of those benefits,” said Mehrotra, co-author of the editorial questioning the value of traditional physical exams.

“We have not seen people have less illness, and we have not seen any decrease in mortality,” he said.

“I’m a big fan of trying to do anything that’s going to help the health of the U.S.,” Mehrotra added. “But in this case, we’ve studied it, and it hasn’t helped. We shouldn’t waste time and money on this.”

Overall, these annual visits cost more than $10 billion a year, Mehrotra said. And yearly physicals can be harmful, he added, noting tests like urinalysis in patients without symptoms often yield false positive results, causing patients needless anguish.

Proponents of the physical exam say critics overlook benefits that are harder to measure, but important to patient care.

By regularly seeing their patients, doctors can learn about many aspects of a person’s life — work stresses, family issues, financial pressures — that can affect their health and well-being, said Dr. Allan Goroll, a professor of medicine at Harvard.

That “can’t be done in five minutes, and it can’t be done by a questionnaire. It’s done by looking a patient in the eye and giving them the feeling they aren’t being rushed,” said Goroll, who wrote the editorial defending the annual exam.

“By calling for the elimination of the annual checkup, they risk compromising the delivery of a comprehensive, whole-person approach to health care,” he said.

Both Mehrotra and Goroll said there’s a need for reform of the annual physical.

Mehrotra believes regular checkups should be reserved for people who haven’t seen their physician in two or three years. “I do acknowledge for people who haven’t seen a primary care doctor for several years, going in to maintain that relationship does make sense,” he said.

Doctors should use electronic health records to maintain preventive health care for everyone else, Mehrotra said.

A health clinic’s computer can easily keep track of people who haven’t gotten their flu shot, or who need to have their blood pressure, cholesterol levels or blood sugar checked. Reminders can be sent to them, allowing the doctor to proactively pursue preventive care, he said.

“You don’t have to passively wait for patients to come in for this big annual visit to make sure people are up on their preventive care,” Mehrotra said.

Goroll argues that the annual physical should be continued for everyone, but in a team-based approach where nurses, medical assistants and care coordinators handle most of the routine preventive-care chores.

That will give doctors the time to have in-depth conversations with patients, which could help guide their future health care, Goroll said.

“Let’s not eliminate the annual physical, which is really an annual health review, but let’s enhance it so it’s a meaningful experience,” he said.

In his editorial, Goroll noted this already is happening for patients who can afford “concierge” physicians. These people pay generous fees for easy and regular access to their doctor.

“Many people are paying thousands of dollars to ensure they have that relationship with their primary care physician,” he said. “We need to come up with an approach that will give us concierge service at Wal-Mart prices.”

More information

The U.S. Centers for Disease Control and Prevention recommends routine checkups.

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Obamacare Allows Tobacco Surcharge on Older Smokers

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — Older smokers purchasing insurance through Obamacare may have a new reason to kick the habit: the Affordable Care Act allows plans on the health exchange to add a surcharge for tobacco use, new research shows.

For the study, scientists examined health insurance tobacco surcharges across the United States. In nearly every county of the 37 states that used healthcare.gov to sell health plans in 2015, people who used tobacco were charged more than other health plan enrollees.

For example, a 55-year-old smoker in Oregon would pay about 2 percent more than a nonsmoker for the least expensive plan (before subsidies). The same smoker in Nevada would pay 46 percent more than a nonsmoker, the study found.

Even within states, there were large variations. Compared to a 50-year-old nonsmoker, a smoker in San Antonio, Texas, would pay 10 percent more for the least expensive coverage, while a smoker in nearby College Station would pay 32 percent more, the researchers found.

The study was published online Oct. 8 in the American Journal of Public Health.

Age-dependent tobacco surcharges of up to 50 percent are allowed under the Affordable Care Act, the study authors said in a news release from the American Cancer Society.

“Our study shows these premiums vary almost randomly across the country and strike some people very hard, while they aren’t being imposed at all on others,” study leader Alex Liber, a data analyst with the American Cancer Society, said in the news release.

