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Thursday, August 16, 2018

Childhood Smoke Exposure Tied to Early COPD Death


Long-term exposure to secondhand smoke during childhood was linked to an increased risk of death from chronic obstructive pulmonary disease (COPD) among lifelong non-smokers in a study conducted by American Cancer Society (ACS) researchers.
In the analysis of data from a large prospective study involving older adults who had never smoked cigarettes, growing up in the same household with a daily smoker was associated with a 31% higher likelihood of death from COPD.
Ten or more hours a week of secondhand smoke exposure during adulthood was associated with a 42% increased risk of death from COPD and a 9% increased risk of death from all causes in the lifelong non-smokers, according to the study online in the American Journal of Preventive Medicine.
“This is the first study to identify an association between childhood exposure to secondhand smoke and death from chronic obstructive pulmonary disease in middle age and beyond,” wrote W. Ryan Diver, MSPH, of the Epidemiology Research Program, and co-authors.
They noted that although secondhand smoke exposure is known to have adverse health effects during childhood, including increasing the risk for asthma, the impact of childhood secondhand smoke exposure on the risk of disease later in life has not been well studied. “It is plausible that childhood secondhand smoke exposure resulting in damage to the lung and cardiovascular system would increase the risk for fatal outcomes in adults.”
In an effort to better understand this potential association, the team examined childhood and adult secondhand smoke exposure and death from COPD, ischemic heart disease, stroke, and all causes among 70,900 never-smokers enrolled in the ACS’s Cancer Prevention Study-II Nutrition Cohort between 1992 and 1993.
At enrollment the participants completed a 10-page questionnaire that included information on demographic, medical, behavioral, environmental, occupational, and dietary factors. Follow-up questionnaires were completed every 2 years after that, beginning in 1997.
In the initial questionnaire the participants were asked: “During the period from birth to age 18, did you ever live for more than 1 year with someone who smoked on a daily basis?” Those who answered yes were then asked how many years they lived with a smoker during childhood.
All participants were age 50 or older at enrollment, and a total of 25,899 deaths were reported during follow-up through 2014. Cox proportional hazards regression models were used to calculate multivariable-adjusted hazard ratios and 95% confidence intervals.
Childhood secondhand smoke exposure was not found to be associated with all-cause mortality, but living with a smoker for 16 to 18 years during childhood was associated with a higher risk of death from COPD (HR 1.31, 95% CI 1.05-1.65).
Adult secondhand smoke exposure of 10 or more hours a week at enrollment was also associated with higher risk of death from all causes (HR 1.09, 95% CI 1.04-1.14), ischemic heart disease (HR 1.27; 95% CI 1.14-1.42), and stroke (HR 1.23, 95% CI 1.04-1.45). Risk of death from COPD also appeared increased (HR 1.42) but with a nonsignificant 95% confidence interval.
The researchers cited the study’s large size and 2-decade follow-up as major study strengths, in addition to the detailed questionnaires examining active and passive smoking histories. The self reporting of childhood secondhand smoke exposure at least 3 decades after exposure was cited as a study limitation.
The researchers concluded that despite this limitation, secondhand smoke exposure is a moderate risk factor for death “comparable with other secondary risk factors.”
“More than 50 years after the publication of the first Surgeon General report on smoking and health, these findings suggest that researchers and scientists still do not fully understand the long-term health consequences of smoking — particularly, the potential delayed effects of childhood secondhand smoke exposure in later adulthood,” the team wrote.
“Understanding these long-term effects are relevant in the U.S. and potentially even more relevant in countries where smoking rates and secondhand smoke exposure are higher. The results of this research provide further support for the implementation of smoke-free air laws, smoke-free home policies, and clinical interventions to reduce secondhand smoke exposure.”
The authors reported no disclosures.
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5 Symptoms in Young Girls Tied to Early Adult Anxiety


