Hazardous Chemicals From Scented Laundry Products Released Through Dryer Vents

The same University of Washington researcher who used chemical sleuthing to deduce what’s in fragranced consumer products now has turned her attention to the scented air wafting from household laundry vents.

Findings, published online this week in the journal Air Quality, Atmosphere and Health, show that air vented from machines using the top-selling scented liquid laundry detergent and scented dryer sheet contains hazardous chemicals, including two that are classified as carcinogens.

“This is an interesting source of pollution because emissions from dryer vents are essentially unregulated and unmonitored,” said lead author Anne Steinemann, a UW professor of civil and environmental engineering and of public affairs. “If they’re coming out of a smokestack or tail pipe, they’re regulated, but if they’re coming out of a dryer vent, they’re not.”

The research builds on earlier work that looked at what chemicals are released by laundry products, air fresheners, cleaners, lotions and other fragranced consumer products. Manufacturers are not required to disclose the ingredients used in fragrances, or in laundry products.

For the new study, which focuses on chemicals emitted through laundry vents, researchers first purchased and pre-rinsed new, organic cotton towels. They asked two homeowners to volunteer their washers and dryers, cleaned the inside of the machines with vinegar, and ran full cycles using only water to eliminate as much residue as possible.

At the first home, they ran a regular laundry cycle and analyzed the vent fumes for three cases: once with no products, once with the leading brand of scented liquid laundry detergent, and finally with both the detergent and a leading brand of scented dryer sheets. A canister placed inside the dryer vent opening captured the exhaust 15 minutes into each drying cycle. Researchers then repeated the procedure with a different washer and dryer at a second home.

Analysis of the captured gases found more than 25 volatile organic compounds, including seven hazardous air pollutants, coming out of the vents. Of those, two chemicals – acetaldehyde and benzene – are classified by the Environmental Protection Agency as carcinogens, for which the agency has established no safe exposure level.

“These products can affect not only personal health, but also public and environmental health. The chemicals can go into the air, down the drain and into water bodies,” Steinemann said.

The researchers estimate that in the Seattle area, where the study was conducted, acetaldehyde emissions from this brand of laundry detergent would be equivalent to 3 percent of the total acetaldehyde emissions coming from automobiles. Emissions from the top five brands, they estimate, would constitute about 6 percent of automobiles’ acetaldehyde emissions.

“We focus a lot of attention on how to reduce emissions of pollutants from automobiles,” Steinemann said. “And here’s one source of pollutants that could be reduced.”

The project’s website also includes letters from the public reporting health effects from scented consumer products. Steinemann says that people’s reports of adverse reactions to fragranced air coming from laundry vents motivated her to conduct this study.

Steinemann recommends using laundry products without any fragrance or scent.

Co-authors are Lisa Gallagher and Amy Davis at the UW, and Ian MacGregor at Battelle Memorial Institute.

Better Stroke Survival Rates For African-Americans

A study just published shows that African Americans have a better survival rate compared to whites after being hospitalized for a stroke. This conclusion contradicts prevailing wisdom and is one piece in a growing body of evidence that points to the important role that patients – and the decision they and their families make in terms of treatment – may play on mortality rates.

The study found that – after adjusting data for variables such as age, socioeconomic status, and risk factors – that African Americans who were hospitalized for acute ischemic stroke had a significantly lower mortality rate than whites. The survival advantage was most pronounced early after the stroke but persisted for up to one year. The study also found that African Americans were also more likely during their hospitalization to have received more aggressive treatment measures, such as kidney dialysis, a tracheostomy, or cardiopulmonary resuscitation. They were also less likely to use hospice care. These results were published in the Annals of Internal Medicine.

“These results fly in the face of conventional wisdom that says that black patients with strokes have worse outcomes,” said University of Rochester Medical Center (URMC) neurologist Robert Holloway, M.D., M.P.H. a co-author of the study. “Even though we do not know the exact reasons for these differences, these data highlight the potential importance of treatment intensity, and the expression of patient preference for different treatments on survival and mortality. This is not such a far-fetched idea for physicians who take care of a lot of stroke patients.”

“We know that African Americans have a higher prevalence of stroke and higher risk factors for stroke,” said Ying Xian, M.D., Ph.D., a former graduate student in Health Services Research and Policy with URMC Department of Community and Preventive Medicine and now a fellow with the Duke Clinical Research Institute and co-author of the study. “But this data shows that African Americans have lower mortality rates than whites. It also shows that African Americans are more likely to be treated aggressively and we suspect that this may have an impact on their mortality outcomes.”

