By MyHealthNewsDaily.com

Members of the military exposed to blasts in combat can develop the same brain disease as professional athletes who experience multiple concussions, a new study suggests.

Researchers found evidence of chronic traumatic encephalopathy, or CTE, in the brains of all four deceased U.S. military veterans they examined. The men were exposed to blasts or to multiple concussions during combat.

CTE is a degenerative brain disease previously seen mainly in professional athletes, including boxers, hockey players and football players. It is usually caused by repeated blows to the head, but results from the new study suggests that exposure to a single blast equivalent to that of a improvised explosive device (IED) can result in CTE. The condition causes symptoms such as impaired learning and memory, and has been linked with suicide, the researchers said.

"Our study, for the first time, shows military personnel that have experienced blast exposure exhibit CTE that's basically indistinguishable from the athletes we've looked at," said study researcher Patric Stanton, a cell biology professor at New York Medical College in Valhalla, N.Y.

The findings indicate that brain injuries with different causes — concussions and exposure to blasts — may trigger the same disease in the brain, Stanton said.

The link between CTE and suicide can be seen in the case of former National Football League star Dave Duerson, who committed suicide last year. An examination of his brain after his death revealed he had CTE, as he suspected. CTE has also been suspected of playing a role the suicide of NFL player Junior Seau earlier this month.

The new findings suggest that blasts on the battlefield may lead to suicidal thoughts in veterans, Stanton said. Blasts may be a factor in the recent rise in military suicides, he said, and researchers should investigate this..

Degenerative brain disease
The researchers analyzed the brains of four male military veterans, ages 22 to 45 (CTE can be diagnosed only after death). Three of the men had been exposed to at least one blast from an IED, and two of them had concussions earlier in life. One soldier experienced four concussions throughout his life, although he was not exposed to a blast.

All the men had symptoms such as headaches, irritability, difficulty sleeping, depression and short-term memory loss.

One man died from a brain aneurysm, one from a brain hemorrhage and one from a self-inflicted gunshot wound. The fourth man inhaled foreign material while under the influence of pain medication and later died from lung complications. About two years had passed between their last brain injury and their death.

The researchers also examined the brains of three football players, a professional wrestler and four men of similar ages with no history of blast exposure or concussions.

Signs of CTE were seen in the brains of the military veterans and the professional athletes. One characteristic of CTE is abnormal deposits of a protein called tau, which can kill brain cells, Stanton said.

Mouse model
It can be difficult to say whether CTE was definitely caused by a blast, by previous events in a person's life, or a combination of both, Stanton said.

To study CTE in a more controlled environment, the researchers created a mouse model and simulated blasts from an IED.

The rapid movement of air that occurs after an explosion may play the biggest role in causing blast-related brain injuries, Stanton said. This blast wind can be stronger than the winds of a hurricane, and can rapidly shake the head back and forth, compressing the brain, Stanton said.

About two weeks after exposure to a simulated blast, the mice showed learning and memory problems. These problems were averted when the animals' heads were prevented from moving during the blast, the researchers said.

The findings provide a new pathway for developing methods to prevent blast-related brain injuries, the researchers said.

The study is published today (May 16) in the journal Science Translational Medicine. Study experiments were conducted by researchers at Boston University, New York Medical College and the Veterans Affairs Boston Healthcare System.

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Should high school kids get a genetic test for the risk for Alzheimer’s disease before they’re allowed to play football? Two prominent scientists who study both Alzheimer’s and the traumatic brain injury suffered by some football players raise that ethically charged question in an editorial out Wednesday in the journal Science Translational Medicine.

We all carry a gene called APOE which comes in three forms. If we carry one copy of the form called E4, it triples our lifetime risk for Alzheimer’s. About 10 percent of the U.S. population falls in that category. If we have two copies of E4, the lifetime Alzheimer’s risk is 15 times greater. About 2 percent of us have that genetic makeup.

Although the connection between APOE E4 and Alzheimer’s risk has been known for years, few have suggested it as a screening tool because there’s no known way to prevent the mind-robbing disease. But, now as scientists want to test drugs as early as possible as potential methods of preventing Alzheimer’s, APOE is getting more attention, as are brain scans and other techniques that might determine who is at risk.

At the same time, scientists have been finding that football players, boxers and soldiers suffering blast injuries are more likely to develop chronic traumatic encephalopathy (CTE), the form of dementia that can follow a brain injury -- if they have one or two copies of the E4 version of APOE.

Neurologist Dr. Sam Gandy of Mt. Sinai Medical Center in New York and Alzheimer’s researcher Dr. Steven DeKosky of the University of Virginia School of Medicine, Charlottesville, conducted a poll of 49 colleagues. By a 2 to 1 decision their fellow scientists said it is not yet appropriate to test high school students, and by a 3 to 1 ratio they opposed testing military recruits. But few of the scientists dismissed the ideas out of hand.

As the evidence of a connection mounts, testing may become more of an imperative.

There are obvious, enormous ethical difficulties. Telling a 14-year-old that he or she faces an increased lifetime risk of Alzheimer’s could lead to unknowable future strains on individuals and families, as well as a lifetime of difficulty in getting health and life insurance. But if scientists learn how to intervene to prevent the Alzheimer’s, or if the evidence of increased risk from sports or on the battlefield becomes overwhelming, the question may be asked more often.

Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter: @RobertBazellNBC.

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By Judith Graham
Kaiser Health News

Doctors assess patients' breathing, heart rate and blood pressure routinely at office visits. Soon, they may be adding body mass index to that list too.

Tracking this measure – an indicator of whether someone is obese or overweight – as if it were a vital sign at medical checkups is among a new set of strategies recommended for battling obesity, a concern that some experts predict will affect 42 percent of adults by 2030.

Although professional medical societies have said for years that physicians should monitor patients' body mass index, most doctors fail to do so. For example, a 2006 survey of family physicians found that fewer than half checked BMIs for children over the age of 2, even though 71 percent knew this has been recommended.

Just over 40 percent of adult patients in commercial HMOs had documented BMI measurements in 2009 and 2010, according to a survey by the National Committee for Quality Assurance, an organization that evaluates health plans. That figure falls to 12 percent for patients in commercial PPOs, a more common type of plan.

The Institute of Medicine last week called for the medical profession and health insurers to become more rigorous in their approach in a report proposing an anti-obesity campaign that would involve every part of society, from individuals and families to schools, communities, workplaces, the food industry and the media.

Pointing to the more than 90 million children, teens and adults counted as obese, well-established links to medical conditions such as diabetes, hypertension, heart disease, and arthritis, and annual healthcare expenses exceeding $190 billion, the report urged comprehensive and sustained action.

For physicians, monitoring body mass index – a ratio of height to weight – is at the top of the list of priorities because it's the best way to identify people who have a weight problem. (Adults are counted as obese if they have a BMI of 30 or higher; children if their BMI is at the 95 percentile or higher for kids of the same age and sex.)

"We need to normalize the process of obesity screening and lifestyle counseling so they're usual and people expect this," said Dr. Sandra Hassink, a member of the panel that prepared the IOM report and director of the Obesity Initiative at Nemours, a pediatric health system in four states.

Medical groups call for change
Groups such as the American Medical Association and the American Academy of Pediatrics have recommended regular BMI checks for years. Several health care systems also have embraced the practice. Kaiser includes BMI as a "vital sign" in electronic medical records for nearly 9 million members, and it is planning to do the same for physical activity, another contributor to the obesity epidemic, said Ray Baxter, the plan's senior vice president for community benefit and health policy.

(Kaiser Health News is not affiliated with Kaiser Permanente.)

So why the problem? Many harried physicians are unprepared to advise people about how to change their behaviors, unconvinced they have time to do so, and therefore look skeptically at screening, said Dr. Robert Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

If doctors are overweight themselves, they're less likely to recognize the issue in their patients, research shows. What's more, doctors aren't trained in medical school to handle weight issues. They also often aren't convinced obesity treatments work, and many believe there aren't good community programs to which they can refer patients.

"The question is, how many programs are out there for primary care doctors to refer to in the community, and answer is – not many," said Dr. Ned Calonge, a Colorado physician who is the immediate past chairman of the U.S. Preventive Services Task Force.

Northwestern is tackling a part of that by weaving instruction in "lifestyle medicine" throughout all four years of a new medical school curriculum being introduced this August.

Another significant problem has been a historic lack of reimbursement from insurers for obesity screening and counseling. That changed last year for seniors, when Medicare said it would cover up to six months of weight loss counseling for obese beneficiaries as part of a package of new preventive services. Nearly 13 million Medicare members are thought to be obese.

Meanwhile, new preventive services guidelines from the government call for all insurance plans to cover obesity screening and counseling without charge to patients.

And insurers are expanding childhood obesity programs following a 2010 recommendation from the U.S. Preventive Services Task Force that endorsed comprehensive weight management programs for youngsters at least 6 years old. Previously, the task force supported BMI screening but not weight loss programs.

Seeking evidence-based programs
For the insurance industry, the challenge now is providing evidence-based programs that can be introduced on a broad scale.

UnitedHealth Group is promoting "Join for Me," a year-long behavioral modification program piloted with the YMCA of Greater Providence, R.I., in which youngsters 6 to 17 years old, accompanied by a parent, learn about healthy eating and exercise in a group led by a coordinator.

"Doctors are in short supply" and it makes sense to conduct intensive behavioral change programs in the community, not in their offices, said Dr. Deneen Vojta, senior vice president of UnitedHealth's Center for Health Reform & Modernization. For overweight and obese adults, the company is looking at offering a version of the Diabetes Prevention Program, a well-studied intensive intervention that has been shown to help people lose weight.

WellPoint has taken a different approach, choosing to work through doctors and with the Alliance for a Healthier Generation, an organization that's trying to convince health plans to offer more comprehensive coverage for obesity counseling and treatment. The alliance asks participating plans to offer four visits with a child's primary care doctor and four visits with a dietitian if the youngster is found to be overweight or obese. So far several plans, including WellPoint, Aetna, Humana and Highmark, Inc., have signed up, and 2.4 million children are covered.

WellPoint recently launched a limited pilot study of this type of benefit in California and is learning what physicians need and members want before deciding whether to roll it out more broadly, said Harvinder Sareen, clinical program director for the insurance company.

