Kids Playing With Laser Pointers May Be Aiming for Eye Trouble
Teen boy damages retina with Internet-purchased 'toy,' doctors say
 

A 15-year-old Swiss boy attempted to create his own laser show using a laser pointer he bought on the Internet and a mirror. Instead, he inadvertently beamed the laser into his eyes, creating permanent damage to his vision.

"These high-power laser products are very dangerous," said Dr. Martin Schmid, head of the retina unit in the department of ophthalmology at Lucerne Cantonal Hospital in Switzerland. Schmid is also one of the authors of the case report detailing the young boy's eye damage in a letter in the Sept. 9 issue of the New England Journal of Medicine.

Schmid said that part of the problem is that not all laser pointers are labeled properly, so it's not always easy to know if you have a pointer that could create serious damage. One sure way to know if you have a potentially dangerous laser pointer is if the laser can burn through paper, explained Schmid.

"Every laser pointer which is capable of burning holes into paper or of lighting matches or of popping balloons is highly dangerous for the eye and must not be used by non-professionals," he cautioned.

Those are exactly some of the uses the Swiss youngster was planning for his laser pointer. He told doctors that he purchased the laser pointer so that he could pop balloons from a distance, burn holes in paper cards and burn holes in his sister's sneakers.

While he was attempting his "laser light show," the teen said that the laser beam hit his eyes several times. Although he immediately noticed that his vision was blurry, he was afraid to tell his parents what had happened. He waited two weeks before letting them know that he was still experiencing blurred vision.

The vision in his left eye was so damaged that he couldn't count how many fingers a doctor was holding up until they were just three feet away. His visual acuity in his right eye was 20/50.

Schmid said the boy wasn't sure if the laser was dangerous, and he definitely didn't know it could cause immediate eye injury.

When the teenager's eyes were examined, doctors discovered that there had been significant internal bleeding in the left eye and that there were several small scars in the right eye. Even with treatment, there's still a scar that diminished the boy's vision in his left eye. However, his visual acuity has returned to near normal, according to the report.

The laser used by the boy produced an output of 150 milliwatts (mW), far above the maximal output of 5 mW that's expected from a laser pointer sold to the public. The authors point out that it's possible to purchase laser pointers as strong as 700 mW, although such a device may not look any different than a lower-powered device.

Additionally, Schmid said there are instructions available over the Internet for turning low-power devices into high-powered ones.

And, the authors pointed out, high-powered laser pointers can produce immediate and severe retinal injury -- so severe that even blindness can occur.

Dr. Roy Chuck, chair of ophthalmology and visual sciences at Montefiore Medical Center and the Albert Einstein College of Medicine in New York City, said, "We've seen lots of cases of laser burns, usually from researchers giving presentations, but now we're seeing more cases of people ordering these products over the Internet, though eye injuries in lay people are still pretty rare."

Chuck said that children shouldn't have access to laser pointers. "They're not giving presentations, so why would they need to have them?" He said that when it comes to laser toys -- like those used for laser tag -- buying a well-known name brand may be helpful in this case. "When you're buying off the Internet, it's not as regulated and you just can't tell what the strength of the laser is," noted Chuck.

Schmid added that lasers used in toys will generally be labeled as Class 1, although he said that products aren't always labeled properly.

And, even if you've purchased a "safe" laser toy, it's possible that creative children may turn to the Internet and figure out ways to boost the power of the laser. "By searching YouTube for 'burning laser pointers,' you will find a huge amount of videos showing such dangerous experiments. Moreover, there is an increasing number of homepages and videos demonstrating how to turn legal low-power lasers into burning, high-power lasers," said Schmid.

Dementia Warning Signs Identified in Type 2 Diabetics: Study

High blood pressure, slow gait, self-reported bad health might signal decline, researchers say

Three factors linked to cognitive deficits in older adults with type 2 diabetes have been identified in a new study.
Canadian researchers looked at 41 adults, ageds 55 to 81, with type 2 diabetes and found that those who had high blood pressure, walked slowly or had balance problems, or believed they were in bad health were much more likely to have poorer memory and slower, more rigid cognitive processing than those without these three problems.
The study appears in the September issue of the journal Neuropsychology.
While these factors may not actually cause cognitive deficits, their presence could alert doctors that such problems may exist or soon develop, the researchers said.
"Awareness of the link between diabetes and cognition could help people realize how important it is to manage this disease -- and to motivate them to do so," study co-author Roger Dixon, of the University of Alberta, said in an American Psychological Association news release.
Previous research has shown that type 2 diabetes nearly doubles the risk of dementia and Alzheimer's disease. Increasing rates of diabetes among older people in Western nations could lead to a dramatic increase in the number of people with dementia, Dixon noted.
In the United States, 23 percent of people older than 60 have diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Statins May Guard Against Rheumatoid Arthritis
Study showed only an association between the two, expert notes

Statins, lauded for their ability to lower cholesterol and prevent heart attacks and strokes, may also reduce the risk of developing rheumatoid arthritis, Israeli researchers report.