Specific behavioral and emotional symptoms in girls ages 6 to 10 were linked with the development of future anxiety disorders, according to a network analysis of a Canadian cohort study.
Among 932 kindergarten girls in Quebec, five symptoms — solitary, often cries, irritable, blames others, not liked — had the strongest ties to anxiety disorders developing at ages 15 and 22, reported Alexandra Rouquette, MD, PhD, of Paris-Saclay University in France, and colleagues.
“Not liked” was the only one of these so-called bridge symptoms (symptoms linked to different disorders within a network perspective) connected to future anxiety at each early time point studied — age 6, 8, and 10.
“We identified, for what we believe to be the first time, bridge symptoms between disruptive and internalizing communities in childhood and our findings suggest that these symptoms could be central in the developmental process leading to long-term anxiety,” the authors wrote in JAMA Psychiatry. “Bridge symptoms should be investigated further as potential early targets in disease-prevention and health-promotion interventions.”
The study also looked at symptoms in early childhood that were linked to major depression, but found none.
Among 783 girls who later completed the follow-up at ages 15 or 22, 77% had intact family units and 27% demonstrated disruptive behavior problems. In this follow-up group, 34.6% developed anxiety disorders and 16.4% developed major depression, which were classified using the Diagnostic Interview Schedule of the DSM-III-R.
“This study showed that the network structure of Social Behavior Questionnaire (SBQ) symptoms, including bridge symptoms, was relatively stable over a 5-year developmental period,” they wrote. “This finding challenges recent claims that network analyses do not replicate and suggests that, as the importance of bridge symptoms remains similar over time, the symptoms could be seen as providing leverage for altering the network early in childhood.”
The researchers explained that the network perspective, which classifies symptoms as distinct entities, can be beneficial in studying bridge symptoms, which can causally influence each other and be self-reinforcing. Poor concentration in children, for example, is situated between hyperactivity and attention-related symptom groups. Interventions targeting poor concentration, therefore, could reduce attention-deficit symptoms in hyperactive children, the authors noted, although this hypothesis requires additional testing.
Additionally, symptoms can be a part of feedback loops, which can eventually form disorders, according to the study. However, while the network perspective has the potential to provide clues on the development of disorders, the researchers admit it may not be effective when studying symptoms across a lifetime, since these symptoms vary across different developmental stages.
This study explored 33 symptoms, or nodes, and categorized them into the following 5-factor model, excluding two items (bites nails, twitches).
  • Attention (4 items)
  • Hyperactivity (2 items)
  • Disruptive (9 items)
  • Internalizing (6 items)
  • Prosocial (10 items)
Parents completed SBQs at ages 6 (baseline), 8, and 10, and the researchers recorded the level of connectivity (the weighted absolute sum of all “edges” or intersymptom associations) of each symptom at ages 8 and 10. At baseline the frequency of these bridge symptoms were solitary 50% (occurring sometimes or often), often cries 76%, irritable 67%, blames others 61%, and not liked 16%.
Using Gaussian graphical models, the researchers reported that when the five bridge symptoms were included in the network they demonstrated the strongest links to future anxiety (highest regularized edge weights 0.015 to 0.076). For positive edges included in the network, bootstrapped 95% CIs ranged from (-0.063 to 0.068) to (0.561 to 0.701); for negative edges they ranged from (-0.156 to 0.027) to (-0.081 to 0.078).
The authors reported several limitations. First, the relatively low sample size of 932 participants (plus 45% attrition rate at last follow-up) might not be adequate when investigating the large number of variables in a 33-node network. Second, a Bonferroni correction was applied to control for multiple testing, but resulted in a loss of power, which might not allow the results to be applicable to the population level. Third, the diagnoses identifying women with anxiety disorder at follow-up were heterogeneous, which caused less specificity in determining links in symptom networks. Lastly, the fact that the study focused solely on girls, due to the higher prevalence.
The Quebec Longitudinal Study of Kindergarten Children was supported by the Quebec Fund for Research on Society and Culture, the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research, and grants from the U.S. National Science Foundation and the U.S. National Institute of Mental Health.
The current study was supported by a grant from the OpenHealth Institute.
Rouquette and colleagues reported that they had no conflicts of interest.
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FDA updates on probe of McDonald’s salad-related Cyclospora illnesses


As of August 16, 2018, a total of 476 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. The investigation is ongoing and the FDA is currently reviewing distribution and supplier information for romaine and carrots.
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New accounting rule aims at GE-like multi-billion insurance errors


General Electric’s $6.2 billion hit to income in January to catch up on losses on long-term care insurance contracts highlights the problem accounting standard-setters now say will be solved with some new rules, set to take full effect in 2021.

