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Diabetic nephropathy is damage to the kidneys caused by complications of diabetes. In cases of diabetic nephropathy, the kidneys don’t function properly, and may even stop working completely, the American Academy of Family Physicians warns.

The academy offers this list of possible warning signs:
Having swollen ankles and feet.
Feeling weak.
Having loss of appetite.
Having nausea or stomach upset.
Having problems getting to sleep or staying asleep.
Having difficulty concentrating, or feeling confused.

Average life expectancy in the United States has reached almost 78 years, a record high, federal health officials said Wednesday.

From birth in 2007, women can expect to live to 80.4 years on average and men to 75.3 years, according to the report from the U.S. Centers for Disease Control and Prevention.

But even though Americans can expect to live longer than their parents, life expectancy in the United States is still lower than in many other industrialized countries, including Canada and Japan.

Along with increased life expectancy, the report notes the death rate has dropped to an all-time low of 760.3 deaths per 100,000 people, continuing a long-term trend.

“The risk of dying has dropped to a record low level, and life expectancy has reached a record high,” said report co-author Arialdi M. Minino, a statistician at the CDC’s Center for Health Statistics, Division of Vital Statistics.

“Ever since the 1960s, the death rate has been decreasing in the United States,” he said. Fewer deaths from heart disease, stroke and cancer are driving the trend, he said.

The report is based on data from nearly 90 percent of U.S. death certificates.

According to the report, life expectancy in 2007 increased to 77.9 years — or 77 years and 11 months — up from 77.7 years in 2006. Since 2000, life expectancy has increased 1.4 years.

The five leading causes of death, accounting for 64 percent of all deaths, are heart disease, cancer, stroke, chronic lower respiratory diseases and accidents.

Other findings include:
Death rates in the United States vary by region and state, with the Southeast leading the nation. West Virginia’s death rate is 25 percent higher than average, while Hawaii has the lowest death rate.
White women have the longest life expectancy (80.7 years) followed by black women (77 years).
At age 65, life expectancy was 18.6 years in 2007, an increase of 6 percent since 2000.
Since 1989, the gap in life expectancy between whites and blacks has dropped 35 percent, to 4.6 years.

“This is great news,” Dr. William O’Neill, executive dean for clinical affairs at the University of Miami Miller School of Medicine, said of the overall findings.

Many people say the United States health care system is broken, O’Neill said. “But, this is kind of great evidence to show there has actually been some dramatic improvements in the health of Americans over the last 20 years.”

However, living longer will also have unforeseen effects on the country, he said.

“We are going to have many people 80 to 90 years old,” O’Neill said. “So how is the U.S. going to handle this huge increase?”

People living 20 years or more than their predecessors will have to rethink retirement planning, O’Neill said.

Also, the nation will see a significant drain on Social Security and Medicare benefits, he said. These programs weren’t designed to support people for that long, he said, noting people typically lived five to 10 years after retiring, he said.

Increased life expectancy is largely the result of better treatment for heart disease, he said.

“The biggest reason people are living longer is that we have done a fantastic job in dealing with coronary artery disease,” O’Neill said. In time, cancer may overtake heart disease as the nation’s number one killer, the report noted.

O’Neill anticipates the trend toward longer life will continue, especially as cancer treatment improves. “I am seeing people living with cancers that 15 years ago would have been considered hopeless,” he said.

Researchers have developed a tool to predict whether a patient will suffer a second stroke within 90 days of a first stroke.

“This is an important new tool because studies have shown that people who have a second stroke soon after a first stroke are more likely to die or have severe disability,” Dr. Hakan Ay, of Massachusetts General Hospital and Harvard Medical School, said in an American Academy of Neurology news release. “This tool can help doctors identify people who are at high risk of having another stroke and need immediate evaluation based on information typically available at the time of initial evaluation.”

The tool — called the Recurrence Risk Estimator at 90 Days score — uses brain scan results and a number of stroke risk factors to calculate a person’s chances of having another stroke within three months. The risk factors include history of transient ischemic attack (mini-stroke), age and type of first stroke. The higher a patient’s score, the greater their risk for a second stroke.

In a study of 1,458 ischemic stroke patients, Ay and colleagues found that those with four or more risk factors were about 40 times more likely to suffer a second stroke than those with no risk factors. The study also found that more than 96 percent of patients who had a second stroke showed signs of one or more risk factors.