The study used data from the New York State Statewide Planning and Research Cooperative System, a reporting system that collects detailed information on every hospital and emergency department admission in the state. They compiled information for all non-Hispanic blacks and non-Hispanic whites age 18 and older who were admitted to a hospital with a diagnosis of acute ischemic stroke in 2005 and 2006.

The researchers used a novel statistical approach to minimize the difference between two pools of black and white patients in terms of demographic profiles, co-morbidities, and the type of hospital where they received their care. They then looked at mortality rates for several incremental periods beginning at 7 days and up to a year after the stroke and what life-sustaining interventions the patients received during their hospitalization. The authors found that over the course of the year African American patients had a statistically lower rate of mortality and at the same time were more likely to receive aggressive life-sustaining treatments.

While the data used for the study does not illustrate the role of patient preference – either expressed intent or in the form of do not resuscitate orders, health care proxies, or living wills – or the decisions made by family member on their behalf, the authors believe the evidence indicates that there might be a link between the treatment decisions made by patients and their families when seriously ill with stroke and survival rates.

“Although we don’t show any causal relationship, the association of lower risk of death and increased use of life-sustaining interventions is actually very consistent with the idea that preference sensitive end-of-life care may have an important impact on short-term mortality,” said Holloway. “We were unable to measure health or quality of life in those patients who survived, which is a critically important question. We also need much more research on ways to measure the quality of the decision process itself to make sure that the treatments patients receive are consistent with their underlying values and preferences.”

“Even though people who receive aggressive life-sustaining care have lower mortality it does not mean they have better quality of care or quality of life,” said Xian. “Mortality is important measure but not only measure.”

Notes:

Other authors of the study include Katia Noyes, Ph.D., M.P.H.; Manish N. Shah, M.D., M.P.H.; and Bruce Friedman, Ph.D., M.P.H. with URMC. The study was supported by funding from the American Heart Association.

Source:
Mark Michaud
University of Rochester Medical Center

Older Adults With Depressive Symptoms Are More Likely To Become Cognitively Impaired

Older adults with depressive symptoms are more likely than those without depression to develop mild cognitive impairment (MCI) within six years, according to a study conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

The greater the degree of depression, the more likely the impairment, the researchers found.

“This is important, because mild cognitive impairment often precedes dementia,” notes lead author Deborah Barnes, PhD, MPH, a mental health researcher at SFVAMC. Approximately 50 percent of patients diagnosed with MCI go on to develop dementia within three years, according to the study authors.

The study also found no correlation between depression and vascular disease — a significant finding, say the authors, because other researchers have hypothesized that vascular disease might lead to both depression and cognitive impairment by causing inadequate blood flow to different brain structures. “We found no evidence to support that hypothesis,” reports Barnes, who is also an assistant professor of psychiatry at UCSF.

The study appears in the March, 2006 issue of Archives of General Psychiatry.

The researchers looked at 2,220 participants in the Cardiovascular Health Study, a longitudinal prospective study of adults 65 and older living in four American communities that is sponsored by the National Heart, Lung, and Blood Institute. The researchers measured the subjects’ depressive symptoms using a standard depression scale. Six years later, the subjects were assessed for MCI by a team of dementia experts.

Ten percent of subjects with no depressive symptoms went on to develop MCI, and 13.3 percent of subjects with low depressive symptoms did. In contrast, 19.7 percent of subjects with moderate to high depression developed MCI after six years — nearly twice the rate of subjects with no depressive symptoms.

The findings were consistent among all subgroups in the study — men and women, younger and older, with and without vascular disease, and regardless of education level.

One major implication of the study, according to Barnes, is that family members and health care providers should pay attention when an older person seems newly depressed. “Even if they don’t have cognitive impairment at that time, our study suggests that you probably want to keep an eye on them,” she says. “Depression might be an early sign of neurodegeneration — in fact, it might be the first symptom that a family member notices.”

Kristine Yaffe, MD, chief of geriatric psychiatry at SFVAMC and the principal investigator of the study, says the next step is to investigate whether treating older adults with newly diagnosed depressive symptoms might be effective in preventing the development of MCI. “Perhaps getting a family member in for early treatment would make a difference,” she speculates. “We don’t know the answer yet, but I think it’s important to evaluate.” Yaffe is also associate professor of psychiatry, neurology, and epidemiology at UCSF.