"We found that statin users who purchased their medication persistently were less likely to develop rheumatoid arthritis over a long follow-up period," said lead researcher Gabriel Chodick, from Maccabi Healthcare Services in Tel Aviv.

For example, compared with patients who took statins less than 20 percent of the time, patients who took statins for 40 percent to 59 percent of the time had a 23 percent lower risk of developing rheumatoid arthritis, he said.

"Patients who were covered for more than 80 percent of the time, had a 40 percent lower risk of developing rheumatoid arthritis," Chodick said. "The effect was stronger in younger patients and in patients using more effective statins."

The report was published online Sept. 7 in PLoS Medicine.

For the study, Chodick's team collected data on 1.8 million patients who got their health care through the Maccabi Healthcare Services, an HMO in Israel.

The researchers looked for connections between statin use and the development of both rheumatoid arthritis and osteoarthritis, a degenerative joint disease that is unlikely to be affected by statins, the researchers noted.

Over nine years of follow-up, 2,578 people developed rheumatoid arthritis and 17,878 developed osteoarthritis.

When Chodick's group looked at statin use, they found that those not taking statins had a 51 percent higher risk of developing rheumatoid arthritis over about 80 percent of the follow-up period.

After looking for other possibilities, those who took statins regularly had a 41 percent lower risk of developing rheumatoid arthritis compared with people who were not taking statins regularly.

Among those taking statins, there was only a small, short-term reduction in risk of development of osteoarthritis.

"Although the study does not have immediate clinical implications, our findings may suggest that patients who were prescribed statins and take it persistently may benefit from the many effects of statins, which go far beyond cholesterol reduction, including the reduction of rheumatoid arthritis risk," Chodick said.

A previous study on the same group indicated that persistent use of statins was associated with substantially lower all-cause mortality, which could not be explained only by the prevention of cardiovascular disease, he said.

"We believe that a major part of the improved survival among statin users comes from the anti-inflammatory effects demonstrated by lower risk of rheumatoid arthritis. Unfortunately, our previous study indicated that, despite their benefits, many patients on statins discontinue their treatment," Chodick said.

This work received no outside or corporate finding, the researchers noted.

Dr. Robert Myerburg, a professor of medicine and physiology at the University of Miami Miller School of Medicine, stressed that "this is a study looking for an association, and it doesn't prove that starting statins early in life will prevent or delay the onset of rheumatoid arthritis."

The only way to prove the connection is with a clinical trial, Myerburg said. "At this point, I would not use a statin for that [prevention of rheumatoid arthritis] indication," he said.

Working Overtime Adds to Heart Risk for Out-of-Shape Men

But being physically fit seems to protect those who work longer hours, researchers say

Out-of-shape men who work long hours more than double their risk of dying from heart disease compared to non-fit men working fewer hours, researchers report.
The study also found that when men are fit, working long hours doesn't boost heart risk at all.
The new study included 5,000 Danish men, aged 40 to 59 years, who worked at 14 different companies. Their fitness levels were assessed at the start of the study and they were followed-up for more than 30 years. During that time, 587 (about 12 percent) of the men died as result of narrowed and hardened arteries (also known as ischemic heart disease).
The study, released online Sept. 6 in advance of publication in an upcoming print issue of the journal Heart, also found the following:

• Compared with men who worked less than 40 hours per week, unfit men who worked 41 to 45 hours a week were 59 percent more likely to die of heart disease, although they were not more likely to die of other causes.
• Compared with unfit men, those who were physically fit and worked longer hours were 45 percent less likely to die of heart disease and 38 percent less likely to die of other causes.
• Being both unfit and working more than 45 hours per week more than doubled a man's risk of dying of heart disease compared with those who worked less than 40 hours per week.

"The finding that working more than 45 hours a week is associated with more than a doubled risk of [death from heart disease] among men with low physical fitness, and not among men with moderate or high physical fitness, is a new observation," Andreas Holtermann, of the National Research Centre for the Working Environment in Copenhagen, and colleagues said in a news release from the journal's publisher.
"If the relationship is causal, it obviously has major implications for the prevention of heart disease," they added.