Surprisingly, long-term predictors of stroke — such as smoking, diabetes and hypertension — didn’t predict short-term risk.

“We currently don’t have a well-developed tool for predicting short-term risk of early recurrent stroke, so this tool could help improve stroke care and outcome,” Ay said. “For example, people at high risk of a second stroke can be immediately admitted to specialized stroke centers and given preventive treatment.”

When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production – particularly when enriched foods and supplements are safe and effective sources of this vitamin.

Speaking today at the American Academy of Dermatology’s SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy’s increased recommendation on the minimum Sun Protection.

Factor (SPF) of sunscreen.
“Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production,” said Dr. Tanzi. “The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal.”

Myth: Sun exposure is the best source of vitamin D.
Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.

While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.

“Although studies showing the benefits of increased vitamin D intake have caused some to propose ‘sensible sun exposure’ or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer,” said Dr. Tanzi. “UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure – especially in relation to vitamin D.”

Myth: All sunscreens are created equal.
While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun’s burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product’s ability to deflect the sun’s burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.

“SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays,” said Dr. Tanzi. “The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective.”

Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.

For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.

Myth: Using a higher SPF will ensure you don’t burn.
Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors – including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.

Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.

“For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating,” said Dr. Tanzi. “Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. ”

To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :
Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.
Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
Get vitamin D safely through a healthy diet that may include vitamin supplements. Don’t seek the sun.
Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Welcoming a new baby is a happy and exciting time, but it’s also full of stress. Postpartum depression affects many new moms, and it’s important to recognize the signs and seek treatment.

The American Academy of Family Physicians lists these warning signs of postpartum depression:
Persistent feelings of sadness and crying.
Having little desire to eat.
Significant weight gain or loss.
Irritability, anxiety and restlessness.
Inability to find pleasure or interest in life.
Feeling exhausted or having no motivation to get things done.
Insomnia.
Feelings of hopelessness, worthlessness or guilt.
Having little interest in your newborn.

Laser eye surgery doesn’t appear to have long-term effects on the cells that line the inside of the cornea, a new study has found.

The study included 29 eyes of 16 patients who had undergone either photorefractive keratectomy (PRK) or laser in situ keratomileusis (Lasik) procedures. Photos of the cells lining the cornea (endothelial cells) were taken before and nine years after surgery. The researchers compared the annual rate of corneal endothelial cell loss in the eyes of the patients who had laser surgery with 42 eyes of people who didn’t have laser surgery.

Nine years after laser surgery, the density of corneal endothelial cells was 5.3 percent less than it was before surgery. But the annual rate of cell loss (0.6 percent) was the same in patients who had surgery and those who didn’t, the researchers found.

The study findings are published in the November issue of the journal Archives of Ophthalmology.

“Our results support the findings of numerous short-term studies that found no significant endothelial cell loss after Lasik and PRK,” wrote Drs. Sanjay V. Patel and William M. Bourne, of the Mayo Clinic in Rochester, Minn.

“The importance of the findings in our study relates to using corneas that have undergone Lasik or PRK as donor tissue,” they concluded. “Our findings of no difference in endothelial cell loss after keratorefractive surgery compared with normal eyes suggests that corneas after keratorefractive surgery should be suitable for posterior lamellar keratoplasty,” a surgical treatment that uses donated tissue to correct corneal problems.

Exposure to several common pathogens may increase the risk of having a stroke, a new study shows.

Led by Dr. Mitchell Elkind, an associate professor of neurology at Columbia University Medical Center in New York City, the research team found that the pathogens Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus and herpes simplex virus 1 and 2 may be implicated in accelerating arterial disease, which in turn increases the risk of stroke.

The team’s work appears in the Nov. 9 online edition of the Archives of Neurology, and will be published in the January 2010 print issue of the journal.

“These are infections that regularly pop up when we study heart disease,” said Elkind. “They are very common in the population.”

Scientists are not completely sure how the pathogens harm arterial function, but several theories offer suggestions. One possibility is that chronic infection leads to inflammation in the blood vessels, which can constrict blood flow. Another possibility, said Elkind, is that the pathogens disrupt the normal functioning of the arterial walls.

Strokes occur when there is a disruption in the blood supply to the brain, such as a blockage in an artery or other blood vessel. When this happens, brain cells begin to die, causing brain damage and even death. Common functions affected or lost during a stroke include speech, movement and memory.