The Financial Accounting Standards Board introduced a big change on Wednesday in how U.S. insurers must update for economic events that should change their assumptions on long-term insurance contracts. FASB says new rules will now require insurers, and their auditors, to annually review the assumptions made at the inception of the contract and over its life and update each year, if necessary.
The impact of applying new discount rates, for example, will be recognized immediately in earnings when the rule goes into affect in 2021.
Until now, when a long term insurance contract was signed, for example in 1980, the original assumptions such as discount rates that were used to estimate cash flow each year stayed in place, even if the contract was still in force almost forty years later.
Under existing accounting standards, the assumptions used for long-term care contracts such as GE’s GE, +0.65%  North America Life & Health reinsurance portfolio, aren’t reviewed if they don’t show losses.
FASB board member Christine Botosan told an audience of accounting professors in Washington, D.C., on Aug. 6 that “current accounting for long duration insurance contracts did not provide relevant information or timely information, and it wasn’t transparent.”
Botosan explained that when insurance companies originally established the assumptions that impact how they measure cash flow for long-term insurance contracts, they were “locked in” and never updated, unless the contract went into a loss position.
“That’s why we saw things like GE taking a $6.2 billion charge related to insurance in January. They had crossed over that threshold and this set of contracts was now in a loss position.”
A GE spokeswoman did not immediately respond to a request for comment.
GE’s decision to retain this reinsurance portfolio, 60% of which is related to long-term care insurance, after mostly exiting the business between 2004 and 2006, was based on the view that a gradual runoff of existing claims would be more profitable than selling the business, GE Chief Executive John Flannery told analysts in January when the company announced the huge hit.

Genworth Financial GNW, +1.78%  , the reinsurance business that GE spun off in 2004, disclosed in a routine SEC filing that year that periodic reviews of claim reserves are common and charges are to be expected. Genworth Financial has disclosed nine changes in estimates related to its long-term care portfolio, totaling $3.8 billion since 2004.
GE told analysts in January that it had totally reconstructed its long-term care claims cost projections. The charge in the fourth quarter of 2017 was driven by higher cost estimates combined with claims costs that now extend out over 40 years based on current life expectancies.
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OxyContin maker Purdue taps financial restructuring adviser


OxyContin maker Purdue Pharma LP has tapped law firm Davis Polk & Wardwell LLP for financial restructuring advice, as its potential liabilities swell with a wave of lawsuits over the opioid addiction epidemic sweeping the United States, people familiar with the matter said on Thursday.

Purdue and other opioid manufacturers, including Endo International Plc and Johnson & Johnson, have been fighting hundreds of lawsuits filed by U.S. states, counties and cities accusing the drugmakers of pushing addictive painkillers through deceptive marketing.
U.S. President Donald Trump said on Thursday that he would like to bring a federal lawsuit against the companies over the opioid crisis. According to the U.S. Centers for Disease Control and Prevention, opioids were involved in more than 49,000 deaths in the United States last year.
The sources that disclosed the appointment of Davis Polk asked not to be identified because the matter is confidential.
“Purdue is preparing for a bright future that includes diversification into non-opioid products,” Purdue told Reuters in a statement.
The privately held company said that it retains firms with a variety of expertise but declines to discuss publicly who those firms are and the reasons for which they are retained
Davis Polk did not immediately respond to a request for comment.
Purdue has been participating in settlement talks with lawyers for the plaintiffs, who have often compared the cases to the litigation by states against the tobacco industry that led to a $246 billion settlement in 1998.
The lawsuits have accused Purdue of deceiving doctors and patients and of misrepresenting the risks of addiction and death associated with the prolonged use of its prescription opioids. The company has denied the allegations.
At least 27 states and Puerto Rico have sued Purdue. New York became the latest state to sue Purdue, in a lawsuit filed on Tuesday alleging that the company sought to boost profits at the cost of lives.
The drugmaker, which is owned by the Sackler family, announced in June that it had laid off 350 employees including the remainder of its sales force, which had been reduced in February when Purdue said it would stop sending representatives to doctors’ offices to discuss the pain medications.
The company currently has 550 employees and has focused its efforts on developing medications for sleep disorders and cancer.
In July, Steve Miller, a restructuring veteran who recently retired as chief executive of automotive supplier International Automotive Components Group and is the author of “The Turnaround Kid,” joined Purdue’s board as the chairman.
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Signs of concussion in children and toddlers


