Dangerous Urinary Tract Infections Common in Nursing Homes

By E.J. Mundell
HealthDay Reporter

FRIDAY, June 10, 2016 (HealthDay News) — Urinary tract infections (UTIs) in nursing home residents can often have serious effects, including delirium, debilitating falls and even fatal blood infections.

Now, new research finds the infections are common in nursing homes, often due to a lack of proper prevention.

UTIs “can have a devastating impact on frail, debilitated individuals,” said Donna Armellino, a nurse and vice president of infection prevention at Northwell Health, in Lake Success, N.Y. She reviewed the new findings.

“It is obvious, based on this random survey of nursing homes, that there is a lack of education and inconsistent practices that can raise the risk for infection,” she said.

In younger people, UTIs can be a painful nuisance that is usually treated with an antibiotic. But in the infirm elderly, the risk to health can be much greater, another expert explained.

“UTIs in the elderly can have a significant health impact by leading to a confused delirious state or — if undiagnosed — leading to dehydration or infection in the bloodstream,” explained Dr. Paula Lester, a geriatrician at Winthrop-University Hospital, in Mineola, N.Y.

Since so many nursing home residents suffer from dementia, or have conditions that rob them of their ability to communicate, identifying a UTI can be difficult, she said.

“Nonverbal patients, or those with cognitive impairment, usually cannot report traditional UTI symptoms of painful urination, foul odor of urine or increased frequency of urination,” Lester noted.

So, how good a job are U.S. nursing homes doing in preventing these infections?

To find out, a team from New York City’s Columbia University School of Nursing surveyed 955 nursing homes in 2014. The researchers also analyzed data from the Centers for Medicare and Medicaid Services.

They found that in any given month, for over 88,000 nursing home residents in the study, an average of 5.4 percent of them — more than 4,700 people — had suffered a UTI.

As Armellino noted, catheters used in nursing home care can be a prime source of the infections.

UTIs often occur “when bacteria enters the urinary tract through the urethra and move up the tract to infect the bladder or kidneys,” she explained. “This infection is often related to an inserted device referred to as an indwelling urinary catheter.”

In fact, in the Columbia study, nursing home residents with catheters were four times more likely to get a UTI than those without catheters.

However, UTIs were more often linked to causes other than catheter use, according to the study.

The findings were presented this month at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), in Charlotte, N.C.

“What was particularly interesting about this study was that there were more UTIs that were not associated with catheterization than those that were,” said study lead author Carolyn Herzig, project director at Columbia’s School of Nursing.

“This means that a larger focus should be placed on identifying practices to prevent UTIs — regardless of catheter placement,” she said in an APIC news release.

Nursing homes typically have four main ways of lowering UTI rates, Herzig’s team noted. However, facilities rarely implemented such measures.

For example, nursing homes that used portable bladder ultrasound scanners to confirm that a patient had voided all urine were 10 percent less likely to have high rates of UTIs not associated with catheter use.

Unfortunately, only about one in every five facilities surveyed had this policy, the researchers found.

Another helpful policy: regularly cleaning the urine collection bag attached to the resident’s leg. That step cut catheter-linked UTI rates by 20 percent.

However, only 44 percent of facilities had this policy in place, Herzig’s team found.

Nursing homes with “infection preventionists” on staff — who also took a national course through APIC — were also 20 percent less likely to have high rates of UTIs, the study found.

But again, only 9 percent of the nursing homes in the study had such staff.

APIC President Susan Dolan said the issue is only going to get more pressing with time.

“Infection prevention in long-term care is going to become an increasingly important issue because of the aging of the U.S. population,” she said in the news release. “Every day, 8,000 baby boomers reach the age of 65, and by 2020 the number of older adults will outnumber the number of children younger than 5.

“Recognizing the severity of UTIs for older adults, and implementing policies in nursing homes and long-term care facilities to prevent and effectively treat these infections, is critical,” she concluded.

Armellino agreed.

“A UTI can also go beyond infection of the urinary tract and the bacterium can go into the bloodstream and potentially result in death,” she said. “Standards of care to minimize a UTI exist in acute care facilities and are imbedded into bedside practice, but it appears to be lacking in long-term care facilities.”

She said that quality nursing homes can help prevent UTIs by make sure the patient is mobile when possible, has “regular toileting” and is kept clean and dry.

