(HealthDay News) -- Sedative drugs called benzodiazepines (such as Valium) don't increase the risk of hip fractures in the elderly, a Harvard Medical School study says.
The finding suggests that U.S. federal and state policies that restrict access to these drugs among the elderly need to be re-examined, the study authors added. Their work is published in the Jan. 16 issue of the Annals of Internal Medicine.
Concerns about misuse and the adverse effects of benzodiazepines have led to federal and state laws that regulate access to the drugs. For example, since 2006, benzodiazepines have been excluded from coverage through the Medicare Part D benefit, according to background information in a news release.
Hip fractures often lead to disability and death in older people.
In this study, researchers examined hip fracture rates among more than 90,000 Medicaid recipients aged 65 and older before and after the state of New York implemented tight controls on benzodiazepine prescriptions in 1989. The researchers also looked at hip fracture rates in New Jersey, which did not put restrictions on benzodiazepine prescriptions.
The New York policy resulted in an immediate 60 percent drop in benzodiazepine use among elderly women and a 58 percent decline among men. But there was little change in the incidence of hip fractures.
"The policy drastically decreased use of benzodiazepines in New York, and we did not see any decline in hip fracture rates compared to New Jersey; in fact, we seem to see an increase in New York over New Jersey," study author Anita Wagner, an assistant professor of ambulatory care and prevention at Harvard Medical School, said in a prepared statement.
She said biases in previous studies may have led researchers to make a link between benzodiazepines and hip fractures.
"It is very challenging to answer the question whether or not benzodiazepines cause hip fractures. People who get benzodiazepines, such as chronically ill elderly patients with dementia, have conditions, like dementia, that can cause hip fractures -- and their hip fractures may not be due to their benzodiazepines," Wagner said.
More information
The U.S. National Library of Medicine has more about benzodiazepines.
Selasa, 16 Januari 2007
Combining Heart and Stroke-Prevention Surgeries Raises Death Risk
(HealthDay News) -- Combining heart-bypass surgery with surgery to prevent stroke increases the risk that a patient will die or suffer a post-operative stroke, a new study has found.
"This means that the benefit of combining the two-in-one operation or one hospital stay hasn't been proven," said study lead author Dr. Richard M. Dubinsky, associate professor of neurology at the University of Kansas Medical Center in Kansas City. "This is something that would be worthy of a randomized controlled trial."
Heart-bypass surgery reroutes blood flow around clogged arteries, while carotid endarterectomy, the most commonly used stroke-prevention surgery, removes plaque in the carotid arteries, which supply blood to the brain, the study authors said.
The idea behind combining the procedures is to protect the carotid artery from becoming blocked during the heart-bypass surgery and to reduce the overall risk by having just one surgery.
But while the frequency of combined surgery has increased, evidence of any real benefit is unclear.
According to the American Academy of Neurology, about 700,000 people have a stroke each year. Some 80 percent of these are due to a blood vessel being blocked.
For this study, published in the Jan. 16 issue of Neurology, the researchers reviewed hospital discharge data on almost 658,000 patients from the Nationwide Inpatient Sample, all of whom were admitted to U.S. hospitals for carotid endarterectomy or coronary bypass artery surgery from 1993 to 2002.
Because of limitations of the database, some of the patients may have had the procedures a few days apart, while others had both at the same time. For the purposes of this study, however, all were grouped together.
Patients who combined the two procedures had a 38 percent greater chance of death or postoperative stroke than patients who underwent coronary artery bypass surgery alone, the study found.
However, one problem with the study is that the authors weren't able to compensate for disease severity. "The excess of mortality may just be that they're sicker," Dubinsky said.
Women had a lower risk of postoperative death or stroke than men, the researchers noted. This is the first study to show this, the team said.
A second study in the same issue of Neurology found that fewer elderly people are undergoing carotid endarterectomy for the wrong reasons. This apparently is the result of publication of randomized controlled trials that concluded that about one-third of these surgeries were unnecessary.
"Fewer patients are undergoing stroke prevention surgery for the wrong reasons and this can be viewed as a success of evidence-based medicine and public investment in rigorous evaluation of surgical procedures," said Dr. Ethan Halm, lead author of the study and associate professor of medicine and health policy at the Mount Sinai School of Medicine in New York City.