Concussion is an injury to the brain caused by either a blow to the head or body. A child’s developing brain is more at risk than an adult’s, so parents and caregivers may want to know the signs of concussion in children.
A survey published in 2017, looking at more than 13,000 adolescents in the United States, found that almost one-fifth reported having had a concussion at least once.
In this article, we will look at the warning signs and how to spot concussion in a child, plus what to do if you think a child has concussion.

What is concussion?

Concussion is a type of brain injury that happens when a blow to the head or body causes the brain to move in its surrounding fluid.
The brain can twist or knock against the skull, temporarily affecting how a child thinks and acts.
Concussion is a mild form of traumatic brain injury or TBI.

Signs and symptoms of concussion in children

It may not be a hard hit that causes a concussion. In most cases, the child does not lose consciousness.
Signs of concussion may not be obvious. They can be physical such as a headache, but may also show in the way the child acts or feels.
People should look for the following warning signs of concussion in children:
  • headache
  • sleepiness
  • feeling like they are in a fog
  • feeling sick or vomiting
  • sensitivity to noise or light
  • seeming irritable
  • sleeping more or less than usual
  • feeling depressed or sad
  • feeling dizzy or having problems with balance
  • unable to think properly or concentrate
The signs of concussion do not necessarily develop right after impact. Some can take hours or even days to appear. Parents and caregivers must, therefore, keep a watchful eye on the child for some time after they hit their head.
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The child or teen may not always be aware of their symptoms, and so adults need to watch for signs that the child may not report.
When checking for signs of concussion, people can ask questions, such as, does the child:
  • seem confused or dazed
  • struggle to answer questions
  • have no memory of what happened before or after the knock
  • move clumsily
  • remember the score or the game if injured during sport

Concussion in babies and toddlers

Babies and very young children may not be able to tell you what is wrong. As well as all of the signs above, people should also watch for a young child who is:
  • unable or unwilling to nurse or eat
  • crying and will not be comforted
  • losing interest in toys
  • losing new skills, such as toilet training

What to do if you think your child has concussion

If the child is playing in a sport and someone or something hits their head, immediately stop them from playing any more and observe them. Many states in the U.S. have laws to make sure this happens, and all states have some concussion law.
If a person is unsure whether a child has got a concussion, the CDC recommend they should avoid returning to the game, including the slogan “When in doubt, sit them out” in their advice.
People must call a doctor if the child reports or shows any of the above symptoms or signs. These can happen at the time of the injury or several hours or days later.

When to go to the emergency room

In rare cases, a head injury can cause a hematoma in a child’s brain.
A hematoma is a collection of blood that forms in the brain and squeezes it against the skull. Doctors view a hematoma as a medical emergency.
People should either go to the emergency room or call an ambulance if a child has:
  • lost consciousness when hit
  • loss of memory for more than 24 hours
  • seizures, which could mean shaking or twitching
  • one pupil larger than the other
  • slurred speech
  • been unable to wake up
  • vomited repeatedly
  • symptoms that suddenly get worse

Treatment

The primary treatment for concussion is rest. Rest helps the brain to heal.
The American Academy of Neurology, the American Academy of Pediatrics and the Child Neurology Foundation, as well as other experts, all recommend rest for children who have had a concussion.

What can you do at home?

What people do at home to help a child recover from concussion is vital. Steps to take include:
  • make sure the child has physical rest and avoids sports or physical activity.
  • allow the child to rest mentally, too. They should not do anything that needs a lot of concentration, such as school work. Limit their screen time, such as video games and television.
Many children experience disturbed sleep after a concussion. They may sleep more than usual or find it hard to fall asleep or to sleep through the night. Caregivers can help by:
  • removing distractions from the bedroom
  • encouraging regular sleep routines, with no sleepovers or late nights
Headaches are the most common problem after a concussion. Simple analgesics can help, but people should check with their doctor.

How can a child’s school help?

