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Face shields a potential alternative to masks, experts say

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Hundreds of millions of Americans heeded recent government advice and rushed to wear cloth face masks, hoping they might prevent transmission of the new coronavirus.

But there’s another option: The clear plastic face shield, already in use by many health care personnel.

Now, a team of experts say face shields might replace masks as a more comfortable and more effective deterrent to COVID-19.

“Face shields, which can be quickly and affordably produced and distributed, should be included as part of strategies to safely and significantly reduce transmission in the community setting,” said a trio of physicians from the University of Iowa.

Reporting in the April 29 Journal of the American Medical Association, experts led by Dr. Eli Perencevich, of the university’s department of internal medicine, and the Iowa City VA Health Care System, said the face shield’s moment may have come.

While the U.S. Centers for Disease Control and Prevention began advocating the use of cloth masks to help stop COVID-19 transmission in April, laboratory testing “suggests that cloth masks provide [only] some filtration of virus-sized aerosol particles.”

According to Perencevich’s group, “face shields may provide a better option.”

To be most effective in stopping viral spread, a face shield should extend to below the chin. It should also cover the ears and “there should be no exposed gap between the forehead and the shield’s headpiece,” the Iowa team members said.

Shields have a number of advantages over masks, they added. First of all, they are endlessly reusable, simply requiring cleaning with soap and water or common disinfectants. Shields are usually more comfortable to wear than masks, and they form a barrier that keeps people from easily touching their own faces.

When speaking, people sometimes pull down a mask to make things easier — but that isn’t necessary with a face shield. And “the use of a face shield is also a reminder to maintain social distancing, but allows visibility of facial expressions and lip movements for speech perception,” the authors pointed out.

And what about the ability of a face shield to prevent coronavirus transmission?

According to the Iowa team, large-scale studies haven’t yet been conducted. But “in a simulation study, face shields were shown to reduce immediate viral exposure by 96 percent when worn by a simulated health care worker within 18 inches of a cough.”

“When the study was repeated at the currently recommended physical distancing distance of 6 feet, face shields reduced inhaled virus by 92 percent,” the authors said.

No studies have yet been conducted to see how well face shields help keep exhaled or coughed virus from spreading outwards from an infected wearer, Perencevich and his colleagues said, and they hope that studies on that issue will be conducted.

And they stressed that face shields should only be one part of any infection control effort, along with social distancing and hand-washing.

There will never be any intervention — even a vaccine — that can guarantee 100 percent effectiveness against the coronavirus, the authors said, so face shields shouldn’t be held to that standard.

Dr. Robert Glatter is on the front lines of the COVID-19 pandemic in his role as emergency physician at Lenox Hill Hospital in New York City. Reading over the new report, he agreed that “common sense” measures are crucial in curbing infections.

“One approach that makes the most sense, especially in light of the limitations of face masks and face coverings, is the use of face shields,” Glatter said.

“While we don’t have hard trials or data on the efficacy of face shields at this time, early data from their use in patients with influenza [which is droplet-spread] is promising,” he noted. “What’s clear is that their success in hospital settings provides the basis for their utility in the community setting as we relax physical distancing going forward.”

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The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

Copyright 2020 HealthDay. All rights reserved.



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New veterans have 93% higher risk for suicide than general public, study finds

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Sept. 11 (UPI) — New military veterans are 93% more likely to die by suicide than the general public, an analysis published Friday by JAMA Network Open found.

The assessment, which focused on nearly 1.9 million service members that left the military between 2010 and 2017, found that more than 3,000 service of them died by suicide, with the vast majority of them — just over 94% — men.

The study found men were more than three times as likely to die by suicide after transitioning to civilian life than women, the researchers said.

Younger members, 17 to 19 years old, were 4.5 times as likely to die by suicide after leaving the service than older veterans — those 40 years old and older — according to the researchers.

“National leaders at the highest levels of the U.S. government have been concerned about suicide rates among service members transitioning to civilian life,” wrote the researchers, who are from the Veterans Affairs Puget Sound Health Care System in Washington.

“We believe this cohort study provides much-needed data to help inform prevention efforts among this veteran cohort,” they wrote.

More than 78,000 veterans died by suicide between 2005 and 2017, when a high 6,139 suicide deaths were reported, according to the Department of Veterans Affairs.

In addition, suicide rates across the United States have been increasing since at least 2000, and suicide has been the 10th leading cause of death in the country since 2008, the Centers for Disease Control and Prevention reported last month.

To address the issue, several branches of the service, including the Army and the National Guard, have stepped up suicide prevention initiatives, particularly since the start of the COVID-19 pandemic, when leaders became concerned that veterans isolating themselves to prevent infection would as a result stop accessing support services.

In the JAMA Network Open analysis, among those who left the military from the beginning of 2010 through the end of 2017, suicide rates were highest among American Indian and Alaska Native service members — 56 per 100,000 veterans — and White American service members — 46 per 100,000 veterans.

Marine Corps veterans were more than twice as likely to die by suicide than those of other branches of the military.

Veterans without a high school degree were 71% more likely to commit suicide, the data showed.

Those who were single or never married had a 21% higher risk for suicide, while those who were divorced, separated or widowed had a 43% higher risk, according to the researchers.

Suicide rates among service members peaked six to 12 months after separation from the military, the data showed.

“This pattern was true for service members who left the Army, Marine Corps or Air Force, [while] the rates for those who last served in the Navy peaked three to six months after their transition,” the researchers wrote.

“After transition, veterans can face challenges in a variety of areas, including employment, finances, mental health, access to health care and social support.”



