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Biomedical Engineer Tames Cardiac Arrhythmia
400,000 Americans die each year from cardiac rhythm disorders, commonly known as arrhythmias. Yoram Rudy, a professor of biomedical engineering at Case Western Reserve University, would like to change those statistics for the better. That's why he has spent the last two decades exploring the electrical activity of the heart to learn more about these abnormal heart rhythms. Rudy, who is founding director of CWRU's Cardiac Bioelectricity Research and Training Center, believes that understanding the mechanisms for these abnormal rhythms could save lives through better diagnosis and treatment of cardiac arrhythmias. What's so special about Rudy's work? He uses theoretical techniques such as mathematical modeling and computer simulations combined with experimental and clinical data to find out why these rhythm disorders occur, where they originate from, and what might be done to prevent or treat them.
The work is complex because abnormal rhythms can begin in a single cell and trigger the collapse of the entire circulatory system. "The electrical activity of the heart is really the signal that tells the heart to contract," says Rudy. "It allows the heart to pump blood in a synchronous manner." Normally, the heart's natural pacemaker produces electrical impulses that spread throughout the heart like a wave, telling it to contract. The wave of electrical excitation travels in a precisely defined path that is repeated during every heart beat, explains Rudy. However, if a person has heart disease, fibrillation can occur, causing fast and irregular heartbeats. As a result, the heart's electrical impulses can become chaotic, leading to sudden death.
Rudy's work has helped CWRU researchers develop a mathematical model that allows them to predict electrical behavior of cardiac cells affected by heart disease and how to modify their activity with drugs and other treatments. He hopes his research will help diagnose rhythm disorders and identify patients at risk for sudden death. It also could assist surgeons in planning anti-arrhythmic heart surgery, steer them to affected sites, or help in guiding catheters to remove the foci of the arrhythmia without surgery. He believes that it may also be a noninvasive tool for evaluating the effectiveness of anti-arrhythmic drug therapy. Important people think Rudy is onto something. In fact, the National Institutes of Health's National Heart, Lung, and Blood Institute are interested enough to provide $2.6 million over the next five years for two of his critical research projects.
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Religious Are More Faithful to Ways of Wellness
Lately, it seems that religion and faith exert positive effects on people's health. But that wasn't always the case. Not too long ago, "the suggestion that religion might influence mental or physical health outcomes was greeted with skepticism," say Dr. Christopher G. Ellison (UT-Austin) and Dr. Jeffrey S. Levin (National Institute of Healthcare Research). "On average, high levels of religious involvement are moderately associated with better health status," say Ellison and Levin.
The research duo explored a range of explanations for the positive health effects of religious practices and spiritual beliefs, many of which have been scientifically demonstrated to promote health and reduce disease. Here are just a few examples.
- Healthy Behavior
Religious involvement may discourage behavior that increases health risks, such as tobacco and alcohol consumption, or it may encourage other positive lifestyle choices.
- Social Support
People who regularly attend religious services appear to have larger and denser social networks to provide emotional support and other forms of assistance than less frequent attendees.
- Self Esteem
Religious involvement may promote feelings of self-worth and confidence in the ability to control one's own affairs and destiny.
- Coping Skills
Prayer, meditation and other religious activities may help people deal with stressful events and conditions.
- Positive Emotions
Religious activities may also lead to positive emotions, which have been shown to influence immune functions and other physiological factors that influence health.
- Healthy Beliefs
Faith may promote a positive outlook that offers both emotional and tangible means of promoting individuals' health and well-being.
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Stress of Care-giving Often Health-robbing
You're old and sick. Your best resource is the loving support provided by a family caregiver. In fact, that caregiver's actions are your lifeline to sustained health. Ironically, however, the stress of caregiving often reduces the caregiver's ability to sustain her own health. In a nutshell, caregiving can be health-robbing. That's because chronic stress may reduce the activity of cancer-fighting natural killer (NK) cells in the immune systems of those already predisposed to cancer, according to a new study released by the Center for the Advancement of Health.
Among people who cared for spouses with Alzheimer's disease, those with a cancer history and high perceived stress had lower levels of NK cell activity than did similar caregivers who did not have cancer. They also had lower levels of NK cell activity than a group whose spouses did not have Alzheimer's, according to Peter P. Vitaliano, PhD, of the University of Washington, Seattle, and colleagues writing in the current issue of Annals of Behavioral Medicine (Vol. 20, No. 3). Caring for a demented loved one may not in general reduce the body's ability to fight cancer, but it may do so in individuals who specifically perceive themselves as highly stressed and who have a biological predisposition, such as a cancer history, the investigators suggest.
The researchers examined NK activity levels, daily "hassles" and "uplifts," and mood in 80 persons caring for a husband or wife with Alzheimer's disease and 85 who were not caring for a demented spouse. About one quarter of the entire sample had a history of cancer. Spouses were tested initially and again 15 to 18 months later. NK cell activity was lowest among caregivers with a cancer history who reported a high level of daily hassles, but few daily uplifts, the researchers report. The results held even after they controlled for factors known to influence NK cell activity, including alcohol intake, estrogen replacement therapy, and exercise. Interestingly, depressed mood was not related to NK cell activity at any time during the study. "Caregivers with cancer histories and high perceived stress initially continued to maintain low levels of NK activity at follow-up," the investigators write. "One might predict that these individuals would have a greater frequency of cancer relapses relative to other older adults."