Stroke is the third-leading cause of death in the United States, according to the National Stroke Association. Strokes have many causes, but it is widely known that certain risk factors increase the chances of having a stroke. These include high blood pressure, diabetes, high cholesterol, smoking and obesity.

In recent years, evidence has been uncovering the role of pathogens in cardiovascular disease, particularly the pathogens featured in Elkind’s research. Scientists reported several years ago that untreated gum disease and other oral infections can spread and cause heart disease.

Elkind’s study tracked 1,625 adults from a multi-ethnic community in Manhattan for 7.6 years. During that time, 67 patients suffered a first stroke. Even taking into account other risk factors, such as high blood pressure and diabetes, Elkind’s team found that the majority of the patients tested positive for one or more of the suspected pathogens.

“Each individual infection was positively, though not significantly, associated with stroke risk after adjusting for other risk factors,” the researchers wrote. “The infectious burden index was associated with an increased risk of all strokes after adjusting for demographics and risk factors.”

It is too early to tell which pathogens contributed to the strokes, to what extent they contributed and how they contributed (through simple exposure or chronic infection), said Elkind. What’s more, there may be other pathogens involved that were not included in the study, he added.

It is also too early to make any clinical recommendations. If scientists conclusively determine that pathogens are capable of causing strokes years after people come in contact with them, possible treatments may include wider and longer use of antibiotics, Elkind added.

Dr. Kishore Ranade, a neurologist affiliated with the Mount Kisco Medical Group in New York, said he was impressed with the findings. He suspects that pathogens work with other risk factors to cause strokes.

“Cumulative data have been suggesting that pathogens play a role in heart disease in general,” said Ranade. “And what’s bad for the heart is bad for the brain.”

Methods to gauge blood cholesterol to determine vascular disease risk can be simplified, researchers in England say.

Their method measures levels of either total or high-density lipoprotein (HDL, or “good” cholesterol) in the blood or apolipoproteins (proteins that help transport cholesterol), without the need to have patients fast and without regard to another form of blood fat called triglycerides.

“Expert opinion is divided” on which combination of measurements is ideal in gauging cardiovascular risk, explained John Danesh, of the Emerging Risk Factors Collaboration Coordinating Centre at the University of Cambridge, and colleagues.

In order to examine the association between major blood fats and apolipoproteins and coronary heart disease and ischemic stroke, the researchers analyzed data on more than 300,000 people without initial vascular disease who took part in 68 long-term studies.

During the follow-up periods of the studies, there were almost 8,900 nonfatal heart attacks, more than 3,900 coronary heart disease deaths, over 2,500 ischemic strokes, 513 hemorrhagic strokes and more than 2,500 unclassified strokes, the study authors noted.

The analysis of the data yielded a number of findings.

First of all, risk tied to blood levels of non-HDL-C and HDL-C were nearly identical to those seen with the two apolipoproteins (B and AI), the team found. “This finding suggests that current discussions about whether to measure cholesterol levels or apolipoproteins in vascular risk assessment should hinge more on practical considerations (e.g., cost, availability, and standardization of assays),” Danesh and colleagues wrote.

Secondly, risk assessments “were at least as strong in participants who did not fast as in those who fasted [before testing],” the team added, and risk was similar with non-HDL cholesterol as with directly measured LDL (”bad”) cholesterol.

Finally, measuring for triglyceride blood fats “provides no additional information about vascular risk given knowledge of HDL-C and total cholesterol levels, although there may be separate reasons to measure triglyceride concentration (e.g., prevention of pancreatitis),” according to the report in the Nov. 11 issue of the Journal of the American Medical Association.

“The current analysis of more than 300,000 people has demonstrated that [blood fat] assessment in vascular disease can be simplified by measurement of either cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride,” the researchers concluded.

Hospital workers who see many patients may play a disproportionate role in spreading dangerous hospital-acquired infections, a new study finds.

These so-called peripatetic workers, such as radiologists or physical therapists, visit many patients in the course of a day, said Laura Temime, a researcher at the Conservatoire National des Arts et Metiers in Paris, and lead author of a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.

“Although to my knowledge, an increased super-spreading potential of ‘peripatetic’ health-care workers has never really been formalized as a major hypothesis, there have been several reports of nosocomial outbreaks that have been traced back to such ‘peripatetic’ health-care workers,” Temime said.

