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The risk of placental separation during labor is three times higher than normal in pregnant women with antibodies that indicate early thyroid disease, a new study has found.

However, the findings don’t suggest that routinely screening pregnant women for thyroid problems or providing them with thyroid supplementation would offer any benefit, according to the researchers at the University of Texas Southwestern Medical Center in Dallas.

Thyroid peroxidase (TPO) is an enzyme that incorporates iodine into thyroid hormones. In some autoimmune diseases, the body creates antibodies against TPO. This leads to lower TPO levels and slower body metabolism. But when antibody levels are low, the thyroid may be able to compensate and produce normal amounts of thyroid hormones, the study authors explained in a news release from UT Southwestern Medical Center.

In the new study, the researchers analyzed levels of anti-TPO antibodies from 17,298 women before they reached 20 weeks of pregnancy and compared those levels with the mothers’ and babies’ health after birth.

Nearly 6 percent of the women had anti-TPO antibodies, but the rate varied according to ethnicity — 8.4 percent for whites, 6.1 percent for Hispanics and 2.6 percent for black women. The women with anti-TPO antibodies had normal levels of thyroid hormones, the study authors noted.

Rates of birth complications were the same for women with anti-TPO antibodies and those without the antibodies, with the exception of placental abruption. This is a rare but potentially fatal situation in which the placenta separates from the uterus too early. Placental abruption occurred in 1 percent of antibody-positive women and in 0.3 percent of antibody-negative women, the investigators found.

A mother’s antibody status had no effect on the health of her baby, the authors noted.

“Our work shows a link between anti-TPO antibodies and placental abruption, but that does not necessarily mean that thyroid supplementation would improve the health of the women or babies,” co-lead study author Dr. Brian Casey, a professor of obstetrics and gynecology, said in the news release.

The study is published in the August issue of Obstetrics & Gynecology.

An increasing number of elderly Americans are being admitted to long-term acute care hospitals after they’ve been treated for a critical illness, a new study has found.

Researchers analyzed Medicare data from 1997 to 2006. During that time, the number of long-term acute care hospitals doubled from 192 to 408, the percentage of Medicare patients who were transferred to a long-term acute care hospital after a critical illness tripled from 0.7 percent of patients to 2.5 percent of patients, total associated costs increased from $484 million to $1.325 billion, and the one-year survival for these patients was poor.

“Over time, transferred patients had higher numbers of [co-existing illnesses] [5.0 in 1997-2000 versus 5.8 in 2004-2006] and were more likely to receive mechanical ventilation at the long-term acute care hospital [16.4 percent in 1997-2000 vs. 29.8 percent in 2004-2006],” wrote study author Dr. Jeremy M. Kahn, of the University of Pennsylvania in Philadelphia, and colleagues.

The rates of death within one year of long-term acute care hospital admission were high throughout the entire study period: 50.7 percent in 1997-2000 and 52.2 percent in 2004-2006, the authors pointed out.

“The clinical and economic burden of patients with chronic critical illness is significant and likely to expand with the aging of the population and advances in critical care that increase patient survival. Long-term outcomes of the chronically critically ill are poor, with substantial need for new approaches to their care. We demonstrate that long-term acute care hospitals play an increasingly important role in patients with chronic critical illness, despite scant data to guide decision making about transfer or inform policy decisions about whether to support or restrict this rapidly growing cost center,” Kahn and colleagues wrote in the June 9 issue of the Journal of the American Medical Association.

“Our results underscore the capability of the medical system to adopt new organizational innovations and highlight the need for a diverse program of comparative effectiveness research to determine the optimal organization of care for patients recovering from critical illness, including the best way to maximize survival and control costs for this high-risk patient group,” the researchers concluded.

Researchers report that only about a quarter of people who have strokes caused by blocked arteries arrive at a hospital within one hour of the attack — the “golden hour” where treatment with a powerful clot-dissolving drug is expected to work best.

The report also notes that only one in four of patients who do arrive within an hour go on to get the potentially lifesaving therapy, called tissue plasminogen activator (tPA).

Overall, there is a “modestly improving trend” in time of arrival at hospitals of patients with ischemic stroke, the most common form, said study author Dr. Jeffrey L. Saver, director of the Stroke Center at the University of California, Los Angeles.

His team’s report uses data from nearly 107,000 stroke patients treated between 2003 and 2007 at 905 hospitals participating in the American Stroke Association’s “Get With the GuidelinesStroke” program.

Ischemic stroke, where a clot blocks an artery, can be treated by injecting tPA, which can quickly dissolve the blockage. Restoring blood flow quickly is key to limiting stroke damage.

Current guidelines direct that tPA be given for up to 4.5 hours after a stroke occurs, but it is best used during the first three hours.

Time of arrival is a key to getting that treatment within that window, the study shows. While one in four patients arriving in the “golden hour” got tPA, only one in eight arriving one to three hours after stroke onset got the drug, and virtually none arriving later than that got the treatment.