The child’s school can help by:
  • providing rest breaks during or between classes
  • allowing a shorter school day
  • giving more time for homework and assignments
  • postponing tests
  • providing a quiet area if a child is sensitive to noise
After a few days of rest, the child can gradually return to their usual activities. Typically, they should not return to sports or vigorous physical activity until they have no symptoms at rest.

How long will my child take to recover?

According to the CDC, most children will feel better within a couple of weeks. But for some children, symptoms can last for months or even longer.
A 2014 study found that nearly a quarter of children still complained of a headache one month after injury. About a fifth suffered from tiredness, and almost 20 percent said that they still took longer to think than they did before their injury.
People should talk to their doctor if the child’s symptoms get worse or do not go away. If a child is involved in sports, their doctor should be consulted to help develop a plan for safe return to play.
Some children may get post-concussive syndrome, causing their symptoms to linger. This is especially likely in children who have had more than one concussion.

Who is at risk of concussion?

Any child or adult can have a concussion, though some groups are more likely to experience concussion than others, and for various reasons.
According to the Centers for Disease Control and Prevention (CDC), falls are the most likely cause of TBI diagnosed in the emergency room in infants aged 4 years and under.
Children aged 5–14 years old are prone to TBI from both falling and being struck by something or against something.
Young athletes seem to face an exceptionally high risk of concussion, especially those playing certain sports, including women’s soccer, football, basketball, and ice hockey.

Dangers of another concussion

Many states have concussion laws preventing people from returning to sports until doctors have given them medical clearance.
Children are at greater risk of receiving another injury to the brain during the period after a concussion.
The brain is particularly vulnerable during childhood and adolescence. A second concussion during this period is much more dangerous than the first. Chemical changes in the brain make it more sensitive to stress or another injury while it is recovering.

Outlook

Most children will recover fully from a concussion. But for some, the effects can be serious and long-lasting.
The risk of severe complications is why people should always take a concussion in a child or teenager seriously, and the more adults who are aware of the signs, the better.
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NFL Alumni, Cancer Treatment, LabCorp, Health Testing Offer Prostate Screenings


Prostate cancer is the second most common cancer among men. To raise awareness of the disease and the benefits of early screening, the NFL Alumni (NFLA), Cancer Treatment Centers Of America (CTCA), LabCorp® (NYSE: LH) and Health Testing Centers are collaborating for the second year as part of the Prostate Pep Talkcampaign to educate men and their loved ones, and to increase access to screenings.
Beginning in September (Prostate Cancer Awareness Month), the Prostate Pep Talk messaging will encourage men to get screened for prostate cancer. Information can be found on the campaign’s website, prostatepeptalk.com, which has educational videos and a public service announcement featuring legendary NFL head coaches Herm Edwards, Dick Vermeil and Bill Cowher.
“Cancer affects everyone,” says Coach Edwards. “It affects millions of people every year, and it goes under the radar until it affects you or someone you know. Cancer sees no color, it sees no age. Go get checked.”
From Sept. 1 through Oct. 15, as many as 1,500 men ages 40 and older may sign up to receive a free Prostate Specific Antigen (PSA) screening at nearly 2,000 LabCorp locations throughout the United States. In addition, NFLA chapters, LabCorp and Health Testing Centers are teaming with CTCA® comprehensive care and research center locations in Atlanta, Chicago, Phoenix, Philadelphia and Tulsa to host community-based events to raise awareness of the importance of early detection in prostate cancer.
“We believe many of our members, whether they are players or coaches, may not understand how simple it is to take these tests,” says NFL Alumni CEO Elvis Gooden. “We are encouraging them to get screened. It’s not that hard.”
Eligible men may order their free or discounted PSA screening by visiting Prostate Pep Talk or Health Testing Centers – Prostate Pep Talk. Testing will be performed by LabCorp and will be available at LabCorp’s patient service center locations across the country. After the first 1,500 free PSA screening spots are filled, eligible men can still access a discounted rate of $25 per screening throughout the sign-up period. Screenings must be performed within six months of the sign-up date.
Men who have a PSA considered outside the normal range should consult with their physician to determine next steps that best suit their needs. Elevated PSA levels do not always indicate prostate cancer.
For more information, visit prostatepeptalk.com.
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