Insurance companies and some self-insured employers are also exploring the use of financial incentives -- cash payments or reduced premiums or deductibles – to motivate members to keep their weight in check and to adopt other lifestyle changes. One program at UnitedHealthcare offers members up to $250 for reaching a BMI of 25 or less, and similar incentives for not smoking and lowering cholesterol and blood pressure.

"Is there coverage [for obesity] is yesterday's conversation. Today's conversation is how to design coverage to encourage people to use it and continue using it," said Karen Ignagni, president of America’s Health Insurance Plans, an industry trade group.

Others disagree that coverage for obesity counseling is adequate.

"The problem is there's no real incentive for the insurance industry to pay for better prevention and treatment, because the costs are immediate while the benefits are long-term," said Dr. David Ludwig, director of the new Balance Foundation Obesity Prevention Center at Children's Hospital, Boston. "Although reducing the prevalence of obesity is one of the most profitable investments the healthcare system could make, it doesn't make a lot of sense for individual plans when families change policies every three to five years."

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A test to determine if you are infected with HIV should be made available over-the-counter, a federal advisory panel to the Food and Drug Administration has recommended. 

Having a home test kit available would seem to be a good idea for cutting down on new cases. About 1 in 5 people with HIV don't know they are infected, according to the Centers for Disease Control, and could be passing the virus on to others.

And early treatment seems to help diminish the virulence of HIV so a home test kits sounds like a better idea.  And given that it was just recently announced by another FDA advisory panel that the drug Truvada ought to get the FDA’s blessing as a way to prevent HIV transmission, would seem to be a great idea.

But is an HIV home test kit really a great idea? On the whole yes, but, there are some big ethical holes facing home testing.

First, there is no mandatory counseling to go along with the test. You can get some counseling by phone if you want it but you do not have to do so. Shouldn’t counseling be mandatory? After all, if you test positive don’t you need to hear some information about getting medicine fast, telling sexual partners, changing any risky behavior you are engaged in and what to do if you are pregnant or have a serious disease?  When you test at home shouldn’t you have to contact someone who can tell you the facts you need to know?

Having a home test kit for HIV is a bit like relying on a bathroom scale in the battle against obesity. Both tests can tell you important information. That information may well save your life. But, unless someone discusses the significance of the test result with you telling you what can be done to battle the problem, there is a pretty good chance you will either say “Thank goodness I did not test positive” and keep doing whatever it is you are doing even if it is bad for you --  or test positive and say “I have a problem and I am so ashamed or frightened I won’t do anything at all about it.”

There is another problem facing the home HIV test kit.  It is not 100 percent accurate. A negative result can occur by error, misusing the test or because the infection is too recent to register. A positive result needs reconfirmation by a blood test.

Another concern is that a home test kit can be used surreptitiously. The screening test relies on a simple swab of the gums. Someone could get your DNA while you are sleeping or under false pretense or even from a toothbrush.  You might get tested without your knowledge or consent.

It is still true that finding ways to let people know they are infected is better than doing nothing. Home testing will cut the rate of infection and that is good. Still, to get the most out of home testing it is important that someone from outside the home be involved in discussing the results.

What do you think about an at-home HIV test? Tell us on Facebook.

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By David Morgan
Reuters

WASHINGTON - A U.S. Food and Drug Administration panel of outside experts concluded that OraSure Technologies Inc's over-the-counter, in-home HIV test is reasonably safe and effective for determining whether someone has the AIDS virus.

The 17-member FDA advisory committee voted unanimously that the drug's ability to prevent new HIV infections and provide HIV-positive people with access to medical care and social services outweighed the risks of false results.

Tuesday's recommendations will now be considered by agency regulators as they determine whether the product, known as the OraQuick In-Home HIV Test, should be approved as the first-ever over-the-counter, completely in-home HIV test.

Advocates say the in-home test would provide a new and potentially powerful strategy for attacking an U.S. HIV epidemic that has infected nearly 1.2 million people and increases by 50,000 new cases each year.

Trading in OraSure's shares was halted for the FDA meeting after closing on Monday at $9.10.

The company said it would expect the product to retail for less than $60, if approved and marketed over the next the several months.

Panel members urged OraSure to undertake post-marketing studies to ensure that the test is available to under-served populations in a manner that would link those who use the kit to the healthcare services including confirmatory tests at professional settings.

A home version of the professionally administered OraQuick Advance test, the new product is an oral swab rapid test that produces results within 20 minutes. The test should not be taken until 90 days after an individual last had an risky behavior.

FDA officials said the OraQuick In-Home test showed a high degree of effectiveness in detecting HIV infection. But some research data suggested the test lacked sufficient sensitivity to avoid false negative results.

False negatives are of particular concern because they could lead HIV-positive individuals to take fewer precautions, raising the danger that they will engage in unprotected sex.

Some panel members argued for strongly worded labeling about false results and procedures to link those who telephone a company hotline with questions with healthcare professionals.

U.S. health officials told the panel that home-testing could help get needed healthcare to HIV-positive individuals earlier. At present, only 62 percent of those with HIV are linked to the healthcare services and just 28 percent have access to drugs capable of suppressing the infection.

The panel heard overwhelmingly supportive public testimony from more than two-dozen witnesses including HIV activists, black community representatives and public health experts, some of whom received money and other assistance from OraSure.