According to Armellino, other things to look for if you visit an infirm loved one in a nursing home include:

  • Making sure that urinary catheters are inserted “only when clinically needed,” assessed daily and removed when no longer necessary.
  • Urine collection bags are kept below the bladder.
  • Urine flows freely in the drainage tube.
  • The device is “secured to the leg to minimize movement.”
  • Patients are washed frequently with soap and water.
  • Staff members use proper hand hygiene before and after touching the catheter device.

Armellino stressed that since a UTI is always a possibility when catheters are in place, “residents with an indwelling urinary catheter require continuous assessment for symptoms related to infection.”

If a UTI is detected, “prompt and appropriate treatment to minimize progression of the infection into the bloodstream and potentially avoiding hospitalization,” she said.

Because this research was presented at a medical meeting, the findings should be considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on urinary tract infections in older adults.


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Waistline May Predict Heart Disease Better Than Weight

By Don Rauf
HealthDay Reporter

SATURDAY, April 2, 2016 (HealthDay News) — When it comes to heart health, new research adds to the argument that a pear-shaped body, which is heavy in the hips, may be better than an apple-shaped body, which carries more weight around the belly.

A study of diabetes patients found that increasing waist size appears to be a stronger predictor of serious heart disease than body weight or body mass index (BMI, the weight-to-height ratio).

“We have known that abdominal obesity is more linked to coronary atherosclerosis [plaque buildup in the arteries] than other forms of obesity,” said Dr. Brent Muhlestein, a study author and co-director of research at the Intermountain Medical Center Heart Institute in Salt Lake City.

“We found that left ventricle heart function got worse with progressive waist circumference. The relation between left ventricle function and waist circumference remained highly significant, even after adjusting for body weight,” Muhlestein said.

The left ventricle is the heart’s primary pumping chamber, and abnormal ventricular function is a common cause of heart disease, including congestive heart failure, the study authors noted.

Muhlestein added that reducing your waist size may reduce your risks.

For this investigation, scientists measured waist circumference, total body weight and BMI in 200 men and women with type 1 or type 2 diabetes. Diabetes can raise heart risks, but patients did not start the study with any symptoms of heart disease.

The researchers evaluated the heart function of study participants by using echocardiography — a type of ultrasound. They noted that left ventricular function got progressively worse as waist sizes got bigger, with heart decline eventually leveling off at 45 inches of waistline.

The study authors noted that the link between waist circumference and reduced heart function was independent of total body weight and BMI.

Dr. Sarah Samaan, a cardiologist and physician partner at the Heart Hospital at Baylor in Plano, Texas, said these results support previous research indicating that fat in the abdominal area is much more risky than fat elsewhere in the body.

“Abdominal fat produces a wide range of inflammatory substances, and is more highly correlated with heart disease, high blood pressure and diabetes than other types of fat,” said Samaan, who was not involved with the study. “We know that heavier people are more likely to have stiffer hearts, which in turn can predispose to heart failure. This study shows us that fat in the abdominal area is especially harmful to heart function.”

When compared to men, women in the study in general had better heart function at each increasing level of abdominal obesity. “In general, abdominal obesity had a greater adverse effect on men than women,” Muhlestein said.

He said women are advised to maintain a waist size of about 34 inches or less, while men should try to keep their waist circumference at 40 inches or less.

Previous research from the same team of scientists at Intermountain Medical Center Heart Institute and Johns Hopkins Hospital in Baltimore showed that the greater your BMI, the greater your risk of heart disease.

Exercise and diet remain the mainstays of treatment for all obese persons, including those with an apple shape, said Muhlestein. “This study emphasizes, however, that those of us who have an apple shape should perhaps be even more motivated to reduce all of our cardiovascular risk factors, including our waist circumference,” he said.

Samaan added that aerobic exercise is the best type of exercise to burn belly fat.

“While crunches may strengthen the abs, they won’t necessarily burn abdominal fat,” she said. “Also, smokers tend to hold more belly fat, even if their total body weight is normal, so quitting smoking may help.”

The report was to be presented Saturday at the annual meeting of the American College of Cardiology, in Chicago. Until published in a peer-reviewed medical journal, data and conclusions presented at meetings are usually considered preliminary.

More information

The American Heart Association has more on how body composition affects heart health.