“These surcharges are likely to harm older tobacco users, the very ones who are most likely to become sick due to their smoking,” he said, adding that the extra monthly premiums don’t provide these people with any additional benefit.

More information

The U.S. Department of Health and Human Services explains how smoking harms your health.

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Job Stress Tied to Stroke Risk, Study Suggests

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Oct. 14, 2015 (HealthDay News) — Having a high-stress job, particularly one that is demanding but offers little personal control, may raise the risk for a stroke, Chinese researchers report.

An analysis of six previously published studies from several countries included nearly 140,000 people who were followed for up to 17 years. It found those with high-stress jobs had a 22 percent higher risk of stroke than those with low-stress jobs. Among women, the increased risk was even higher — 33 percent, the researchers reported.

“Many mechanisms may be involved in the association between high-stress jobs and the risk of stroke,” said lead researcher Dr. Yuli Huang, from the department of cardiology at Southern Medical University in Guangzhou.

Most important, high-stress jobs may lead to unhealthy behaviors, such as poor eating habits, smoking and a lack of exercise, Huang said.

“It is vital for people with high-stress occupations to address these lifestyle issues,” said Huang.

The report was published online Oct. 14 in the journal Neurology.

The studies that Huang’s team analyzed included one in the United States, three in Sweden, one in Japan and one in Finland.

Huang and colleagues grouped jobs into four categories based on how much control workers had over their job and how hard they worked or the psychological demands of the job. The categories included passive jobs, low-stress jobs, high-stress jobs and active jobs.

Job factors included time pressure, mental demands and coordination burdens. Physical labor and total number of hours worked were not included.

Those with passive jobs included janitors, miners and other manual laborers, who had little demand and little control. Low-stress jobs included scientists and architects, who had low demand and high control, according to the study.

High-stress jobs, which have high demand and low control, included waitresses, nursing aides and other service industry workers. People with active jobs, like doctors, teachers and engineers, had high demand and high control, the researchers said.

People in high-stress jobs were 58 percent more likely to have a stroke caused by a blood clot in the brain — an ischemic stroke — than those with low-stress jobs. Those with passive and active jobs did not have any increased risk of stroke, Huang said.

The researchers said that more than 4 percent of overall stroke risk was caused by high-stress jobs. For women, however, high-stress jobs increased that risk to 6.5 percent.

The study has some limitations, the researchers noted. First, job stress was measured only once in the original studies. Second, other risk factors for stroke, such as high blood pressure or high cholesterol, were not accounted for in the original studies.

Dr. Jennifer Majersik, an associate professor of neurology at the University of Utah School of Medicine in Salt Lake City, and author of an accompanying journal editorial, said the study “shows what people have thought for a long time — that certain kinds of stress cause negative effects on health.”

Previous studies have shown a connection between work stress and heart disease, but this is the first research to show that association for stroke, she said.

However, the new study did not prove a cause-and-effect relationship between work stress and stroke.

Majersik thinks that lowering the risk of stroke may mean having more control over your work.

“There are ways in your workplace to increase control,” she said. These might include flexible hours and more power to make decisions. “These may not work, but I’d love to see them tried,” Majersik said.

In addition, people can change jobs to find one where they have more control, she said.

“I view job stress as another modifiable risk factor,” Majersik said. “We don’t yet know what to do about it. But I counsel my patients that this is something they should look at.”

Patients often ask if stress caused their stroke, Majersik said. “I haven’t known what to say, now I feel I can say, ‘You know, maybe.’ “

More information

Visit the U.S. National Library of Medicine for more on stroke.

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5 Times Ronda Rousey Seriously Inspired Us

Photo: Getty Images

With her recent 34-second beat-down of Bethe Correia in Rio de Janeiro, multiple big acting gigs on the horizon, a fresh New York Times profile, a Men’s Fitness magazine cover, and a love life that has officially been scrutinized by the media, it’s safe to say that Ronda Rousey has become one of the most famous female athletes—scratch that, one of the most famous athletes, period.