The witnesses urged the panel to back the test as a means of eliminating HIV's public stigma, a main barrier to testing, by making the home test just another item that can be purchased at a local pharmacy along with aspirin or condoms.

Whitney Engeran of the AIDS Healthcare Foundation, a Los Angeles-based group that provides care for nearly 170,000 HIV patients, said the potential ability to break down the stigma outweighed the product's shortcomings. "The perfect cannot be the enemy of the good," he said.

One witness, who represented healthcare providers, urged the FDA to withhold approval until further study can raise the test's accuracy to a level more in line with those administered in clinics and other professional settings.

Last week, another FDA panel recommended regulatory approval for Gilead Sciences Inc's HIV drug, Truvada, as the first pill treatment for protecting uninfected individuals. 

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President Obama's pronouncement last week in favor of same-sex marriage has no legal effect on employers’ decisions on whether to offer benefits to workers’ domestic partners, but some advocates believe it could reinforce a decade-long trend toward coverage.

Last year, 52 percent of all employers offered domestic partner health benefits, with the percentage varying widely by region and industry, according to a nationally representative sample of about 3,000 employers surveyed by benefit consultant Mercer.  That’s up from 31 percent in 2010.

 The biggest factors driving that change are employers’ views on whether such benefits help them attract and retain desirable workers.

 "Employers started doing this because they felt they needed to be competitive in the labor market, just like with other benefits," said Paul Fronstin of Employee Benefit Research Institute, a think tank in Washington D.C.  "I don’t see that changing."

 The Village Voice newspaper in New York is credited with being the first private employer to offer workers domestic partner benefits in 1982.  In 1995, Vermont became the first to offer coverage to state workers.

 "There’s been a steady growth for a long time," says Joan Smyth, a partner at Mercer.  In the early days, some employers worried that adding coverage for domestic partners could make their costs skyrocket by attracting people with higher-than-average health risks, she said, but "that did not happen."

The District of Columbia and almost half of states currently offer benefits to domestic partners or same-sex spouses of state workers, according to the advocacy group Human Rights Campaign.  

Same-sex partners of federal workers are not eligible for coverage under the Federal Employees Health Benefits Program (FEHB) because the Defense of Marriage Act, passed in 1996 and signed into law by President Bill Clinton, defines marriage as a legal union between a man and woman, the FEHB website says. That law is being challenged and may well end up before the Supreme Court.  The Obama administration has said it will not defend the statute.

In the Mercer survey, coverage of same-sex partners was most common in the West, with 79 percent of large employers offering such benefits. It was least common in the South, at 28 percent.  Big differences were also noted within industries.  Among manufacturing firms, for example, the coverage rate ranged from a high of 96 percent for pharmaceutical companies to 18 percent for machinery and heavy equipment makers.

Public sector jobs had a lower rate of coverage, averaging 26 percent across state, county and municipal workers, the Mercer survey found.

While Smyth at Mercer doesn’t think the president’s pronouncement will sway employers, the Human Rights Campaign’s state legislative director Sarah Warbelow has a different take.

"Hearing the president supports this as well makes this even easier for corporations to get on board," says Warbelow, adding that 58 percent of Fortune 500 companies currently offer domestic partner benefits. Some of those companies limit those benefits to same-sex couples, while others include domestic partners of opposite sexes.

The climate remains volatile, particularly for state and municipal employees. What, for example, will happen in states like North Carolina that passed a ban on same-sex marriage and have municipalities that offer domestic partner benefits to government workers?

With last week’s vote in North Carolina, there are at least 31 states that bar gay marriage.

In North Carolina, attorneys for cities such as Carrboro and Chapel Hill are still evaluating whether they can continue to offer domestic partner benefits, according to reports from the area’s local NBC television affiliate.

"We have employees asking us, 'What's going to happen?' These are people who otherwise wouldn't have health care, children who wouldn't have health care," Chapel Hill Mayor Mark Kleinschmidt told NBC-17 in Raleigh, N.C.

Court decisions in other states with similar laws have split on whether domestic partnership benefits can be retained for state or municipal workers, says Warbelow.

Meanwhile, private-sector employers must contend with a confusing array of state laws governing the types of unions residents may enter.

Eight states and the District of Columbia have passed laws to allow same-sex couples to marry, for example, while an additional nine allow civil unions or domestic partnerships, which offer many, if not all of the same legal protections as marriage. 

While many employer health programs are exempt from state law because they are self-insured, some employers buy coverage from insurers that are subject to state rules.

Employers who buy coverage from insurers in those states must follow that state’s law, even if the employees live another state, Smyth says.  

A separate Mercer report out last week gave an example set in Virginia: "Ellen and Sue live in Virginia, which doesn’t permit same-sex marriage. Ellen works in Washington, D.C., and is covered by a group health insurance policy issued in D.C., which must cover same- and opposite-sex spouses equally. Ellen and Sue marry in D.C., even though they live in Virginia. Ellen may add Sue to her health coverage because they are lawfully married and covered by a D.C. policy."

Employers are "focused on this right now and are watching" the changing political landscape to make sure they are in compliance with the rules, says Smyth. "They need to be really careful that they know the laws."