Barnes says she would also like to see other researchers investigate the reasons for the association between depression and MCI. “If vascular disease is not the mechanism, what is?” she asks. “One theory is that people who are undergoing stress or experiencing depression often have elevated levels of the stress hormone cortisol. There is growing evidence that this may lead directly to brain damage in the hippocampus,” a part of the brain that plays a significant role in memory and Alzheimer’s disease. “It would be good to find out,” she concludes.

###

Co-authors of the study were George S. Alexopoulos, MD, of Cornell University; Oscar L. Lopez, MD, of the University of Pittsburgh School of Medicine; and Jeff D. Williamson, MD, MHS, of Wake Forest University School of Medicine.

The research was supported by grants from the National Heart, Lung, and Blood Institute, the National Institute on Aging, and the National Alliance for Research on Schizophrenia and Depression.

UCSF is a leading university that consistently defines health care worldwide by conducting advanced biomedical research, educating graduate students in the life sciences, and providing complex patient care.

Contact: Steve Tokar
steve.tokarncire
University of California – San Francisco

CDC Recognizes 73 Alabama Water Systems For Water Fluoridation Quality, USA

The Alabama Department of Public Health announces that 73 Alabama public water systems
will receive Water Fluoridation Quality Awards from the U.S. Centers for Disease Control and
Prevention.

Fluoridation is the adjustment of fluoride in the water to a level that is optimal for preventing
tooth decay. The award recognizes those communities that maintained a consistent level of
optimally fluoridated water throughout 2007. According to CDC’s Water Fluoridation Reporting
System, Alabama has 121 public water systems that provide adjusted fluoride to their water
supplies.

“We are very pleased to announce that Alabama water systems have shown marked increases
in maintaining optimal fluoridation in the past three years,” said Dr. Donald Williamson, state
health officer. The number of systems which have received this honor grew from just 4 in 2005,
to 53 in 2006, to 73 in 2007.

The CDC recognized community water fluoridation as one of 10 great public health
achievements of the 20th Century. CDC recommends water fluoridation as a safe, effective and
inexpensive method of preventing decay; every $1 invested in fluoridation saves approximately
$38 in costs for dental treatment. In addition, studies have shown that tooth decay is prevented
among all age groups, not just children.

More than 184 million people, or 69.2 percent of the United States population served by public
water supplies, currently drink water with optimal fluoride levels for preventing decay.

“Our latest national and state fluoridation statistics show us that we have made significant
progress towards our national objective of reaching 75 percent of U.S. residents,” stated Dr.
William R. Maas, DDS, MPH, director of the CDC Division of Oral Health. “This is largely due to
the efforts of the states and communities who are receiving these quality awards for fluoridation.
Alabama Department of Public Health’s county environmental and oral health staff, Alabama
Department of Environmental Management staff, local water plant staffs and CDC made this
achievement possible by submitting or collecting data to report in the Water Fluoridation
Reporting System.

For more information contact Shellie Lyles, Oral Health Program, Alabama
Department of Public Health, at (334) 206-3896 or visit adph/oralhealth/.

Alabama
Department of Public Health

CDC Recognizes 73 Alabama Water Systems For Water Fluoridation Quality, USA

The Alabama Department of Public Health announces that 73 Alabama public water systems
will receive Water Fluoridation Quality Awards from the U.S. Centers for Disease Control and
Prevention.

Fluoridation is the adjustment of fluoride in the water to a level that is optimal for preventing
tooth decay. The award recognizes those communities that maintained a consistent level of
optimally fluoridated water throughout 2007. According to CDC’s Water Fluoridation Reporting
System, Alabama has 121 public water systems that provide adjusted fluoride to their water
supplies.

“We are very pleased to announce that Alabama water systems have shown marked increases
in maintaining optimal fluoridation in the past three years,” said Dr. Donald Williamson, state
health officer. The number of systems which have received this honor grew from just 4 in 2005,
to 53 in 2006, to 73 in 2007.

The CDC recognized community water fluoridation as one of 10 great public health
achievements of the 20th Century. CDC recommends water fluoridation as a safe, effective and
inexpensive method of preventing decay; every $1 invested in fluoridation saves approximately
$38 in costs for dental treatment. In addition, studies have shown that tooth decay is prevented
among all age groups, not just children.