Heart Health Rises With Education in Rich Nations

But findings don't apply to low- or middle-income countries, study says

A higher level of education is associated with reduced risk of heart disease and stroke for people who live in rich countries, but not for those in low- and middle-income nations, finds a new study.
Highly educated men in high-income countries had the lowest level of cardiovascular disease, according to the researchers. The findings show that the results of research conducted in richer nations can't be applied to poorer nations.
"We can't simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries. We need dedicated studies in those settings," Dr. Abhinav Goyal, an assistant professor of epidemiology and medicine (cardiology) at Emory Rollins School of Public Health and Emory School of Medicine in Atlanta, said in an American Heart Association news release.
Goyal is lead author of a two-year study that included more than 61,000 people from 44 countries who were diagnosed with heart disease, stroke or cardiovascular disease risk factors, such as high blood pressure, obesity, clogged blood vessels and smoking.
The researchers were surprised to find that nearly half of highly educated women in high-income countries smoked, compared with 35 percent of those with the least amount of education. In middle- and low-income countries, 21 percent of highly educated women smoked, compared with 14 percent of those with the least education.
"We can't assume that just because certain groups are more educated than others that they're going to have healthier lifestyles. Everyone needs to be educated about the risk of heart disease in particular and counseled to adopt healthy lifestyles and to quit smoking," Goyal said.
Among men in high-income countries, 66 percent of those with the most education smoked, compared to 75 percent of those with the least education. In low- and middle-income countries, smoking rates were similar for men of all education levels, the study found.
The study was published Sept. 7 in the journal Circulation.

Many HIV-Infected Kids Could Use Cheaper Treatment Safely

Study found that returning to nevirapine still kept viral load down for most

For HIV-infected children in the developing world, treatment choices have been limited by concerns over the possible development of resistance to drugs they received as infants during failed attempts to prevent their infection in the first place.
But a new U.S. National Institutes of Health-funded study suggests there may be a way to administer one particularly cheap and practical HIV drug -- nevirapine -- safely and effectively to many of these children.
The finding was detailed by study co-author Louise Kuhn, a professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, and Dr. Lynne Mofenson, chief of the pediatric, adolescent and maternal AIDS branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, during a recent teleconference.
The study itself will be published in the Sept. 8 issue of the Journal of the American Medical Association.
Mofenson noted that globally 430,000 infants become infected with HIV. About 90 percent of these children live in sub-Saharan Africa.
To tackle this immense problem, public health officials often turn to nevirapine. A single dose of the drug given at birth to the newborn of an HIV-infected mother can reduce the risk of HIV transmission by as much as 50 percent, Mofenson explained.
However, those infants who go on to become infected run the risk of developing a nevirapine-resistant strain of virus. And resistance testing, though available, is far too expensive to be considered a practical screening tool in the developing world.
So, about three years ago the World Health Organization recommended that HIV-infected children who had first been given nevirapine not be given the effective and cost-effective treatment again in favor of a costly protease inhibitor cocktail that is difficult to store and transport.
In this latest study, the researchers focused on the treatment of 195 children infected with HIV who were cared for at one hospital in Johannesburg, South Africa, between 2005 and 2009.
For these children, nevirapine at birth had failed to prevent HIV infection.
As a result, each child was placed on a protease inhibitor regimen, which involved three drugs: ritonavir-boosted lopinavir, stavudine and lamivudine. All the children fared well on this cocktail, having maintained a desirably low viral load for a minimum of three months over the course of their first year of treatment.
At the launch of the study, about half the children were randomly switched to a nevirapine treatment: namely, replacing ritonavir with nevirapine in the drug cocktail. The other children stayed with their standard protease inhibitor regimen. Blood samples were taken at 4, 12, 24, 36 and 52 weeks.
The authors found that children who had fared well (for an average of nine months) under a non-nevirapine protease-inhibitor drug regimen appeared to fare even better once they switched to a nevirapine treatment.
"Those children who changed to nevirapine were actually more likely to maintain the virus below 50 copies per milliliter (ml) in the blood, which is the lowest detectable limit that we use to measure the amount of virus in the blood," explained Kuhn.
Among the nevirapine group, 66 percent of the children remained below this threshold. For the standard treatment group, just 42 percent achieved that goal.
However, they cautioned that about one in five of the children who switched to nevirapine did not fare well, with viral loads rising beyond 1,000 copies/ml.
Nevertheless, with a majority of children reacting well to the switch, Kuhn and her colleagues suggest the approach could cut costs and improve treatment, so long as viral loads are monitored.
"What this shows is that this is a unique and innovative, but also reasonable, alternative strategy, and it will allow us to treat many more children," Mofenson said. "Because compared with the protease inhibitors we use now, nevirapine is much less expensive -- about $55 a year per child compared to about $280 a year for the PIs."
"So this will allow us to treat five times as many children for the same price," she noted. "Which is why this is so critical."
Kuhn added that nevirapine offers other crucial pluses.
"Our group is very, very encouraged by these results, because the biggest factor in HIV treatment is adherence," she explained. "The drugs don't work if you don't take them. And here the big problem is that it's very, very difficult for parents to get their children to take what we currently offer them two times a day because they are really horrible, foul-tasting drugs."
"So if we can move to something like nevirapine - which has a kind of a sweet taste that children don't really mind so much -- it would be very helpful," she said.
Dr. Geoffrey A. Weinberg, a pediatric infectious disease expert at Golisano Children's Hospital at the University of Rochester Medical Center in New York, agreed that a nevirapine treatment option would be helpful.
"The important message is that many children will do better with anti-HIV therapy based on nevirapine," he said.