Kaiser Health News, an editorially independent news service, is a program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. Our stories appear in media outlets nationwide and on our website, www.kaiserhealthnews.org.

By Rachael Rettner
MyHealthNewsDaily

Colonoscopies could be made a bit more comfortable for people if they involved lying in a CT scanner, rather than being probed with an endoscope, and at the same time didn't require drinking upward of a gallon of laxative fluid beforehand — current requirements that most consider unpleasant.

A new type of "virtual colonoscopy" that uses CT scans to construct images of the colon, as well as to virtually "clean" the organ, was just as effective as a standard colonoscopy in finding colon polyps 1 centimeter or larger in size, a new study finds. Most polyps, or growths on the lining of the colon, are benign, but some can turn cancerous.

"The subtraction of the laxative can only make what's already an attractive test even more attractive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, who was not involved with the study.

The discomfort of colonoscopies may deter some people from getting screened, said study researcher Dr. Michael Zalis, an associate professor of radiology at Massachusetts General Hospital.

If this laxative-free, CT scan type of virtual colonoscopy becomes an option for colon cancer screening, Zalis said, it could increase the number of people who get screened, and thus reduce the number of deaths from the disease.

The laxative-free method was not as effective as a standard colonoscopy in finding polyps smaller than 1 centimeter, but polyps of this size are less likely to cause cancer, according to the National Institutes of Health. The new findings must be confirmed by larger studies before the test is put into practice, Zalis said.

The study is will be published Tuesday (May 15) in the journal Annals of Internal Medicine.

No laxative required

Each year, there are about 120,000 new cases of colon cancer in the United States, and 50,000 people die from the disease,Zalis said.

Several methods are available to screen for colon cancer, including blood and fecal tests. But the "gold standard" is the colonoscopy, and the type most commonly performed is the optical colonoscopy, which uses a fiber optic tube with a light and camera to examine the internal surface of the colon. Another method, computed tomographic colonography (CTC), uses images produced by CT scans to indirectly view the colon. Both methods require patients to drink a laxative the day before their procedure.

More than 90 percent of colon cancer screening is done with colonoscopies or the blood tests, Brooks said.

In the new study, 604 people ages 50 to 80 who were eligible for a colonoscopy received the new test — a laxative-free CTC. Participants were required to eat a low-fiber diet for two days before the procedure, and to ingest small doses of a contrast agent that labeled their stool so that it was distinct from the colon on an X-ray. About five weeks later, the same patients were given an optical colonoscopy.

The laxative-free CTC correctly identified 91 percent of people with polyps 1 centimeter (10 millimeters) or larger. The results for the optical colonoscopy test were similar; it identified 95 percent of people with polyps of this size.

However, the colonoscopy was better at finding smaller polyps: it correctly identified 76 percent of people with polyps 0.6 centimeters or larger, while laxative-free CTC identified 59 percent of people with polyps of this size.

Three cases of colon cancer were diagnosed in the study. These cases were detected by both screening methods.

Participants said the laxative-free method was more comfortable and easier to prepare for than the colonoscopy. Sixty-two percent said the laxative-free method was their preferred method of screening.

Not a 'game changer'?

While laxative-free screening might increase the number of people who get colon cancer screening, "I don’t think it will be the big game changer that [the authors] suggest," said Dr. John Monson, chief of the division of colorectal surgery at the University of Rochester Medical Center, in New York, who was not involved in the study.

There are many reasons people do not get screened for colon cancer besides the requirement of a laxative, Monson said. For instance, some find other aspects of the test not agreeable, and others may be frightened to know the results, he said.

All virtual colonoscopies have a disadvantage in that, if polyps are found during the test, a follow-up colonoscopy is needed to remove them, Monson said. In addition, while polyps larger than 10 millimeters confer the greatest risk of colon cancer, most doctors do not feel comfortable leaving behind polyps that are 0.6 centimeters in size, Monson said.

CTC is currently considered an accepted method of screening by the American Cancer Society, but not by the U.S. Preventative Services Task Force.

The ACS recommends that people who get virtual colonoscopies be re-screened in five years; those who get optical colonoscopies are recommended to wait 10 years between tests.

Zalis said laxative-free CTC might first be offered to people who have only a moderate risk of colon cancer (those 50 and older without a family history of the disease, or other risk factors, such as inflammatory bowel disease). Some people may also be unable to have a colonoscopy, for instance, if they cannot be sedated for a medical reason.

While CTC uses X-rays, the dose is much lower than that required for a CT scan used to diagnose disease, Zalis said. A study published in 2005 published in the journal Gastroenterology concluded the cancer risks associated with exposure to radiation from CTC are small.

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By Dr. Rohan Ramakrishna

Researchers from the University of Munich recently reported that they were able to awaken an 82-year-old woman who’d been in a persistent vegetative state by using injections of her own immune cells.

The woman, who had suffered a stroke, had been cared for at home by her family and a home health nurse -- for nine long years.

Then her doctors proposed an experimental new treatment, offering to give the octogenarian intramuscular injections of her own immune cells, specially activated in the laboratory to produce substances thought to modulate brain activity.

Remarkably, after starting the weekly injections, the patient began to respond to commands and even regain some movement in previously weakened limbs. She opened her eyes and turned toward people entering the room, grabbed the hands of her grandchildren (with both hands) and looked at them, and would voluntarily move her tongue when her teeth were brushed.

