Medical News

Many people who have died from 2009 H1N1 influenza in the United States had co-infections with a common bacteria (Streptococcus pneumoniae, or pneumococcus) which likely contributed to their death, according to a report published in the Centers for Disease Control and Prevention′s (CDC) Morbidity and Mortality Weekly Report. CDC is reminding people of the importance of being vaccinated against this common bacterium.

“Our influenza season is off to a fast start and unfortunately there will be more cases of bacterial infections in people suffering from influenza,” said CDC Epidemiologist Dr. Matthew Moore. “It′s really important for people, especially those at high risk for the serious complications from influenza, to check with their provider when they get their influenza vaccine about being vaccinated against pneumococcus.”

The CDC report included an analysis of specimens taken from 77 fatal cases of 2009 H1N1. Bacterial co–infections, including some caused by Streptococcus pneumonia, were noted in about a third of those cases. CDC′s recommendations for vaccination against Streptococcus pneumonia are listed below.

• All children <5 years of age should receive pneumococcal conjugate vaccine according to current recommendations (http://www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm).
• In addition, the 23–valent pneumococcal polysaccharide vaccine (PPSV23) should be administered to all persons 2-64 years with high risk conditions and everyone 65 years and older (http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm).

Fewer women in the United States are dying from breast cancer, but disparities in death rates still exist between whites and blacks, a new report shows.

Deaths from breast cancer have dropped more than 2 percent each year since 1990. And in the past decade that decline in deaths has been shared by black, Hispanic and white women. But black women still have a 40 percent higher death rate from breast cancer than white women, according to the report, Breast Cancer Facts & Figures 2009-2010, released Wednesday by the American Cancer Society.

“The breast cancer death rate continues to decrease since the 1990s in U.S. women because of improved treatments and increased mammography screening rates,” said Dr. Ahmedin Jemal, strategic director for cancer surveillance at the American Cancer Society.

The death rate from breast cancer peaked in 1989, Jemal said. “The most recent data from 2006 shows the breast cancer death rates have dropped nearly 30 percent,” he said. “That’s very good news.”

When this data is translated into the number of women with breast cancer who did not die, some 130,000 lives were saved, he noted.

Jemal said the decline in breast cancer deaths could be accelerated with more targeted treatment, more access to mammography, and more treatment for the poor and the uninsured.

Among uninsured women, only 30 percent had a mammogram during the past two years, compared with about 70 percent of insured women, he said.

All women should have regular screening for breast cancer, Jemal said. “If breast cancer is caught early, the five-year survival rate is 98 percent, but if you catch it late the survival rate is only 24 percent,” he added.

Another way to lower the risk of death from breast cancer is to promote prevention, Jemal said. This includes maintaining a healthy body weight, keeping fit through exercise, and limiting alcohol consumption, he said.

Dr. Harold J. Burstein, of the Dana-Farber Cancer Institute in Boston and an assistant professor of medicine at Harvard Medical School, said, “We are making real progress against breast cancer.”

“Sometimes there is a lot of nihilism. People worry that we are not winning the war on cancer,” he said. “In this particular battle, we are clearly winning. It is slow, hard progress, but we are winning.”

“We are not winning because we have a new secret weapon,” Burstein added. “We are winning because we have a better infrastructure, because we have educated patients and doctors, because we do have new tools becoming available, because we have new insights into the biology of the cancer — all those things are making a difference.”

Other highlights of the report include:
In 2009, some 192,370 American women will be diagnosed with breast cancer, accounting for more than one in four cancers diagnosed.
In 2009, an estimated 40,170 women will die from breast cancer; only lung cancer kills more women.
Data from 2006 — the most recent statistics available — showed that about 2.5 million American women have a history of breast cancer. Most of these women were cancer-free. Others were still undergoing treatment.
From 2002 to 2003, there was sharp decline in breast cancer rates, particularly for women aged 50 to 69. This reflects the drop in hormone replacement therapy by menopausal and postmenopausal women that began in 2002. Breast cancer rates have remained about the same since 2003.
Since 1990, breast cancer death rates have dropped steadily. The decline has been greater among women under 50 (3.2 percent per year) than among women over 50 (2 percent per year).
From 1997 to 2006, breast cancer deaths dropped by 1.9 percent a year among white and Hispanic women, 1.6 percent a year among black women, and 0.6 percent annually among Asian-American and Pacific Islander women. Death rates have stayed the same for American Indians and Alaska Natives.

Mangat said that when players reach the NFL — where safety is taken more seriously because of the money involved — brain damage may already have occurred. “There should be regular neuropsychological testing prior to joining a college team or a professional team to be able to ‘red flag’ someone who starts to show some decline,” he said.

The University of Michigan study wasn’t limited to mental health. According to the authors, the survey found “retired players to be in very good stead, overall. They are satisfied with life and deeply connected within their social networks and communities. Their history of physical fitness [including low rates of smoking and high levels of physical activity] shows up in lower rates of diabetes and cardiovascular disease. On most other health problems, they are similar to or healthier than the general population. However, they do have much higher rates of arthritis and reported pain and mobility problems than the general population.”

The NFL released this statement about the survey on Wednesday: “The primary purpose was to get a better look at the overall condition of retired players, and identify specific areas where we can further address their needs. The survey found that playing in the NFL was a very positive experience for most retired players, and that overall they are in very good physical and financial condition.”

