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A brain scan may predict alzheimer’s disease. Should you get one?

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Juli Engel was delighted when a neurologist recommended a PET scan to determine whether amyloid — the protein clumps associated with an increased risk of Alzheimer’s disease — was accumulating in her mother’s brain.


“My internal response was, ‘Yay!’” said Engel, 65, a geriatric care manager in Austin, Tex., who has been making almost monthly trips to help her mother in Florida. “He’s using every tool to try to determine what’s going on.”

Sue Engel, who’s 83 and lives in a retirement community in Leesburg, Fla., has been experiencing memory problems and other signs of cognitive decline for several years. Her daughter checked off the warning signs: her mother has been financially exploited, suffered an insurance scam, caused an auto accident.


Medicare officials decided in 2013, shortly after PET (positron emission tomography) amyloid imaging became available, that they lacked evidence of its health benefits. So outside of research trials, Medicare doesn’t cover the scans’ substantial costs ($5,000 to $7,000, the Alzheimer’s Association says); private insurers don’t, either.


Juli Engel thinks Medicare should reimburse for the scan, but “if necessary, we’ll pay for it out of pocket,” she said.


Her mother already has an Alzheimer’s diagnosis and is taking a commonly prescribed dementia drug. So she probably doesn’t meet the criteria developed by the Alzheimer’s Association and nuclear medicine experts, which call for PET scans only in cases of unexplained or unusual symptoms and unclear diagnoses.


But as evidence mounts that brain damage from Alzheimer’s begins years before people develop symptoms, worried patients and their families may start turning to PET scans to learn if they have this biomarker.


They have few alternatives. Scientists at Washington University in St. Louis announced on Thursday that they’ve developed a blood test for amyloid that can predict the development of plaques in the brain, but it is years away from use in doctors’ offices.


Some experts fear PET scans offer few benefits, at substantial costs. “There are lots of incentives, including financial incentives, for doing more testing and interventions,” said Dr. Kenneth Langa, a researcher at the University of Michigan and author of a recent article in JAMA Internal Medicine about diagnosis of early Alzheimer’s disease. “My hope is we’ll think hard about the unintended downsides.”

What downsides? Amyloid plaques occur commonly in older people’s brains, but not everyone with amyloid will develop dementia, which probably involves multiple factors. Nor does a negative PET scan mean someone won’t develop dementia.


Biostaticians at the University of California, Los Angeles, have calculated that a 75-year-old man with amyloid has a 17.2 percent lifetime risk of developing Alzheimer’s dementia; for a woman that age, with a longer life expectancy, the figure is about 24 percent.


That’s primarily because Alzheimer’s rates climb steeply at older ages, when people grow more likely to die of other causes before they can develop symptoms. (With additional biomarkers, or with the condition called mild cognitive impairment, the lifetime risk rises.)

But older people may also be among the 30 percent or so of those with amyloid deposits who, for unexplained reasons, retain normal cognition.


“If we start treating everyone with preclinical Alzheimer’s, we’ll treat a lot of people who would never have gone on to have dementia at all,” Dr. Langa said.


Moreover, what treatments would those be? Multiple trials have failed to find drugs that prevent, reverse or slow Alzheimer’s disease, perhaps because these treatments were introduced too late in the disease’s course.





©2019 The New York Times News Service


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Sick hospital workers often expose patients to contagious illness

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Hospital workers often come to work with contagious respiratory illnesses, against the recommendations of public regulators, a Canadian study suggests.


Nearly all of the 2,093 care workers in the study who had such symptoms came to work at some point while sick.


For the study, published in the Journal of Infection Control & Hospital Epidemiology, nurses, doctors, and support staff at nine across Canada filled in online illness diaries during four flu seasons, recording symptoms such as a runny or stuffy nose, fever, cough or scratchy throat.


Of the 1,036 participants who had contagious respiratory illnesses during the study period, 52% reported working on every scheduled day of work and 94.6% reported working at least one day of their illness.


The most common reason given for working while sick was that the illness seemed mild and manageable. Compared to other care workers, physicians were more likely to work while sick and nurses were less likely.


But nurses who thought their managers expected them to show up unless they were too sick were more likely to feel obligated to work.


For most people, in fact, feeling obligated was a driving factor behind their decision to come to work sick, as was their perceptions of what managers expected from them. Younger workers, and workers without paid sick leave, were more likely to say they could not afford to stay home.