Aside from her exceptional talent, the fact that the UFC champion is using her celebrity status to promote body confidence and the power of hard work makes us love her even more. Here are five times Rousey made us swoon.

When she silenced her body-shaming critics once and for all

Earlier this year Rousey shutdown critics who called her body too masculine by saying: “Listen, just because my body was developed for a purpose other than f—ing millionaires doesn’t mean it’s masculine. I think it’s femininely badass as f— because there’s not a single muscle on my body that isn’t for a purpose.”

And now the mixed martial artist has one final warning to anyone who wants to share any mean-spirited thoughts about her physique: you should probably think twice. “I swear to God,” Rousey told the New York Times in a new interview, “if anyone calls me fat one more time in my life, I’m going to kill them.”

She opened up to the Times about the ridicule that often comes along with being a woman doing incredible things in the sports world and her willingness to be the face of positive change when it comes to body confidence.

“If I can represent that body type of women that isn’t represented so much in media, then I’d be happy to do that,” Rousey told the news outlet.

When she was completely open about her ups and downs

This self-assurance and shake-it-off outlook didn’t happen overnight, however. Rousey has also addressed her weight and body image struggles as she competed in judo tournaments over the years, which led her to develop a tricky relationship with food and even bulimia for some time.

In an Ask Me Anything on Reddit earlier this year, she explained how liberating it is to have moved past her problems with food. “It feels very liberating to [be] free of the guilt that used to come with every meal,” she wrote. “I feel like I have so much extra space in my brain now that I’m not constantly thinking about the next meal and trying to eat as much as possible every day while still losing weight. I feel amazing. I (think) I look amazing. And I just ate some bomb-ass french toast this morning.”

RELATED: Why Ronda Rousey Is the Body Image Role Model We Need

When she talked about the importance of hard work

What does Rousey value more than straight appearances? Good old-fashioned hard work to earn your stripes.

“We seem to be in this conflicting era for women, where women are doing so amazingly and taking over the athletic world, but we’re also in a time where … how can I really put it? That women without any skills, that freeload, are being glorified,” Rousey told the Times. “That’s something I was raised not to be. [I was taught] that you’re supposed to contribute to the world, not consume from it.”

RELATED: The 10 Best Quotes from Ronda Rousey’s Reddit ‘Ask Me Anything’

When she made magazine history

 

The 28-year-old also just became the first female to grace the cover of Men’s Fitness Australia. Rocking a Reebok tank and a “don’t mess with me” smolder, Rousey can be seen in the image framed by the cover lines, “How Ronda Rousey Can Make You Tougher” and “WTF? Ronda Rousey On the Cover!”

Some Internet trolls whined about Rousey’s moment on the men’s mag, but Rousey neither cares nor agrees with any of the backlash. She addressed it in her Times profile, telling the paper, “When women say that going on publications directed at men is somehow demeaning, I don’t think that’s true. I think that’s one really effective way to change the societal standard women are held to.”

When she showed respect (in the best way possible) for a fellow fierce female

Too often, talented women are pitted against each other (See: Katy Perry and Taylor Swift), but Rousey’s straight awesomeness and humility has prevented that from happening so far.

Rousey recently chatted with E! News about how she felt a wee bit starstruck when  Serena Williams invited her out on a sushi date. “Serena hit me up and I almost died! We’ve hung out a little bit and she’s so cool. She’s so awesome,” she said.

But her fangirl status eased up a bit when she realized the duo had some things in common (besides being total badasses at their respective sports), like a mutual love of sushi.

“At first I was like, ‘Oh my god, I’m so nervous.’ And then after a few minutes I was like, ‘This girl is so awesome!’ We handled some sushi,” Rousey continued. “It was nice to be out with another cool woman who can handle some food.”

Now those are two fit friends we’d like to join for a girls’ night out.

RELATED: Serena Williams to Body-Shaming Critics: ‘I Have Grand Slams to Win’

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