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New Zika estimate suggests millions of cases went unreported

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The Zika epidemic, which began as a mosquito-borne viral infection and led to severe birth defects, affected far more people than previously thought, new research shows.

For the study, researchers analyzed data from 15 countries and territories in South America, Central America and the Caribbean with a combined population of 507 million, and concluded that they had over 132 million Zika infections between 2015 and 2018.

That’s far more than the 800,000 infections estimated by the Pan American Health Organization, a regional office of the World Health Organization.

The study authors said that the results show the need to improve current infectious disease surveillance systems — especially for diseases that yield a high number of asymptomatic infections.

“Fewer than 1% of cases were actually reported and it shows our surveillance systems catch only a small percentage of actual infections,” said study author Sean Moore. He’s a research assistant professor of biology at the University of Notre Dame, in Indiana.

Moore pointed to some similarities with the current coronavirus pandemic.

“Between 20% and 50% of Zika infections are asymptomatic,” he said. “Even when symptoms are present, they tend to be mild, so if the infection is not severe enough for an individual to seek medical attention, those cases can go undiagnosed.”

While Zika cases have dropped substantially since 2018, potential future outbreaks remain a concern.

“Our research suggests a need for a better understanding of how much transmission is happening within a community,” Moore said. “The risk of congenital birth defects in pregnant women infected with Zika virus required a separate surveillance system — testing both the mother and the baby — to capture a more accurate indicator of underlying transmission.”

Without widespread testing and a comprehensive surveillance, Moore said experts can miss how large an outbreak is in the general population.

The report was recently published online in the journal PLOS Neglected Tropical Diseases.

More information

The U.S. Centers for Disease Control and Prevention has more on Zika virus.

Copyright 2020 HealthDay. All rights reserved.



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‘Polypill’ reduces risk for heart attack, stroke by up to 40%, study finds

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Nov. 13 (UPI) — A so-called “polypill” that combines three blood pressure medications and a cholesterol-lowering drug, when taken with aspirin, reduces risk for heart attack or stroke by up to 40%, according to a study published Friday by the New England Journal of Medicine.

Taken alone, the combination drug — which is not available in the United States — lowers a person’s risk for heart attack or stroke, as well as the need for angioplasty or other types of heart surgery, by 20%, the data showed.

When administered with aspirin — with its proven ability to prevent heart attacks by stopping blood clots — the combination works to decrease the risk for these cardiovascular events by twice as much as without it, the researchers said.

“Studies of polypills, now including ours, have shown that they reduce risk by 30% to 40%,” study co-author Dr. Salim Yusuf told UPI.

“We hope our findings add to the momentum created by other similar studies and push drug manufacturers to make these products available in North America,” said Yusuf, a professor of medicine at McMaster University in Canada.

Currently, polypill therapies have been approved and are available for use in Europe and South America, as well as in parts of Asia and Africa, according to Yussef.

U.S.-based drug manufacturers have yet to initiate clinical trials of similar products, despite the positive findings, he said.

Although the formulation of polypills varies from country to country, the product used in this study contained 40 milligrams of simvastatin, 100 mg. of atenolol, 25 mg. of hydrochlorothiazide and 10 mg. of ramipril, according to the researchers.

Simvastatin, also sold under the brand name Zocor, is used to treat high cholesterol, while atenolol, hydrochlorothiazide and rampiril are all blood pressure medications.

Heart disease causes roughly 18 million deaths each year, and more than 40 million people around the world have heart attacks or strokes annually, based on World Health Organization estimates.

In the United States, about 18.2 million adults age 20 and older have heart disease, according to the Centers for Disease Control and Prevention.

The new study was conducted in 89 centers in nine countries and coordinated by the Population Health Research Institute at McMaster University and Hamilton Health Sciences.

For the study, Yusuf and his colleagues assessed the effects of the polypill alone or in combination with aspirin in 5,714 men aged 50 years and older and women aged 55 years and older.

Those who took the polypill with aspirin used a low dose of 75 mg. per day for the aspirin.

After following study participants for an average of about five years, the researchers found that 4.4% of those who took the polypill alone had a heart attack, stroke, heart procedure or died from heart-related causes, compared with 5.5% of those given a placebo.

Of those who took only aspirin, 4.1% suffered these heart-related events, according to the researchers. Similarly, about 4.1% of those who took the polypill with aspirin experienced heart complications, the data showed.

The chief benefit of the polypill, in addition to its effectiveness, is convenience, as it means those for whom treatment is needed will have to take only one pill daily, instead of three or four, Yusuf said.

This should improve compliance with prescribed treatments, he added.

“In addition to stopping smoking, the most modifiable risk factors for cardiovascular disease are high blood pressure and elevated cholesterol,” Yusuf said.



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Healthy diet lowers erectile dysfunction risk by 20%, study finds

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Nov. 13 (UPI) — A healthy diet reduces men’s risk for erectile dysfunction by more than 20%, according to a study published Friday by JAMA Network Open.

Men with scores on the Mediterranean Diet scale and the Alternative Healthy Eating Index-2010 in the highest percentiles were 22% less likely to develop erectile dysfunction, or ED, than those with lower scores, the data showed.

The benefits of healthy diet were also seen in older men, with higher Mediterranean Diet scores associated with an 18% reduction in the risk for ED in men aged 60 years and older and a 7% reduction in ED risk in men aged 70 years and older.

Men with healthier diets are less likely to have diabetes, heart disease or high blood pressure — three health conditions linked with ED, according to the researchers.

They suggest that linking a healthy diet with reduced risk for ED might encourage men to make better food choices, which in turn would help prevent heart disease and high blood pressure, among other conditions.