More than 184 million people, or 69.2 percent of the United States population served by public
water supplies, currently drink water with optimal fluoride levels for preventing decay.

“Our latest national and state fluoridation statistics show us that we have made significant
progress towards our national objective of reaching 75 percent of U.S. residents,” stated Dr.
William R. Maas, DDS, MPH, director of the CDC Division of Oral Health. “This is largely due to
the efforts of the states and communities who are receiving these quality awards for fluoridation.
Alabama Department of Public Health’s county environmental and oral health staff, Alabama
Department of Environmental Management staff, local water plant staffs and CDC made this
achievement possible by submitting or collecting data to report in the Water Fluoridation
Reporting System.

For more information contact Shellie Lyles, Oral Health Program, Alabama
Department of Public Health, at (334) 206-3896 or visit adph/oralhealth/.

Alabama
Department of Public Health

Studies On Genetics And Stem Cell Research, Stents Included In Top10 Research Advances, American Heart Association

Several new studies on genetics and stem cell research, along with studies that continue to debate the use of stents to clear coronary artery blockages are among the top research advances in heart disease and stroke for 2007, said Daniel W. Jones, M.D., president of the American Heart Association.

Other major milestones include a study that may change the way lives are saved using a new way to do cardiopulmonary resuscitation.

The American Heart Association in 1996 began compiling an annual list of the top 10 major advances in heart disease and stroke research and continues to highlight influential research annually.

Achievements in 2007 include:

* 1. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls

Genome wide association studies identify genes (strands of DNA) which may cause specific diseases and represent a powerful approach in identifying genes involved in common human diseases. This large-scale genome-wide association (GWA) study found consistent and replicable genetic markers of several complex diseases of adulthood, including atherosclerotic heart disease. Study authors said their analysis of some 17,000 people for seven common familial diseases (bipolar disorder, coronary artery disease, Crohn’s disease, hypertension, rheumatoid arthritis, type 1 diabetes, and type 2 diabetes) confirms previously identified loci (DNA closely linked to genes that may identify a trait of a particular disease) and provides strong evidence for many novel disease susceptibility genes.

Source: Nature, June 7, 2007; Nature 2007. 447:661-78; nature/.

Funding: Wellcome Trust was the principle funding source of this study.

*
2. Genomewide association analysis of coronary artery disease

This study included a joint analysis of two genomewide association studies of coronary artery disease. Researchers used the genetic patterns of the persons (cases) with coronary artery disease (CAD) from the Wellcome Trust Case Control Consortium study (described above) and tried to replicate the genetic patterning for CAD in another genomewide association study – the German MI [Myocardial Infarction] Family Study. Results identified several genetic loci that, individually and in aggregate, substantially affect the risk of developing coronary artery disease.

Source: New England Journal of Medicine, Aug. 2, 2007; N Engl J Med 2007. 357:443-453; nejm/.

Funding: Grants from the Wellcome Trust, the National Genome Research Network 2 of the German Federal Ministry of Education and Research and the Cardiogenics project of the European Union supported this study.

*
3. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-Kanto): an observational study

This work represents the first meaningful chance to improve cardiopulmonary resuscitation (CPR) in more than 50 years. Results indicate chest compression-only resuscitation by bystanders may be the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnea, shockable rhythm or short periods of untreated arrest.

Source: The Lancet, March 17, 2007. The Lancet 2007; 369:920-926; thelancet/.

Funding: Grants from the Laerdal Foundation of Acute Medicine, Norway and the Ministry for Health, Labour and Welfare, Japan supported this study.

*
4. Implementation of a statewide system for coronary reperfusion

This study found that a statewide program focused on regional systems for quickly treating ST-elevation myocardial infarctions (STEMI – heart attacks in which the coronary artery is completely blocked) can significantly improve quality of care. The research sets the stage for collaborative, non-competitive care for patients of a region, expanding door-to-balloon initiatives into the community for a systems approach. The American Heart Association’s Mission: Lifeline program, created to establish systems to provide emergency care for STEMI patients, promotes this strategy for improving patient care.

Source: Journal of the American Medical Association, Nov. 28, 2007; JAMA 2007; 298(20);2371-23809; jama/. This study was also presented at the American Heart Association Scientific Sessions 2007.

Funding: Blue Cross and Blue Shield of North Carolina supported this study.

*
5. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)

This is the first major trial to document that a reduced sodium intake lowers the risk of clinical cardiovascular disease outcomes, not just blood pressure.