Only 8.6 percent of procedures were deemed unnecessary, the study found. That's still a large number, however -- 11,500 in the United States annually, the study concluded.
Still, more patients without symptoms are undergoing the operation. "That's a concern because asymptomatic patients have less to gain from the surgery," Halm said.
More information
The American Heart Association has more on carotid endarterectomy.
"This means that the benefit of combining the two-in-one operation or one hospital stay hasn't been proven," said study lead author Dr. Richard M. Dubinsky, associate professor of neurology at the University of Kansas Medical Center in Kansas City. "This is something that would be worthy of a randomized controlled trial."
Heart-bypass surgery reroutes blood flow around clogged arteries, while carotid endarterectomy, the most commonly used stroke-prevention surgery, removes plaque in the carotid arteries, which supply blood to the brain, the study authors said.
The idea behind combining the procedures is to protect the carotid artery from becoming blocked during the heart-bypass surgery and to reduce the overall risk by having just one surgery.
But while the frequency of combined surgery has increased, evidence of any real benefit is unclear.
According to the American Academy of Neurology, about 700,000 people have a stroke each year. Some 80 percent of these are due to a blood vessel being blocked.
For this study, published in the Jan. 16 issue of Neurology, the researchers reviewed hospital discharge data on almost 658,000 patients from the Nationwide Inpatient Sample, all of whom were admitted to U.S. hospitals for carotid endarterectomy or coronary bypass artery surgery from 1993 to 2002.
Because of limitations of the database, some of the patients may have had the procedures a few days apart, while others had both at the same time. For the purposes of this study, however, all were grouped together.
Patients who combined the two procedures had a 38 percent greater chance of death or postoperative stroke than patients who underwent coronary artery bypass surgery alone, the study found.
However, one problem with the study is that the authors weren't able to compensate for disease severity. "The excess of mortality may just be that they're sicker," Dubinsky said.
Women had a lower risk of postoperative death or stroke than men, the researchers noted. This is the first study to show this, the team said.
A second study in the same issue of Neurology found that fewer elderly people are undergoing carotid endarterectomy for the wrong reasons. This apparently is the result of publication of randomized controlled trials that concluded that about one-third of these surgeries were unnecessary.
"Fewer patients are undergoing stroke prevention surgery for the wrong reasons and this can be viewed as a success of evidence-based medicine and public investment in rigorous evaluation of surgical procedures," said Dr. Ethan Halm, lead author of the study and associate professor of medicine and health policy at the Mount Sinai School of Medicine in New York City.
Only 8.6 percent of procedures were deemed unnecessary, the study found. That's still a large number, however -- 11,500 in the United States annually, the study concluded.
Still, more patients without symptoms are undergoing the operation. "That's a concern because asymptomatic patients have less to gain from the surgery," Halm said.
More information
The American Heart Association has more on carotid endarterectomy.
What does B12 do?
B vitamins help support adrenal function, help calm and maintain a healthy nervous system, and are needed for key metabolic processes. Vitamin B12, also known as cyanocobalamin, is necessary for DNA synthesis and affects the development of red blood cells, normal myelination (covering) of nerve cells, and the production of neurotransmitters.
Deficiencies of B12 can lead to memory loss, confusion, fatigue, and even dementia.
Animal-derived foods, including dairy, eggs, meat, fish and poultry are the only natural sources of B12, so this important vitamin is often deficient in vegan diets. Good sources are clams, herring, cooked oysters and wild Alaskan salmon.
To help meet daily needs, Dr. Weil recommends a B-complex supplement that contains a full spectrum of B vitamins, including thiamine, B12, riboflavin and niacin.
more info at: http://www.dreddyclinic.com/vitamins/Choline.htm
Deficiencies of B12 can lead to memory loss, confusion, fatigue, and even dementia.
Animal-derived foods, including dairy, eggs, meat, fish and poultry are the only natural sources of B12, so this important vitamin is often deficient in vegan diets. Good sources are clams, herring, cooked oysters and wild Alaskan salmon.
To help meet daily needs, Dr. Weil recommends a B-complex supplement that contains a full spectrum of B vitamins, including thiamine, B12, riboflavin and niacin.
more info at: http://www.dreddyclinic.com/vitamins/Choline.htm
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