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Common meds linked to faster mental decline in seniors

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A group of widely used medications might speed up older adults’ mental decline — especially if they are at increased risk of dementia, a new study hints.

The medications in question are called anticholinergics, and they are used to treat a diverse range of conditions — from allergies, motion sickness and overactive bladder to high blood pressure, depression and Parkinson’s disease.

The drugs are known to have short-term side effects such as confusion and fuzzy memory.

But studies in recent years have turned up a more troubling connection: a heightened risk of dementia among long-term users.

The new findings, published Sept. 2 in Neurology, add another layer: Healthy older adults on these medications had an increased risk of developing mild cognitive impairment. That refers to subtler problems with memory and thinking that may progress to dementia.

And the link, researchers found, was strongest among two groups of people already at heightened risk of Alzheimer’s disease: those who carry a gene variant that raises the odds of the disease, and people with certain biological “markers” of the disease in their spinal fluid.

The results do not prove anticholinergic drugs are to blame, cautioned Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

“This study shows an association in a very specific population, but it does not prove causation,” said Snyder, who was not involved in the research.

However, it is biologically plausible that the drugs could increase dementia risk, said Dr. Allison Reiss, an associate professor at NYU Long Island School of Medicine.

The medications, she said, block a chemical called acetylcholine, which transmits messages among nerve cells. Acetylcholine is involved in memory and learning, and is typically low in people with Alzheimer’s.

“The preponderance of evidence suggests it’s better to avoid these medications in older adults,” said Reiss, who is also an advisory board member at the Alzheimer’s Foundation of America.

That’s especially true, she added, when alternatives exist.

Many medications sold for allergies, colds and coughs have anticholinergic properties — and are available over-the-counter. So it’s important, Reiss said, that older adults be aware that non-prescription drugs are not automatically “safe.”

“You don’t want to add any medications that aren’t necessary,” said Reiss, who had no role in the study.

Meanwhile, certain prescription drugs for depression, high blood pressure, Parkinson’s disease and schizophrenia have anticholinergic properties, as do medications for overactive bladder and urinary incontinence.

Reiss said that people with questions about their prescriptions should talk to their doctor.

For the new study, researchers led by Lisa Delano-Wood, from the University of California, San Diego, followed 688 older adults who initially had no problems with memory or thinking skills. One-third said they’d been regularly taking anticholinergic drugs for more than six months — usually far more than one.

In fact, they were taking an average of almost five medications per person.

Over the next 10 years, people on anticholinergics were more likely to develop mild cognitive impairment, which was gauged through yearly tests. Over half — 51% — developed the condition, versus 42% of older adults not taking anticholinergics.

The researchers did consider other factors that affect dementia risk — such as people’s education levels and history of heart disease or stroke. And after adjusting for those factors, older adults on anticholinergics were still 47% more likely to develop mild impairment.

The link was even stronger among people who carried a gene variant that raises Alzheimer’s risk: Anticholinergic use more than doubled their risk of impairment. A similar pattern was seen among study participants with Alzheimer’s-linked proteins in their spinal fluid.

That, Reiss said, suggests the medications might have “accelerated a process that was already in place.”

Snyder said the results “illustrate that we need better treatments — not only for Alzheimer’s and other dementias, but for other common conditions associated with aging.”

More information

The University of British Columbia has more on anticholinergic drugs.

Copyright 2020 HealthDay. All rights reserved.



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Even ‘social smokers’ up their odds of death from lung disease

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Even light smokers are much more likely to die of lung disease or lung cancer than nonsmokers, a new study warns.

“Everyone knows that smoking is bad for you, but it’s easy to assume that if you only smoke a little, the risks won’t be too high,” said study co-leader Pallavi Balte, of Columbia University Irving Medical Center, in New York City.

The new study shows how wrong that thinking can be. It included nearly 19,000 people in the United States, average age 61, who were followed for an average of 17 years. During that time, nearly 650 died of lung disease (such as emphysema) and 560 died of lung cancer.

Among nonsmokers, less than 2% died from lung disease and less than 1% died from lung cancer. But among social smokers (fewer than 10 cigarettes a day), those numbers were over 3% and close to 5%, respectively.

Not surprisingly, heavy smokers (more than 20 cigarettes a day) fared worst, with more than 10% dying from lung disease and about 13% from lung cancer, the study found.

After accounting for other potential factors — such as age, sex, race, level of education and body weight — the researchers concluded that social smokers were 2.5 times more likely to die of lung disease and 8.6 times more likely to die of lung cancer than nonsmokers.

Social smokers had around half the rate of death from lung disease as heavy smokers, but their rate of lung cancer death was two-thirds that of heavy smokers, according to the study.

The results were scheduled for presentation at a virtual meeting of the European Respiratory Society. Data and conclusions presented at meetings should be considered preliminary until peer-reviewed.

The findings show that cutting down on smoking is no substitute for quitting, the researchers concluded.

“Previous research suggests that people are cutting down on smoking. For example, in the U.S.A., the proportion of smokers smoking less than 10 cigarettes per day has increased from 16% to 27%,” Balte said in a society news release.

“You might think that if you only smoke a few cigarettes a day you are avoiding most of the risk. But our findings suggest that social smoking is disproportionately harmful,” Balte said.

If you don’t want to die of lung cancer or respiratory disease, the best action is to quit completely, she added.

More information

The U.S. Centers for Disease Control and Prevention offers a guide for quitting smoking.

Copyright 2020 HealthDay. All rights reserved.



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