Source: British Medical Journal, April 20, 2007; BMJ 2007;334;885; bmj/.

Funding: The National Heart, Lung and Blood Institute, National Institutes of Health supported this study.

*
6. Optimal medical therapy with or without PCI for stable coronary artery disease (COURAGE)

This study compared the initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) vs. optimal medical therapy alone in reducing the risk of cardiovascular events. The authors concluded that, as an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction or other major cardiovascular events when added to optimal medical therapy.

Source: New England Journal of Medicine, April 12, 2007; N Engl J Med 2007; 35;(15);1503-16; nejm/. .

Funding: The U.S. Department of Veterans Affairs Office of Research and Development provided support for this study.

*
7. Generation of functional cardiomyocytes from adult mouse spermatogonial stem cells

This study analyzed the complex functional properties of cardiomyocytes (heart muscle cells) derived from maGSCs in vitro and the behavior of undifferentiated maGSCs in normal hearts of mice in vivo after transplantation. The authors conclude that maGSCs provide a new source of distinct types of cardiomyocytes for basic research/potential therapeutic application.

Source: Circulation Research, June 8, 2007; Circ Res. 07 Jun 8;100(11):1615-25; ahajournals/.

Funding: A grant from the Georg-August-University of GoВЁttingen supported this study.

*
8. HORIZONS: Harmonizing Outcomes with RevascularIZatiON and Stents

This large study examined the safety and effectiveness of anticoagulation medications and drug-eluting stents in patients experiencing a STEMI heart attack, in which the coronary artery is completely blocked, without significantly increasing the rate of death or recurrent heart attacks among these patients.

Source: Late-breaking trial at the Transcatheter Cardiovascular Therapeutics TCT 2007; tct2007/.

Funding: The Cardiovascular Research Foundation supported this study.

*
9. Effectiveness and safety of drug-eluting stents in Ontario

This large Canadian study found that drug-eluting stents are effective in reducing the need for target-vessel coronary artery bypass in patients at the highest risk for re-narrowing of previously blocked arteries, without a significantly increased rate of death or heart attack.

Source: New England Journal of Medicine, Oct. 7, 2007; N Eng J Med 2007; 14;357:1393-1402; nejm/.

Funding: The Ontario Ministry of Health and Long-Term Care to the Program for Assessment of Technology in Health, the CCN of Ontario and the Institute for Clinical Evaluative Sciences supported this study in part.

*
10. Underdiagnosis of Hypertension in Children and Adolescents

This study of more than 14,000 children found that hypertension and prehypertension were often undiagnosed in the pediatric population. Patient age, height, obesity-related diagnoses, and magnitude and frequency of abnormal blood pressure readings all increased the odds of hypertension.

Source: Journal of the American Medical Association, Aug. 22, 2007; JAMA 2007; 298(8):874 — 879; jama/.

Funding: This research did not receive funding support.

###

Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

Source: Cathy Lewis

American Heart Association

New West Nile And Japanese Encephalitis Vaccines Produced

University of Texas Medical Branch at Galveston researchers have developed new vaccines to protect against West Nile and Japanese encephalitis viruses. The investigators created the vaccines using an innovative technique that they believe could also enable the development of new vaccines against other diseases, such as yellow fever and dengue fever, which are caused by similar viruses.

The scientists showed that the vaccines successfully protected laboratory mice and hamsters against the viruses, which can cause fatal brain inflammation in humans. They reported their findings in back-to-back papers published in the current issue of the journal Vaccine.

“These vaccines were created using a system that we think is applicable to producing vaccines that can protect against a wide range of diseases caused by the flaviviruses, an important family of viruses that afflict populations throughout the world,” said UTMB pathology professor Peter Mason, senior author of the Vaccine papers. “Flaviviruses cause tremendous human suffering, but we still only have vaccines for a few of them.”

Currently approved flavivirus vaccines are either “live-attenuated virus” vaccines, which contain weakened but still genetically intact versions of the target virus, or “inactivated-virus” vaccines, which contain viruses that have been chemically neutralized. In each case, the viral material stimulates the immune system to block the progress of any future infection by the virus in question.

The new vaccines – based on a concept devised by Mason and UTMB microbiology and immunology associate professor Ilya Frolov – are known as “single-cycle” or “pseudoinfectious” vaccines, and contain flaviviruses that have been genetically modified so that each virus can only infect a single cell. Unable to spread from cell to cell and create disease, these crippled viruses nonetheless continue to copy themselves within the cells they infect, thus producing the viral proteins needed to induce immune protection.