Although she’d been on a feeding tube for years, her swallowing reflex even began to return.

The implications of her awakening are truly astounding.

As a neurosurgeon who treats patients with traumatic brain injuries and serious strokes on a daily basis, I'm too often presented with a patient, who despite our team's best efforts, fails to awaken from a coma.

Sometimes the combination of time, patience and a tireless family results in a patient who wakes up six months after their injury. Other times, though, they don't -- primarily because no treatments are available to change the outcome for patients in persistent coma. But perhaps this new research will change that. 

According to the article, published in a recent issue of the Journal of Medical Case Reports, the doctors manipulated the patient’s own cells to somehow restore some brain function nine years after a devastating stroke, a claim few physicians can make.

Their results also suggest that injections of these sorts of cells might even be effective in patients who have recently suffered brain injury.

This news is especially significant since, despite decades of research in neuroscience and behavioral medicine, no therapies have emerged in the last 50 years that systematically reverse coma in patients that have suffered significant strokes or traumatic brain injuries. However, the last decade of neuroscientific research has produced a wealth of data regarding neural responses to injury and potential routes to neuronal rehabilitation and even restoration.

Modern medicine is quite good at rehabilitating patients who are awake but disabled from their brain injury. Specifically, physicians and physiatrists in the field of rehabilitation medicine do a superb job at retraining the mind to rewire around injury and compensate for functions that have been lost.  However, modern medicine still has yet to come up with a solution for patients who do not wake up. That’s why this research is so intriguing.

But these new findings also bring up a host of questions:

Could anything else have possibly explained the patient’s improvement? Were there side effects or potential complications to the treatment? Are there plans to test this treatment in a randomized fashion with a large number of patients?

All of these questions need to be considered before an experimental treatment can be considered for wider use. Until then, this research most certainly qualifies as fringe medicine.

It also reopens the debate regarding the care of patients in coma.

For example, is a person really alive if they are unable to meaningfully interact or comprehend the outside world? How you answer that question is a topic of much controversy, as it brings in religion, politics, medicine and culture (the Terri Schiavo case is a perfect example of how complicated -- and heated -- this issue can become). 

Another pertinent question: Is being alive the same thing as being human, a sentient being? If it isn’t, how do you reconcile the societal cost of medical care for persons who are alive but no longer awake? How do you reconcile the human cost? Does your answer to these questions change if there is a treatment that offers a tiny chance of improving the patient’s comatose condition?

In reality, the vast majority of patients in long-term deep coma or persistent vegetative state do not get better despite treatment. Even the 82-year-old woman who was "reawakened" by the use immune cells injections later died after aspirating her food and developing pneumonia.

However, research aimed at protecting or even restoring brain tissue from permanent damage after injury is always welcomed. It may demand further study, but for now, it offers a glimmer of hope to patients and their families.

Dr. Rohan Ramakrishna is a chief resident in neurological surgery at the University of Washington in Seattle.

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This, finally, may explain our cultural obsession with zombies: Long after dark, millions of Americans basically become one.

Without warning, they suddenly rise from their silent, supine states then roam aimlessly, eyes open and mouths sputtering gibberish.

About 8.5 million U.S. adults -- or 3.6 percent of the grownup population -- have taken at least one sleepwalking jaunt during the past year, according to research released today by the Stanford University School of Medicine. That figure, calculated via a survey of nearly 20,000 people, means there are far more nocturnal wanderers than scientists previously suspected.

“It’s something, we were thinking, that was not frequent among the general population. And here, big surprise, it is,” said Dr. Maurice Ohayon, professor of psychiatry and behavioral sciences at Stanford and lead author of the paper. A previous report done a decade ago in European adults showed that 2 percent of that population were sleepwalkers. “It’s astonishing.”

The finding offers American doctors their first, solid sleepwalking benchmark, Ohayon said. Earlier speculation on how often the phenomenon occurred were based on anecdotal clinical reports as well as court cases and media tales of people who had gone sleep-driving, sleep-shopping or sleep-eating. Typically, those more sensational examples were linked to Ambien use.

But Ohayon and his colleagues found no significant link between prescription sleeping pills and increased sleepwalking. What they did discover: Folks who take certain anti-depressants (selective serotonin reuptake inhibitors, or SSRIs) are three times more likely to also take a snoozy stroll than the general population, and people who swallow over-the-counter sleeping pills have a higher likelihood of experiencing sleepwalking episodes at least twice a month month.

Brand names for anti-depressants in the SSRI category include Prozac, Zoloft, Paxil, Lexapro and Celexa. Non-prescription sleep aids linked to increased sleepwalking by the Stanford team contained diphenhydramine. Products laced with that chemical include 40 Winks, Simply Sleep, Sleep-Eze, Sominex, Unisom Sleep, Advil PM, and Tylenol PM, according to the National Institutes of Health. 

Chronic sleepwalking also runs (rambles?) within certain families, Ohayon learned: Nearly one-third of individuals who often do it can point to parents, grandparents, uncles, aunts or siblings who have a history of shuffling while slumbering.