The statement also responded to the dementia finding: “The survey makes no link between concussions and memory disorders. Concussion as one of many potential factors in memory disorders is being studied throughout the medical community, including our own study on the long-term effects of concussions on retired players. Meanwhile, our focus is also on the proper prevention and treatment of concussions in today’s game. We do this through rules changes and enforcement; education of players, their families, coaches and team personnel; and ensuring that our players have the best medical care available. Our medical staffs take a cautious and conservative approach to managing concussions, including expanded use of neuropsychological testing and return-to-play guidelines.”

Dr. Daniel P. Perl, director of neuropathology at the Mount Sinai School of Medicine in New York City, told the Times that he considered the new survey significant. “I think this complements what others have found — there appears to be a problem with cognition in a group of NFL football players at a relatively young age,” he said.

Greg Aiello, a spokesman for the National Football League, said the numbers of former players reporting dementia “aren’t large in terms of the overall population.”

Aiello also said that a phone survey “is not necessarily reliable. It’s self-reporting and in the case of some, the wife was answering, because the guy wasn’t in great shape.”

“It warrants further research, and that’s what we are doing and what we will continue to do,” he said, adding, “We have done everything to reduce and properly manage concussion with our players, from rule changes to guidelines on how to manage concussions. It’s not like we’re minimizing anything here.”

Sean Morey, an Arizona Cardinals player who has pushed for research into brain injuries, told the Times: “This is about more than us — it’s about the high school kid in 2011 who might not die on the field because he ignored the risks of concussions.”

Dr. Halinder S. Mangat, an assistant professor of clinical neurology at the University of Miami’s Miller School of Medicine, said: “There are studies in children, which show that at a young age, if you have a concussion or repeated concussion, when they grow up they do have some cognitive impairment.”

“This applies to football players,” Mangat said, “because the first time they have contact is not when they come into the NFL. It’s a career track, so players started playing when they were very young,” he said, adding that concussions have a cumulative effect on the brain.

Another expert noted the dangers of concussion might be more marked in younger players.

“One of the concerns is, ‘Are concussions in kids that same as they are in adults,’ ” said Dr. Christopher Giza, an associate professor of pediatric neurology at the University of California, Los Angeles. “It has the potential to be a significant problem. It seems that younger brains might be more sensitive to these kind of injuries.”

Giza said it takes a week to 10 days to recover from a concussion. “If you give an appropriate amount of time for the brain to return to normal, there may not be a long-term consequence — the long-term consequence may be minimized,” he said. “But, if you have second or third injuries before the brain is fully recovered, perhaps the risk for a cumulative problem is amplified.”

Giza advises parents and coaches that a concussion can occur even if the child did not lose consciousness. Even if there is any temporary clouding of consciousness, there may be a concussion, he said.

“If the individual is still symptomatic, headache, dizziness, confusion, nausea, unsteadiness, they should not return to play,” Giza said. When the symptoms disappear they can talk with their coach or trainer about returning to sports, which is not the day the symptoms disappear.

Former professional football players suffer from Alzheimer’s disease or other memory-related conditions at rates far higher than the general population, a new study commissioned by the National Football League shows.

And retired players between the ages of 30 and 49 are 19 times more likely to struggle with memory problems than similarly aged men who never played professional football, the study found.

The findings could have implications that reach far beyond the National Football League, which has said in the past that there’s no reliable research to establish the proof of cognitive problems among former players.

Head injuries are not uncommon among college and high school players. University of Florida star quarterback Tim Tebow, the best collegiate player in the nation last year, suffered a head injury during a game on Saturday that briefly left him unconscious on the field. He continued to undergo post-concussion tests Tuesday.

And a study published last year in The American Journal of Sports Medicine examined severe head injuries among high school football players between 1989 and 2002. The researchers found that high school players had more than triple the risk of sustaining catastrophic head trauma compared to college players. High school athletes suffered 0.67 such injuries per 100,000 players, compared with 0.21 injuries per 100,000 college players.

The new study of former pro players has not been peer-reviewed, but the results mirror several other recent studies suggesting a link between dementia and head injuries. The results of the study, conducted by the University of Michigan’s Institute for Social Research, were first reported Wednesday by The New York Times.

“Single incidents of concussion or head injury with loss of consciousness is a fairly well-established risk factor for subsequent Alzheimer’s disease that shows up in big epidemiological projects,” said Greg Cole, a professor of medicine and neurology at the University of California, Los Angeles David Geffen School of Medicine.

“Typically, head injury is found to roughly double the risk for developing dementia,” added Cole, who’s also associate director of the Mary S. Easton Center for Alzheimer’s Disease Research. “But if victims also have the most common genetic risk factor [ApoE4], present in about 20 percent of the population and which similarly increases risk by itself, the combined risk is much higher, around tenfold or more. Animal model studies show this relationship is probably causal because head injury can really speed Alzheimer’s pathology. All of this makes it pretty clear to experts studying AD [Alzheimer's disease] that in individuals with some preexisting genetic risk for Alzheimer’s, repeated head injury should be expected to make dementia much more likely.”

For the NFL survey, the Michigan researchers contacted 1,063 retired players by phone late last year. The players, who had to have played at least three seasons to qualify for the survey, were asked a series of questions on a series of topics, including questions on health, financial well-being and satisfaction with life. Most of the questions came from the standard National Health Interview Survey. That way, answers could be compared to previously collected data from the general population. In some cases, a player’s wife answered the questions.

The Michigan researchers found that, among players aged 50 and older, 6.1 percent of them said they had received a dementia-related diagnosis — five times higher than the national average of 1.2 percent.

Players between the ages of 30 and 49 had a dementia-related diagnosis rate of 1.9 percent — 19 times higher than the national average of 0.1 percent, according to the survey.

The study authors acknowledged that phone surveys aren’t a foolproof scientific method to determine rates of diagnosed dementia.