“With these vaccines, we mimic a viral infection and get amplification of the antigens that are important for stimulating an immune response without amplification of the virus,” Mason said.

To make the West Nile vaccine, the researchers deleted the piece of the West Nile virus genome that codes for a “capsid” (or “C”) protein, a part of the virus particle that encloses the genetic material of the virus and is essential to its ability to move between cells. They then introduced this truncated RNA into cells specially designed to produce high concentrations of the C protein. The result: large numbers of virus particles that had capsids but lacked the ability to pass the C gene on to their progeny.

“A vaccine virus particle grown in the C-protein expressing cells can only infect one cell in a vaccinated individual,” Mason said. “Once it gets into that cell, in order to make a new particle, it needs the C protein – and cells in the vaccinated host do not have the gene to make the C protein. But it can still make all the immunogenic proteins that the virus normally makes, and it can still generate strong immunity.”

The Japanese encephalitis vaccine was built from the West Nile vaccine, using the C-less West Nile genome but replacing the genes for two key immunogenic proteins with their Japanese encephalitis virus counterparts, a process called “chimerization.” The success of such genetic mixing and matching, Mason noted, could open the door for the creation of a wide variety of “chimerized” single-cycle flavivirus vaccines for other diseases.

###

Other authors of “Construction and characterization of a second-generation pseudoinfectious West Nile virus vaccine propagated using a new cultivation system” and “Construction and evaluation of a chimeric pseudoinfectious virus vaccine to prevent Japanese encephalitis” include UTMB graduate student Douglas G. Widman, postdoctoral fellow Tomohiro Ishikawa, associate professor Nigel Bourne and research associate Rafik Fayzulin, as well as Eiji Konishi of the Kobe University School of Medicine, Kobe, Japan. This research was supported by the NIAID through the Western Regional Center of Excellence for Biodefense and Emerging Infectious Diseases; Widman is supported by a fellowship from the James W. McLaughlin Endowment.

The University of Texas Medical Branch at Galveston
Public Affairs Office
301 University Boulevard, Suite 3.102
Galveston, Texas 77555-0144
utmb.edu/

Source: Jim Kelly

University of Texas Medical Branch at Galveston

Tips To Home Safety For The Older Adult

Most seniors prefer to live independently in their own homes for as long as possible, but unfortunately most houses are not designed to meet the needs of their aging owners. Falls are the number one safety risk for older adults. Nearly one third of America’s older adults fall each year with seventy percent of these falls occurring at home.

Seniors need to take extra safety precautions due to physical changes that occur as they get older. Occurrences during the normal aging process – declining vision, hearing, sense of touch, sense of smell or bone density – increase the risk of injury inside the home. Falling does not have to be an imminent part of aging and there are proven strategies that can help reduce them. During Home Safety Month My Health Care Manager’s focus is on tips to create a safe environment to prevent falls.

Ten Tips for Home Safety – Fall Prevention

– Remove all throw rugs; if can not live without throw rugs make sure they are secure with non-slip backing

– Install grab bars in bathroom especially in shower/tub

– Provide adequate lightening – especially around stairwells and pathways

– Keep flashlight by your bed

– Use a nightlight

– Keep pathways clear of objects especially electric cords

– Remove Clutter

– Make sure handrails on stairways are accessible and sturdy

– Check carpets for any tears and/or holes

– Review all medications, prescriptions, over the counter, herbs and vitamins with doctor and/or pharmacist to reduce risk of dizziness and weakness

Other areas for home safety for older adults is same as for others

– Make sure have a working smoke detector in each level of home

– Have a fire extinguisher on each floor

– If there is member in home using oxygen make sure there is an oxygen awareness sign and that no one smokes in area where there is oxygen

– Make sure there is a working carbon monoxide detector in each lever of home

– Telephone within easy reach and numbers large enough to see in hurry

– Have a disaster plan

– Have a fire evacuation plan

My Health Care Manager is a national company that helps seniors and their families manage the complexities of older adult life with unbiased professional guidance related to health and independence. For more information and advice, please visit www.myhealthcaremanager or call My Health Care Manager’s network of nurses at 1-800-499-8020.

Lichen Sclerosis: A New Epidemic?