“These findings suggest that men who are concerned about erectile dysfunction risk should be counseled regarding the potential contribution of their dietary practices,” the researchers, from the University of California-San Francisco and Harvard T.H. Chan School of Public Health, wrote.

The Mediterranean diet centers on meals built around vegetables, fruits, herbs, nuts, beans and whole grains with moderate amounts of dairy, poultry, eggs and seafood and minimal consumption of red meat, according to the Mayo Clinic.

The Mediterranean diet score awards a point each for consuming above the average intake of vegetables, legumes, fruits and nuts, grains, fish, and for consuming less than the average amount of dairy and red or processed meat as well as alcohol, the researchers said.

Alternative Healthy Eating Index-2010 evaluates individual diets based on compliance with the Healthy Eating Pyramid, rewarding higher intake of fruits, vegetables, whole grains, nuts and legumes, polyunsaturated fats and omega-3 fatty acids.

It also rewards lower intake of red and processed meats, sugar-sweetened beverages, trans fats and sodium, according to the researchers.

Among the more than 21,000 men included in this study, 968 developed ED.

Of the ED cases, 478 occurred in men with the lowest Mediterranean diet scores, compared to 229 among men with the highest scores, the data showed.

There were 130 cases of ED among men with the highest Alternative Healthy Eating Index-2010 scores, or half as many as those reported in men — 266 — with lower scores, the researchers said.

Men with ED is may be unable to get or keep an erection firm enough to have sexual intercourse, according to the National Institutes of Health.

Up to 15% of men in the U.S. experience the condition, which is treatable, at some point in their lives, research suggests.



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Study: Black patients get worse care after cardiac arrest

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Minority patients who suffer life-threatening cardiac arrest may get fewer treatments in the hospital — and face a grimmer outlook — than White patients, a new, preliminary study suggests.

The findings add to a large body of research finding racial disparities in U.S. health care, including heart disease treatment.

What’s different is that the study looked at a “particularly dramatic presentation” of heart disease, said senior researcher Dr. Saraschandra Vallabhajosyula.

The study focused on over 180,000 Americans who were hospitalized for a heart attack and suffered cardiac arrest as a complication. During cardiac arrest, the heart stops beating normally and can no longer pump blood and oxygen to the body. It’s fatal within minutes without emergency measures.

There are “very clear-cut” guidelines on how to manage cardiac arrest, as well as guidelines on heart attack care, said Vallabhajosyula, an interventional cardiology fellow at Emory University, in Atlanta.

Yet, his team found, there were racial disparities in certain aspects of hospital care.

Compared with white patients, minority patients were less likely to undergo an angiogram, an imaging technique that looks for blockages in the heart arteries. Just under 62% of Black patients had an angiogram, versus 70% of Asian, Hispanic and Native American patients, and 73% of White patients.

Similarly, while 58% of White patients had angioplasty to clear any heart blockages, that was true for only 45% of Black patients and 53% of other minority patients.

Disparities were seen in survival, as well. As a group, Asian, Hispanic and Native American patients were 11% more likely to die in the hospital than white patients were. The exception was Black patients, whose death risk was not elevated once factors like overall health were taken into account.

The reasons for the findings are unclear, according to Vallabhajosyula. One potential factor is the hospitals — if, for instance, minority patients tended to land in hospitals with fewer resources.

But Vallabhajosyula said his team accounted for broad hospital characteristics — whether they were rural or urban, for example — and that did not fully explain the racial inequities.

The findings were scheduled for presentation this week at the American Heart Association’s virtual annual meeting. Studies presented at meetings are generally considered preliminary.

But a body of research has documented long-standing racial disparities in heart attack care, with Black patients less likely than White people to get angiograms and more aggressive treatments like angioplasty and bypass surgery.

And the gap has not narrowed much over the years.

“This study is yet another example of persistent racial disparities in care throughout the U.S. health care system,” said Dr. Khadijah Breathett, an assistant professor of cardiology at the University of Arizona College of Medicine, in Tucson.

In her own research, Breathett has found racial gaps in care for heart failure — a serious chronic condition that disproportionately strikes Black Americans.

In one study, Black patients hospitalized for worsening heart failure were less likely to be treated by a cardiologist, versus White patients. And care from a cardiologist was linked to better survival.

Breathett called the new findings “worrisome,” partly because hospital care for these acute cardiac complications should be “fairly regimented and standardized.”

Government figures show that Black Americans have the highest death rates from heart disease of all racial groups. That’s due to a mix of factors, from socioeconomics and lack of health insurance to institutional racism.

When it comes to disparities in care, Breathett said “the elephant in the room” is health care providers’ own implicit biases.

In one study, Breathett and her colleagues asked a group of providers to consider whether a heart transplant should be recommended to various hypothetical patients — all Black or White men.

Overall, providers tended to perceive Black men as less healthy than white men, and less likely to stick to post-transplant care.

On the positive side, Breathett said there is evidence that training can help health care providers recognize their own biases.

She said that medical centers should “do the hard work” of finding out where disparities exist within their own walls, and then address them.

Vallabhajosyula agreed that medical professionals need to evaluate themselves. “Are we carrying implicit biases that affect our care decisions?” he said.

And when it comes to cardiac arrest, Vallabhajosyula noted, even lay people’s biases might matter.

Quick action from bystanders — including CPR chest compressions — can make the difference between life and death for cardiac arrest victims.

Yet studies have found that people are more hesitant to perform CPR on women than men — partly out of fear over hurting them, or being accused of sexual assault.

“It’s crucial,” Vallabhajosyula said, “that we keep promoting bystander CPR and educating people on when and how to do it.”

More information

The U.S. Centers for Disease Control and Prevention has more on racial disparities in heart disease.

Copyright 2020 HealthDay. All rights reserved.



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