Health Care Reform: Is There a Doctor in the House?
Reform could strain, or possibly improve, the primary-care experience


Health reform will put insurance cards in the hands of tens of millions of previously uninsured Americans. Many will need physicals, immunizations, preventive screening tests and care for chronic health conditions.

So, how tough will it be to get a doctor's appointment?

Some experts worry that there could be longer wait times to see a doctor, particularly in rural areas and underserved markets where primary-care physicians are in short supply.

"The reality is there's going to be a potential primary-care crisis as health care is expanded," said Dr. John D. Goodson, an internist in primary care at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School in Boston.

A primary-care practice is often a patient's first and ongoing contact with the medical system. Primary-care physicians are generalists trained in family medicine, general internal medicine or general pediatrics. They diagnose and treat acute and chronic conditions, provide preventive services and counseling, coordinate care and make necessary referrals to specialists.

Yet primary-care physicians make up only 35 percent of America's physician workforce, and the pipeline of fresh talent is tapering off. Fewer than 20 percent of U.S. medical students are choosing to practice primary-care medicine, according to the Council on Graduate Medical Education, which advises and makes recommendations to the U.S. Department of Health and Human Services and Congress on physician workforce matters.

Studies project a shortage of 44,000 to 46,000 primary-care doctors by 2025 unless action is taken to lure more medical students into the field and retain experienced primary-care doctors.

And future demand for generalist physicians is expected to swell as the population ages.

"You can put people in the health insurance plans, but if you don't have enough providers to take care of these people, I think that the system will not work," said Janet Selway, president-elect of the American College of Nurse Practitioners, who sees an expanded role for nurses with advanced education and training.

Massachusetts experienced a shortage of primary-care physicians in the wake of the commonwealth's universal health insurance law, which was enacted in 2006. But it had only two years to prepare for the onslaught of patients. The full impact of the federal health reform law won't be felt until 2019.

The Patient Protection and Affordable Care Act -- the sweeping health reform bill signed into law by President Barack Obama in March -- includes a number of programs to strengthen primary-care. But is it enough?

In a "Perspective" article published in the Annals of Internal Medicine in April, Goodson argued that, to avert a primary-care crisis, medical schools must prioritize and support primary-care training, and policymakers have to do something about the nation's lopsided physician reimbursement system, which favors specialists.

"The starting pay for a radiologist coming out of a training program could be $400,000 to $500,000 a year, whereas a trainee coming out of a general medicine program or a family medicine program could be $150,000 a year," he told HealthDay. "I mean, this is just patently absurd."

Goodson and other primary-care advocates also see the need for a better way to take care of patients' acute and chronic health-care needs without burning out doctors.

One potential solution is a team-based model of care called the "medical home." In a medical home, every patient has a personal physician. But instead of acting alone, the physician leads a cadre of non-physician providers. The team may include physician assistants, nurse practitioners and others who are responsible for coordinating patient care.

"In many ways, it's the ideal incarnation what you wish you primary-care physician -- what he or she -- would be able to do to support your care," said Susan Stuard, executive director of the Taconic Health Information Network and Community, a partner in the Hudson Valley Initiative, an effort to improve health-care delivery in six New York counties.

Stuard's organization has helped more than 600 Hudson Valley-area primary-care physicians, including a number of solo and small practices, implement electronic health records. Having information technology in place to coordinate care, avoid repetitive lab tests and ensure timely screenings is a key component of the medical home concept, she said.

Group Health Cooperative in Seattle, an early adopter of the medical home model, recently published results of a pilot program comparing the medical home experience at one clinic with its other practice sites. After two years, patients in the medical home had better experiences and better quality of care, and physicians reported less workplace stress. The study was published in the May issue of Health Affairs.

However, results of a two-year medical home experiment involving 36 primary-care practices across the country found small improvements in quality of care but not in patient experiences. That study appeared in a special supplement to the May/June issue of the Annals of Family Medicine.

"The issue with the medical home is, how it can be done in a way that's really going to serve the needs of the patient best," Goodson said.