“It is only by knowing these reasons that managers and employers can take steps to mitigate the risk of infection to other people,” said Brenda Coleman, senior study author of the study from the Dalla Lana School of Public Health, University of Toronto, in email to Reuters Health. Eleven percent of the hospital workers said they had come to work even while feeling miserable because they had “things to do.” Physicians were under-represented in the study, and self-reporting of the illnesses may also confound the results, the authors acknowledge in their report.


The US Centers for Disease Control and Prevention advises workers to take seven days off or consider temporary reassignment if they have a fever and respiratory symptoms.


The research team suggests that changing sick leave policies and cultural norms could help reduce the risk of disease transmission from sick health care workers to patients.


Also needed, the researchers say, is an understanding of how to balance the costs and risks of absenteeism by sick workers against the costs and risks of illness transmission associated with working while ill.


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First two cases of Ebola confirmed in Congo’s South Kivu: Officials

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A woman and her child were the first two cases confirmed with in Congo’s South Kivu region this week, opening a new front in the fight against the outbreak.


Health officials said on Friday that the latest cases were more than 700 km (430 miles) south of where the outbreak was first detected.


has killed at least 1,900 people in Democratic Republic of Congo over the past year. This is the second biggest toll ever and militia violence combined with local resistance have made the outbreak harder to contain.


The 24-year-old woman had been identified as a high-risk contact of another case in Beni, more than 700 km north, last month, according to a government statement issued on Friday.


She travelled by bus, boat and road with her two children to Mwenga, in South Kivu, where she died on Tuesday night, according to a slide from a presentation by health officials.


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Research shows how nordic walking may benefit breast cancer patients

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Nordic walking, an aerobic activity performed with walking poles similar to ski poles, may benefit patients with breast cancer, according to a review of existing research.


The low-impact exercise improved swelling, physical fitness, disability and quality of life, the study authors conclude in the European Journal of Cancer Care.


“The main strategy in rehabilitation for women with is a change of habits, where physical exercise is a fundamental tool,” said study co-author Jorge Torres of the Faculty of Educational Sciences and Sports at the University of Vigo in Pontevedra, Spain.


“It’s not easy to turn a sedentary person into an amateur athlete, so sports such as Nordic walking are accepted more easily,” Torres told Reuters Health by email, particularly since the activity doesn’t require expensive equipment, can be done in a group with others, and is easy to learn.


Introduced in the 1980s as a summer training exercise that was similar to cross-country, or Nordic, skiing, Nordic walking became more widespread in the 2000s. It’s now part of some exercise-based rehabilitation programs, especially in Northern Europe where it is more common, Torres noted.


He also owns a personal training company, Vigo Entrena, that creates physical activity programs for people with specific needs, including injuries, obesity, pregnancy, postpartum and women with breast cancer, and he specializes in Nordic walking training.


To see if this form of exercise helps women treated for to reduce side effects like arm swelling, and offers other benefits of exercise, Torres and his colleagues analyzed nine studies. Four studies were randomized controlled trials comparing Nordic walking to other activities; the other studies focused on specific effects of Nordic walking.


Periods of exercise in the studies ranged from 30 to 80 minutes and were performed on one to five days a week for up to 12 weeks.


In eight of the nine studies, Nordic walking had a positive effect on a number of symptoms, including lymphedema, fitness, upper-body strength, disability and perceptions of pain and swelling.


A handful of studies also showed improvements in depression, self-efficacy for managing pain and improvements in physical activity levels. They didn’t find any adverse effects, and the study participants seemed to stick with the programs.


The biomechanical gesture of Nordic walking, compared to just walking, seemed to counteract some of the side effects that can come from cancer treatment, such as shoulder-arm mobility and postural problems, the study team writes.


“(Many) health professionals and therapists do not realize that there are contraindicated exercises during breast cancer rehabilitation and that alternatives such as Nordic walking can be very effective,” Torres said.


“Nordic walking is a structured form of physical activity which nowadays has been shown to be ‘more complete’ than basic walking,” said Marco Bergamin of the University of Padova in Italy, who wasn’t involved in the research review.


“Another important point that is less stressed by these authors: quality of life,” Bergamin said in an email. “Nordic walking gives huge benefits because breast cancer patients are survivors, and from a socio-psychological point of view, that really impacts their life.”


Future studies should also investigate the intensity, frequency, duration, and length of exercise needed to help breast cancer patients, said Lucia Cugusi of the University of Cagliari in Italy, who also wasn’t involved in the review.


“What is most evident is the growing interest of the scientific community in tracking the needs, interests and preferences of patients,” Cugusi said by email.


“Offering them novel forms of physical activity that are both effective and engaging has become one of the new and stimulating research fields in cancer therapy and management.”


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