Why do so many patients not receive tPA, even if they arrive at the hospital relatively soon? According to Saver, there are a number of necessary steps that have to be gone through before the treatment can be given. “A stroke physician must examine the patient to determine that a stroke has occurred, a brain scan must be done to determine whether it is an ischemic stroke, blood tests must be done to be sure than tPA therapy will be safe, a medical history must be done and informed consent obtained,” he said.

Several measures are being taken to speed that evaluation process, Saver said. One is to have paramedics in the ambulance call ahead to alert the hospital about the probable need for stroke treatment.

Another effort is aimed at raising public awareness of stroke symptoms and what should be done when they occur, said Dr. Ralph S. Sacco, chairman of neurology at the University of Miami Miller School of Medicine, and president-elect of the American Heart Association.

The association’s public education program stresses the recognition of stroke symptoms, such as a sudden loss of vision, sudden speech problems, sudden severe dizziness and sudden severe headache.

“We currently tell the public to call 911 when these happen, because ‘time is brain’ and every delay in getting to the closest stroke center reduces the chance of improvement,” Sacco said.

Callers should wait for the paramedics to arrive rather than heading to the hospital themselves, Sacco said. “Studies have shown that those who are brought to the hospital by the family do not get triaged as rapidly for stroke as those who arrive by ambulance,” he said.

Triage is the determination of the problem that brought the patient to the hospital, and prioritizing the patient in relation to others waiting for care.

A truly critical moment — recognizing that this is a stroke — occurs in the moments before a 911 call is made, Sacco said.

“Lack of awareness of the warning signs of stroke is the single greatest reason why people do not get treatment in time,” he said.

SOURCES: Jeffrey L. Saver, M.D., professor, neurology, and director, Stroke Center, University of California, Los Angeles; Ralph S. Sacco, M.D., professor and chairman, neurology, University of Miami Miller School of Medicine, and president-elect, American Heart Association.

Variants of a gene called CBLB are associated with multiple sclerosis in humans, a new study finds.

Previous research found that variants of CBLB, which is normally responsible for moderating immune response, influenced MS risk in mice.

In this new study, an international research team analyzed the genomes of MS patients on the Italian island of Sardinia, which has a high incidence of MS and other autoimmune diseases in which the immune system attacks healthy cells.

The study is published in the May 9 issue of Nature Genetics.

Along with the finding about the association between CBLB gene variants and MS, the researchers also confirmed that six genes previously identified as being associated with MS risk in other populations also contribute to the risk of the disease in Sardinians.

People on Sardinia are often used for gene-association studies because of their relative genetic similarity. The initial group of people that settled there more than 8,000 years ago has grown to the modern population of 1.5 million, with few people moving to the island in the interim.

SOURCE: U.S. National Institute of Aging, news release.

People who are uninsured or who are on Medicaid are much less likely to receive adequate care for their migraines than people who have private coverage.

In fact, more than 5.5 million Americans may be at risk of receiving inadequate care for their migraines because of their insurance status, a new study suggests.

“Left untreated or undertreated, as a result of being uninsured, will cause millions of Americans with migraine to suffer needlessly and place them at greater risk for developing more frequent migraine headaches,” said Dr. Brian M. Grosberg, director of the Inpatient Headache Program at Montefiore Medical Center and assistant professor of neurology at Albert Einstein College of Medicine in New York City. He was not involved in the study.

The lag in care may stem from the fact that the uninsured tend to seek care at hospital emergency rooms rather than a doctors’ office, according to findings published in the April 13 issue of Neurology.

“This study is really about the need to improve the healthcare system so everybody has access to a physician in an office so they don’t have to go to an emergency department — where we know they’re not going to get the best treatment,” added the study’s senior author, Dr. Rachel Nardin, chair of neurology at Cambridge Health Alliance and assistant professor of neurology at Harvard Medical School in Boston.

“It’s a sad situation because we actually have pretty good treatments that can help a lot of people, but what we don’t have is a functioning healthcare system that allows us to get treatment to people who need it,” continued Nardin, who is also chair of the Massachusetts chapter of Physicians for a National Health Program.

According to background information in the article, some 18 percent of women and 6 percent of men suffer from migraines.

“Migraines are a whole-system disease. People with migraines are really out of commission,” Nardin said. “They have to lie down and sleep for several hours. People with migraines lose an average of four days of work a year, and that doesn’t include the toll it takes on them as productive members of their family or church.”

Meanwhile, more than 45 million Americans have no health insurance at all, and an additional 58 million are underinsured, according to the latest federal data from the National Center for Health Statistics.

In the study, researchers looked at results from two surveys on visits to doctors’ offices, hospital outpatient visits and trips to the emergency room over a period of 11 years.

They estimated a total of 68.6 million such visits nationally during that time period for migraine complaints.

People with no insurance were twice as likely to receive inadequate therapy, either to treat or prevent migraines, as those with private coverage. Those with Medicaid were 50 percent more likely.

If migraine care was received in an emergency room, uninsured and Medicaid patients were almost five times more likely to receive inadequate care for their migraine.