To assess the sleepwalking rate in America, Ohayon and his Stanford colleagues used phone interviews conducted with 19,136 randomly selected individuals from 15 states. The participants offered baseline information on their mental health, medical histories and use of medications. They were quizzed on the frequency of any sleepwalking episodes as well as whether they had ever suffered any inappropriate or possibly perilous behaviors while asleep.

What's more, participants were asked if they'd sleepwalked when they were kids and if any family members were known to take unintended, nighttime strolls. In addition to the more more than 3 percent of the U.S. population who sleepwalk chronically, the researchers found that 29.2 percent of the test sample had gone sleepwalking at least once during their lives. 

photaigraphy

Robert Budd, a personal trainer from Southern California, takes sleeping strolls about once a month, as do almost all the men in his family.

Personal trainer Robert Budd figures he sleepwalks about once a month. When he gathers with his kin, sleepwalking lore is a common topic: while seemingly in dreamland, his grandfather once urinated in a friend’s drawer, his uncle often meandered the decks of navy boats, and his dad dismantled tents and ceiling fans.

“All the boys in the family do it,” said Budd, who operates a gym called PHYZYKS in Encinitas, Calif. “I've done it since I was a kid. I would walk out the door and my parents had to grab me and get be back inside. The commonality with my family and myself is it seems to happen when we’re really tired, really drained. When you really need sleep, that’s when you get up and sleepwalk.”

Budd has sleepwalked out of a tent at the Grand Canyon (on the floor, not near the rim). His friends spotted him heading off alone -- apparently wide awake -- but he remembered nothing the next day. While dozing, he once packed for a vacation, even remembering his toothbrush. And there was the night he tried to climb out a second-floor window only to be stopped by the woman who is now his ex-wife.

Was that intended exit possibly symbolic, even for a sleeping man? “It might have been,” Budd said with a laugh.

“It drives my girlfriend drives nuts because sometimes we have conversations and she doesn’t know if I’m awake. Like, I can’t be accountable in the middle of the night.”

Sleepwalkers typically have their eyes open and may speak, making detection tricky. But Ohayon isn’t certain, he said, if they are actually seeing what’s in front of them or if sleepwalkers’ brains have simply mapped out their homes in their minds, allowing them not to bump into walls or furniture. He is sure they’re not dreaming, though, because sleepwalking coincides with a period of “slow-wave sleep” or SWS when brain activity is diminished.

During another sleep phase called REM (rapid eye movement), brain neurons are firing as if a person is awake. This is when you dream. A mechanism within the brain blocks stirring and shifting when you’re in REM sleep, Ohayon said.

“During slow wave sleep, you can move,” he added. “This is an old function of our brain, (possibly a evolutionary leftover). You know, when birds fly, they can sleep with one half of their brain, while the other half is analyzing the flight.

“That is why you see the bird going for thousand of kilometers without any problem. They sleep when they fly.”

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By Rachael Rettner
MyHealthNewsDaily

Smoking marijuana may improve some symptoms of multiple sclerosis, a new study suggests.

Patients with multiple sclerosis in the study had less muscle tightness, also called spasticity, and less pain after they smoked marijuana, compared with after they took a placebo.

Spasticity is a common symptom of multiple sclerosis (MS) and can cause exaggerated reflexes, spasms and problems walking. Existing medications can ease spasticity, but they cause side effects, and not all MS patients are helped by them.

However, patients in the study experienced short-term decreases in their abilities to pay attention and concentrate after they smoked marijuana. Patients also reported feeling "high" after smoking marijuana, and two patients withdrew from the study because they felt uncomfortably high.

More research is needed to confirm the findings and to investigate whether lower doses of marijuana may have similar benefits with fewer adverse effects, said study researcher Dr. Jody Corey-Bloom, professor of neurosciences and director of the Multiple Sclerosis Center at the University of California, San Diego.

The study is published today (May 14) in the Canadian Medical Association Journal.

Improved symptoms

Previous studies have suggested marijuana use may have benefits for MS patients, but most have investigated oral forms of the drug, including mouth sprays and capsules. In addition, most studies have asked patients to report changes in their symptoms, rather than having a researcher objectively assess them.

In the new study, Corey-Bloom and colleagues evaluated 30 MS patients, 19 of whom were female, and more than half of whom needed walking aids.

Participants were randomly assigned to receive treatment with a marijuana cigarette or a placebo cigarette, which did not contain delta-9-tetrahydrocannabinol (THC), the active ingredient of marijuana. Participants smoked a marijuana cigarette once a day for three consecutive days under the supervision of a researcher. Eleven days later, participants repeated the procedure, but this time, they switched treatment groups so that everyone received the marijuana cigarette and placebo at some point in the study. On average, participants smoked four puffs of their cigarettes at each session.

Shortly after each treatment session, the researchers assessed participants with a test specifically designed to measure spasticity.

After smoking marijuana, participants experienced a 30 percent reduction in spasticity, compared with when they smoked the placebo cigarette, Corey-Bloom said.

However, patients did not see improvements in the time it took them to walk 25 feet. And 45 minutes after their sessions, participants experienced a small but significant decrease in scores on tests designed to measure attention and concentration.

Participants were not told whether they recieved a placebo or a true marijuana cigarette, more than half correctly guessed the sessions when they were given marijuana.

Marijuana prescriptions?