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Lifestyle Study Says Elders Improve With Age
Yes we’re living longer, but in better health or worse? A new RAND study finds solid evidence that the proportion of older Americans who can perform the simple tasks of everyday life has risen significantly. Researchers Vicki A. Freedman and Linda G. Martin analyzed trends during the period 1984 to 1993 in the prevalence of functional limitations within the 50 and over population. The extent of improvement varied by age group, with the smallest gains occurring among 50-to-64 year olds and the largest among those 80 and over. For all groups combined, there was this heartening news.
- 3.7% decline in difficulty seeing newsprint.
- 4.6% decline in difficulty lifting and carrying a 10 pound bag of groceries.
- 2.5% decline in difficulty climbing a flight of stairs without resting.
- 3.5% decline in difficulty walking a quarter mile, about three city blocks.
There were improvements across most subgroups, but the rate of functional limitations
remained highest among the oldest, women, the unmarried, Hispanics, the least educated and
those without liquid assets. Blacks were more likely to report difficulties than whites.
Previous studies of health trends among older Americans have assessed difficulties in carrying
out activities such as bathing, shopping and doing laundry. The researchers point out, however, that
these kinds of measures can be influenced by living environments (is there a walk-in shower or
an awkward bathtub?) or socially defined roles (some persons have never done their own
laundry). The four indicators they employ seeing newsprint, lifting, climbing stairs and walking
provide an earlier and purer indication of changes in underlying physiological capabilities.
Freedman and Martin caution that their findings do not necessarily imply reductions in the
absolute number of people with limitations. "Given the continuing growth in the older population,
planning for the needs of this population remains a challenge," they observe. "But in relative
terms, if these prevalence trends do continue, the future will not be as daunting as suggested
by earlier work that found no improvements. With continued declines, relatively fewer older
people will need medical care and support services ... and more should be able to work and live
independently." This research was supported by the NIA and by RAND. RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.
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Dentists Help Manage Snoring and Sleep Apnea
About 45 million Americans, or 40 percent of adults by age 50, are habitual snorers. Ten percent of the people making all that racket have sleep apnea, a serious medical condition that can be debilitating and, in worst cases, very dangerous. Estimates are that nine percent of women and 24 percent of men in the middle-aged workforce meet the minimum criteria for obstructive sleep apnea.
Jonathan A. Parker, D.D.S. uses oral appliances that help manage both conditions. Dr. Parker is director of the Snoring and Sleep Apnea Dental Treatment Center and on the staff of three hospital-based sleep disorder centers in Minneapolis-St. Paul. "The dentist can be a great asset in identifying snoring and sleep apnea in patients," Dr. Parker says. "They are experts in oral anatomy and they see their patients every six months, which is more often than people normally see their physician. It’s simply a matter of asking their patients whether they have been told or are aware that they snore." In consultation with their patient’s physician and/or a sleep specialist, dentists can fabricate a comfortable, custom-fitted oral appliance that opens the air pathway during sleep and returns breathing to normal.
As we fall asleep, the soft tissues at the back of the throat, the muscles that line the airway and the tongue muscle all relax. As relaxation occurs, the tongue drops back into the airway, causing it to narrow. As air passes through this narrowed airway, it moves faster and causes the tissues to vibrate against one another, which in turn causes the rattling familiar to anyone who lives with a snorer. The more serious condition of obstructive sleep apnea occurs when the soft tissues in the back of the throat completely close off the airway because of the increasing pressure. The effect is similar to what happens when a person tries to suck a thick milkshake through a narrow straw. Eventually, the straw simply collapses. This airway obstruction can lead to a reduction in oxygen reaching the brain and blood, and the brain signals the airway muscles to tighten up and unblock the air passage. The result is a loud gasp or snort and breathing begins again. Through the night, the process of blocking and unblocking the airway disrupts sleep, often leaving sufferers of sleep apnea debilitated and exhausted in the morning. In fact, drivers with sleep apnea are three times more likely to have an auto accident than the rest of the population.
"Almost everyone can get help for snoring and sleep apnea," Dr. Parker says. "And there are many options for treatment." Strategies to minimize snoring, include sleeping on your side, losing weight if you are obese, relieving nasal congestion, minimizing bedroom light, noise and extremes in temperature, avoiding large meals just before bedtime, avoiding strenuous exercise within two or three hours of bedtime, avoiding alcohol or sleeping pills within four hours of bedtime, and avoiding caffeine, nicotine or other stimulants within four hours of bedtime. If you have symptoms of sleep apnea, Dr. Parker notes, it is important to be evaluated by a physician or sleep disorder specialist prior to any treatment.
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Disease Experts Urge Older Adult Vaccination
Less than half of all U.S. adults 65 and older, and barely a third of older minority adults, are protected against a disease that claims as many as 40,000 lives each year in the U.S. and millions more worldwide. While the number of adults vaccinated against pneumococcal disease is showing an upward trend, according to a state-by-state survey recently released by the Centers for Disease Control and Prevention (CDC), leading infectious disease and immunization specialists encourage more attention to older Americans' vaccination needs.
Jay Butler, M.D., and infectious disease specialist with the CDC and a leading authority on antibiotic resistance, emphasized the danger to public health posed by pneumococcal infection. "Pneumonia and influenza together are the fifth leading cause of death among the elderly in the U.S. Each year, 75,000 persons age 65 and older died of pneumonia and influenza," says Dr. Butler. In addition, one-third of adults hospitalized with pneumococcal pneumonia also develop blood stream infection. Among the elderly with pneumococcal blood stream infections, more than 20 percent will die, even with antibiotic treatment and modern intensive care support. Among those age 85 and older, death rates approach 40 percent.
CDC epidemiologist, James Singleton reports that "two-thirds of minority adults age 65 and older have not been vaccinated against this deadly disease". As a result, Singleton urges physicians to recommend pneumococcal vaccination to their patients.
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