“Migraine can be treated very effectively in a physician’s office,” Nardin said. “We all suffer when people need to use the emergency room because it then becomes less available for true emergencies. Migraines are a great example of where the system is not set up to get the right care in the right place at the right time. If we could do that, we would all benefit.”

SOURCES: Rachel Nardin, M.D., chair, division of neurology, Cambridge Health Alliance, assistant professor, neurology, Harvard Medical School, Boston, and chair, Massachusetts chapter, Physicians for a National Health Program; Brian M. Grosberg, M.D., assistant professor, neurology, Albert Einstein College of Medicine and director, Inpatient Headache Program, Montefiore Headache Center, New York City;

Patients who get a total knee replacement are usually advised to avoid high-impact sports to preserve their new body part. But a new study suggests sport participation is not only safe — it may even help people gain better knee function.

”Initially, we though high-impact sports were terrible for the prosthesis,” said Dr. Sebastien Parratte, a research collaborator at the Mayo Clinic in Rochester, Minn., and an assistant professor at the Aix-Marseille University Center for Arthritis Surgery at Hospital Sainte-Marguerite in Marseille, France.

“Our eight-year results have shown it is not the case,” he said.

He is the lead author of the study, scheduled for presentation Friday at the annual meeting of the American Academy of Orthopaedic Surgeons in New Orleans.

More than a half million total knee replacements are performed annually in the United States, according to the American Academy of Orthopaedic Surgeons. Parratte and his colleagues conducted the study knowing that patients routinely ignore their doctor’s advice to take it easy after receiving a knee replacement. In fact, about one of six patients engage in high-impact activities post-implantation, experts say.

Parratte’s team followed 535 patients in all. A total of 218 underwent knee replacement and then performed heavy manual labor or engaged in a non-recommended sport, such as high-impact aerobics, football, soccer, baseball, jogging or power lifting. The control group of 317 patients had knee replacement but did not engage in sports that were not recommended.

The researchers evaluated the patients clinically and with X-rays. About eight years after surgery, they found no significant radiological differences and no significant differences in the implant durability between groups.

In fact, the sport group had slightly higher knee function scores than the control group.

A first comparison found that the control group had a 20 percent higher need to repeat the operation because of mechanical failure of the knee (from wear, fracture or loosening) compared to the sport group. But when they took into account other health problems such as obesity or diabetes, the sport group had a 10 percent higher risk of mechanical failure compared to the control group, but the difference wasn’t statistically significant.

”The control group was more likely to have high blood pressure, obesity and diabetes,” Parratte added.

He said he doesn’t know why the sport group’s knees held up better.

Still, the study findings are no reason to tell patients with knee replacements to exercise in a high-impact way, said Dr. Christian Christensen, an orthopedic surgeon and head of adult reconstruction at the Lexington Clinic in Lexington, Ky.

“I think it’s a good study and certainly a worthwhile one,” he said. “Would it encourage me to tell my patients to play football? No way.”

More research is needed to evaluate what’s happening, he said. It’s possible that the people with the best results may be the ones engaging in high-impact sports. “People with the knees that feel great, who have excellent results,” are perhaps the ones who can engage in the high-impact sports without ill effect, he said.

Another possibility, he said, is that the follow-up may just not be long enough, that ill effects may show up later. Christensen said he’ll continue to tell his knee-replacement patients to avoid high-impact sports. “Implants aren’t meant to tolerate high-impact sports,” he said.

Dr. Benjamin Bengs, another expert, called the new study findings promising. It shows these devices are long-lasting, can lead to lifelong pain relief and excellent functioning and activity in patients, said Bengs, an orthopedic surgeon at Santa Monica-University of California Medical Center and Orthopaedic Hospital.

But more time and study are needed before we completely release people to all high-impact activities, he said.

”One study is not enough to change the recommendations,” Parratte agreed. He plans to study the topic further.

Higher levels of obesity and inactivity, especially among women, explain why arthritis is more common in the United States than in Canada, according to a new study.

Researchers at the Toronto Western Research Institute analyzed 2002-03 data from both countries and found that the prevalence of arthritis in the United States was 18.7 percent and the prevalence of arthritis-attributable activity limitations (AAL) was 9.6 percent. In Canada, the rates were 16.8 percent and 7.7 percent, respectively.

Women in the United States had a higher prevalence of arthritis (23.3 percent) and AAL (13 percent) than Canadian women (19.6 percent and 9.2 percent, respectively). Men in both countries had similar rates of arthritis (14 percent) and AAL (6 percent).

“Our study results suggest that the higher prevalence of arthritis and AAL in the U.S. may be a consequence of greater obesity and physical inactivity in that country, particularly in women,” study lead author Elizabeth Badley said in a news release.

“Public health initiatives that promote healthy weight and physical activity may benefit from including arthritis concerns to its message, and could potentially reduce the incidence of arthritis and AAL,” she concluded.

The study appears in the March issue of the journal Arthritis Care & Research.

SOURCE: Arthritis Care & Research