The researchers are not advocating marijuana prescriptions for MS patients, Corey-Bloom said. They undertook the study to investigate whether anecdotal reports from MS patients about the benefits of marijuana smoking held up under the scrutiny of science. "I'm not a proponent for marijuana smoking at all," Corey-Bloom said.

Although cannabis may one day be used to treat spasticity in MS patients, delivery through a marijuana cigarette is "probably not the way that it would be done," because of the side effects patients experience, said Dr. Nicholas LaRocca, vice president of health care delivery at the National Multiple Sclerosis Society, who was not involved in the study. "The majority of people with MS experience cognitive changes at some point in their lives," LaRocca said. "We don’t want to add any additional cognitive deficits with treatment," he said.

Researchers are currently investigating other treatments for spasticity, including exercise and Botox injections. "We need to continue to explore all of those possibilities, because any given person with MS may respond better to one [treatment] than another," LaRocca said.

Because many studies have not found a benefit of marijuana for MS patients, and because the new study was small, it's important for researchers to replicate the findings, said Dr. Karen Blitz-Shabbir, director of the Multiple Sclerosis Center at North Shore-Long Island Jewish Health System in Manhasset, N.Y.

Marijuana cigarettes have disadvantages compared with oral forms of the drug, including potential effects on the lungs and problems with administrating a controlled dose, Blitz-Shabbir said.

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Nationwide Children's Hospital

Jackie Sherrill was shocked when her daughter, Morgan, 22 months, fell face-first with her bottle, cutting her lip and chipping a tooth.

Of all the things Jackie Sherrill had to worry about while juggling school, work and two kids, someone breaking a tooth on a baby bottle was least among them.

But that’s exactly what happened earlier this year, when Sherrill’s 20-month-old daughter, Morgan, took a nose-dive off a couch and landed face-first on the edge of an ottoman.

“She had her bottle in her mouth,” recalled Sherrill, 26, from Grove City, Ohio. “She must have hit right at that hard spot.”

The 9-ounce bottle of chocolate milk slammed into Morgan’s face, cutting her lip and chipping one of her baby teeth.

Sherrill, a nursing student, was able to calm her down and take her for treatment, but the incident was shocking: “You just don’t think of that,” she said.

It turns out that Morgan is among thousands of kids -- especially unsteady toddlers -- who get hurt every year while using bottles, pacifiers and sippy cups.  

The seemingly innocuous ba-bas and binkies caused cuts, bruises and other injuries serious enough to send 45,398 children under age 3 to the nation’s emergency rooms between 1991 and 2010, according to the first large-scale analysis of the problem. The findings were published Monday in the journal Pediatrics.

“Baby bottles, pacifiers and sippy cups are extremely popular. Basically every baby uses them at some point,” said Dr. Sarah A. Keim, the principal researcher for the center for behavioral health at Nationwide Children’s Hospital in Columbus, Ohio. “There really hasn’t been much research at all on these products.”

Keim and her colleagues looked at data collected by the National Electronic Injury Surveillance System, or NEISS, and then extrapolated information to the rest of the U.S.

To her surprise, Keim found that there were an average of 2,270 cases each year where child was hurt while using bottles, pacifiers or sippy cups.

Dr. Nancy Snyderman's safety tips for parents with young children

That’s a child treated every four hours, the researchers said.

In most of the cases, 86 percent, the kids were injured when they fell with the object. Bottles were involved in nearly two-thirds of the injuries, while pacifiers accounted for about 20 percent and sippy cups just over 14 percent. About 70 percent of youngsters suffered cuts, and about 70 percent were hurt on or near their mouths, the study found. Others suffered soft tissue or dental injuries.

The trouble wasn’t the kind most parents think of when they ponder harm from the objects, particularly pacifiers and sippy cups. More than 16 million pacifiers and 1 million sippy cups were recalled by federal officials since 1991, but usually it was because they posed risks of choking or poisoning by cup materials.

Instead, Keim noted, the injuries are the kind that occur when a child is moving around the home while drinking from a bottle or cup or sucking on a pacifier.

“They’re convenient, they help quiet a fussy child,” she said.

But, as the injuries indicate, they might also hold potential harm.

Part of the problem may be the widespread use of bottles, pacifiers and sippy cups long past when medical and child development experts advise.

Pacifier use is advised by the American Academy of Pediatrics, for instance, but usually during infancy, up to age 6 months, to help prevent sudden infant death syndrome, or SIDS.

The AAP and the American Academy of Dentistry advise that babies move directly from the bottle to a lidless cup by 12 months to prevent dental decay.

In real life, however, an Arizona study found that about 45 percent of children ages 13 months to 3years still used bottles. A 2011 Canadian study found that 86 percent of children ages 1 to 2 use sippy cups. And a 2008 study in the United Kingdom found that more than 18 percent of toddlers were still using pacifiers at age 3.

Clearly, cutting kids off cold turkey can be tough. But Keim said there are ways to allow children to enjoy their bottles and pacis and prevent injury, too.

“If kids are in the habit of sitting when they’re eating or drinking, it’s the kind of thing parents might want to consider,” she said.

In Jackie Sherrill’s case, Morgan’s accident marked the end of an era.

“She loves drinking out of regular cups anyway,” Sherrill said.

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