Her study adds to the evidence, she said. The study used a mathematical model of a hypothetical intensive care unit that was presumed free of the pathogen to see how easily hospital-based infections, such as methicillin-resistant Staphylococcus aureus (MRSA) spread.

Containing these outbreaks is of grave importance, public health officials agreed.

For the study, Temime divided workers into three groups — a nurse-like group, which made frequent visits to a small number of patients assigned to them; a physician-like group, which made infrequent visits to a larger number of patients, and the peripatetic group, which visits all patients daily, such as physical therapists.

Next, using a complex mathematical model, the researchers assumed how long the patients would stay — an average of 10 days — and how much exposure they would have to each of the three categories of workers, plus how compliant the workers were with hand washing.

Then they computed the impact. They found infection rates increased by up to three times more when a peripatetic worker failed to wash his hands, compared to workers in the other groups.

The conclusions sound very logical, said Dr. Zachary Rubin, an epidemiologist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica. However, he added, “this is a mathematical model, and you have to do studies with human beings to see if the data is still true or not.”

Temime said she and her colleagues are doing just that. They are involved in a European project called Mastering Hospital Antimicrobial Resistance (MOSAR), in which data on exposures and bacterial colonization will be collected on patients and health-care workers. “We are planning to use this data to validate our model,” Temime said.

For now, many hospitals are stepping up efforts to promote hand washing among employees. Because the peripatetic workers have “major superspreading potential,” the study authors recommend individual surveillance of these health-care workers.

Rubin said that hospitalized patients shouldn’t be shy about asking the health-care workers who come in contact with them to follow infection control guidelines. Some hospitals have posted signs in patient rooms asking “Did your health-care worker wash his hands?” to make patients more aware of the importance of hand washing, he said.

“If a patient is concerned [about lack of hygiene from a health-care worker], he can always talk to the head nurse or charge nurse,” Rubin said, as well as the hospital’s patient advocate or his own physician

New research suggests a link between women’s exposure to household insecticides — including roach and mosquito killers — and the autoimmune disorders rheumatoid arthritis and lupus.

The scientist did not find a direct cause-and-effect relationship between insecticide exposure and the illnesses, and it’s possible that the women have something else in common that accounts for their higher risk. But epidemiologist Christine Parks, lead investigator of the study, said the findings do raise a red flag.

“It’s hard to envision what other factors might explain this association,” said Parks, an epidemiologist with the National Institute of Environmental Health Sciences who was to present the study over the weekend at the American College of Rheumatology annual meeting in Philadelphia.

Previous research has linked agricultural pesticides to higher risk of rheumatoid arthritis and lupus, two diseases in which the immune system goes haywire and begins to attack the body. Farmers, among others, appear to be vulnerable.

Parks and her colleagues wanted to find out whether smaller doses of insecticides, such as those people might encounter at home from either personal or commercial residential use, might have a similar effect.

The researchers examined data from a previous study of almost 77,000 postmenopausal women aged 50 to 79. Their findings were to be released Monday at the American College of Rheumatology’s annual scientific meeting in Philadelphia.

Women who reported applying insecticides or mixing them — about half — had a higher risk of developing the two autoimmune disorders than women who reported no insecticide use. This was the case whether or not they had lived on a farm. Those who used or mixed the insecticides the most — judged by frequency or duration — had double the risk.

Even so, the risk of developing the diseases remained very low. Overall, Parks said, about 2 percent of older adults develop the conditions.

Parks said the insecticides that the women used included insect killers, such as those designed to eradicate ants, wasps, termites, mosquitoes and roaches. They didn’t include insect repellents.

There are some caveats to the research. For one, it’s not clear exactly what products the women used or when. “Over time, there have been major changes in what products were available for home use,” Parks said.

And while researchers tried to take into account the influence of factors like age that may boost a woman’s risk of getting autoimmune diseases, it’s possible they missed something that boosted the risk of illness.

Could gardening, which often entails insecticide use, be a contributing factor? That’s possible. But Parks said a lot of insecticide use takes place inside the home, not outside in the garden.

For now, she said, the findings indicate the need for “more research on environmental risk factors and better understanding of what factors might explain these findings, what chemicals might be associated with these risks.”

She declined to speculate on how insecticides might cause problems in the body.

“I would recommend that people read the labels and take precautions to minimize their personal exposure” to insecticides, she said. “This is the case regardless of whether these results are implicating a chemical that’s on the market now or was before.”