ORLANDO, FL (UroToday) – Lichen sclerosis (LS) includes balanitis and xerotica obliterans. There is hyperkeratosis and sclerosis of the dermis with collagen deposition that leads to symptoms of skin irritation. It is much more common in women and also occurs in 10% of boys with phimosis. A larger study of boys more recently showed a 39% incidence with phimosis and circumcision cured almost all patients. In adults undergoing urethroplasty, 14% were found clinically, but in 82% by histology.

Etiology is unclear and may be bacterial, viral, trauma, hormonal changes or an autoimmune problem. A predominance of T cells in the specimens supports an autoimmune origin. 3-6% of women may go on to develop squamous cell carcinoma. Several studies support this link.

The treatment of penile LS includes circumcision, topical steroids, dilation and meatotomy. For urethral involvement reconstruction is often needed. Unobstructed voiding, painless intercourse and acceptable cosmesis are the goals of treatment. Topical steroids such as 0.05% clobetasol propionate are most commonly used. Topical estrogen, progesterone and testosterone have been proposed, but prospective studies do not support their use over steroids. External meatotomy is useful to mange distal urethral obstruction. However, longer strictures are complex to treat and buccal mucosal grafting is often needed. Split thickness skin grafts in addition to buccal mucosa are needed for long strictures.

There are 4 case reports of LS occurring in the mouths of patients who were grafted. Use of perineal urethrostomy is sometimes needed temporarily as well. If the patient is circumcised and has no stricture, topical steroids are prescribed. If not circumcised, that is performed. If a stricture is present, imaging and surgical correction is performed if urethral dilation and topical steroids are not successful. He concluded that LS is often under-diagnosed and good treatment is possible.

Presented by Andrew C. Peterson, MD, at the Annual Meeting of the American Urological Association (AUA) – May 17 – 22, 2008. Orange County Convention Center – Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
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Copyright © 2008 – UroToday

Fesoterodine Provides Significant And Rapid Improvement In Multiple Subgroups With Overactive Bladder

In most subpopulations of patients with overactive bladder (OAB), the percentage of patients who respond positively to treatment is significantly higher in those who receive fesoterodine 4 or 8 mg or tolterodine extended release (ER) versus those treated with placebo, investigators announced here at the 23rd Annual Meeting of the European Association of Urology (EAU).

Importantly, the response was seen as early as two weeks and was usually maintained at the end of the 12-week treatment period.

Andrea Tubaro, MD, with Sant Andrea Hospital in Rome, Italy, and colleagues elsewhere assessed the efficacy of fesoterodine as measured by self-reported treatment response rates at two and 12 weeks in all subjects with OAB drawn from a recent phase III trial and in subpopulations stratified by sex, age, and incontinence status.

In the phase III trial involving men and women who had frequency and urgency or urgency urinary incontinence for at least six months along with at least moderate bladder problems on a six-point Likert scale, fesoterodine was shown to be effective in improving OAB symptoms.

For the sub-analysis, Dr. Tubaro’s team stratified data by sex (889 women and 214 men), age (743 patients under 65 years of age and 360 patients 65 years of age or older), and incontinence status (247 continent and 856 incontinent patients).

Treatment response was derived from a four-point Treatment Benefit Scale, where patients rated their condition as having greatly improved, improved, not changed, or worsened during treatment.

Results showed that for all supopulations, the proportion of patients who reported a positive treatment response was significantly higher in those receiving fesoterodine 8 mg versus those receiving placebo. This was observed at two weeks, which was the time of the earliest measurement, and persisted throughout the trial in most subgroups.

For most subgroups, the percentage of subjects reporting a positive treatment response was also significantly higher at two and 12 weeks in the fesoterodine 4 mg and tolterodine ER groups compared the with the placebo group.

At the end of the trial, the percentage of men and incontinent subjects with a positive treatment response was significantly higher among those receiving fesoterodine 8 mg versus tolterodine ER.

Dr. Tubaro said that the results from this analysis of different subpopulations are in line with previously published data demonstrating that fesoterodine 4 and 8 mg improves the treatment response rate in OAB patients.

Fesoterodine is a new antimuscarinic agent that acts functionally as a prodrug. It is rapidly and extensively hydrolyzed by nonspecific esterases to 5-hydroxymethyl toleterodine, which is also the active metabolite of tolterodine.

Overactive bladder is a chronic condition that affects up to 17 percent of adults in the U.S. and Europe.

By Jill Stein
Jillstein03gmail