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Genetic Tests May Not Change People's Unhealthy Ways

By Karen Pallarito
HealthDay Reporter

WEDNESDAY, March 16, 2016 (HealthDay News) — Genetic tests that predict people’s risk for disease are becoming more common, but a new analysis suggests that having that information doesn’t mean people act on it.

British researchers reviewed the results of 18 studies that looked at whether communicating DNA test results for conditions such as cancer and heart disease led people to make healthy changes.

They found no evidence that people adopted healthier behaviors, such as quitting smoking or eating more healthfully, after receiving their DNA results.

Individuals were neither motivated to make healthy changes nor discouraged from doing so, the review authors noted.

Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, led the investigation. She said the reviewed studies did not address why test results failed to promote risk-reducing behaviors.

The most likely reason is that “risk perceptions have at best only a small influence on behavior,” she said.

The analysis was published March 15 in the BMJ.

Isaac Lipkus, a professor at the Duke University School of Nursing in Durham, N.C., who studies risk communication, said the medical literature shows “weak, if any, effects of providing genetic information on behavior change.”

But Mary Freivogel, a cancer genetic counselor in Denver, wondered how DNA results in the Cambridge analysis were delivered to patients.

For those who did not receive genetic counseling, it’s like “giving someone an unassembled tool with hundreds of pieces without any instructions,” said Freivogel, president-elect of the National Society of Genetic Counselors.

Today, advances in genomic sequencing — the ability to map an individual’s DNA code and detect gene variations that signal trouble — make it possible, at least in theory, for people to identify their genetic disease risks.

Spending on genetic and molecular testing in the United States is projected to reach between $15 billion and $25 billion by 2021, up from $5 million in 2010, according to a 2012 UnitedHealth Group report.

For more than a decade, several companies in Europe and Canada have sold genetic tests for a range of common, complex disorders directly to consumers, the study authors said. In the United States, the genetics testing company 23andMe, Inc., resumed sales of its genetic testing service in 2015, they added.

However, Andy Kill, a spokesman for 23andMe, said the Mountain View, Calif.-based company does not provide information on the conditions mentioned in the study.

“In the U.S., we report on carrier status, traits and ancestry, not disease risk,” he said.

From more than 10,000 study abstracts, the authors pulled 18 studies for review. Included were studies on genetic risks for several conditions that may be altered with lifestyle changes, such as smoking cessation, dietary changes or physical activity.

The Cambridge team excluded studies dealing with genetic conditions, such as Huntington’s disease, with no known intervention for reducing risk.

Overall, there was little to suggest that giving people information about their genetic risks empowers them to change their ways, particularly to eat more healthily or quit smoking, Marteau said.

At the same time, there were no adverse effects, such as depression and anxiety, from receiving their genetic information, the researchers added.

The authors suggested caution in interpreting the results, citing several limitations, including the poor quality of many of the included studies.

DNA testing, however, may still help clinicians identify and treat people at risk, the authors noted.

“For the general public, our message is caveat emptor — buyer beware,” Marteau said.

“Genetic tests may identify risks for which medical intervention could reduce the risk, but this would be something that an individual would be wise to discuss with their primary care physician,” she added.

More information

The National Society of Genetic Counselors has more on ” target =”_new”> your genetic health.


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Bed Bugs Drawn to Red and Black Colors

MONDAY, April 25, 2016 (HealthDay News) — Bed bugs have favorite colors, new research has discovered.

In a series of experiments, researchers noted that the little blood suckers strongly preferred red and black and avoided green and yellow.

Does that mean it’s time to redecorate your bedroom in colors these pests don’t like?

It’s probably too soon for that, study co-author Corraine McNeill, from Union College in Lincoln, Nebraska, said in a news release from the Entomological Society of America.

McNeil said offering advice on what color sheets people use “would be stretching the results a little too much. I think using colors to monitor and prevent bed bugs would have to be specifically applied to some sort of trap, and it would have to be used along with another strategy for control.

“I don’t know how far I would go to say don’t get a red suitcase or red sheets, but the research hasn’t been done yet, so we can’t really rule that out completely,” she added.

The findings were published April 25 in the Journal of Medical Entomology.

Experts thought that bed bugs would go anywhere to hide, but this study showed they select a hiding spot based on color when they’re moving in light.

“We originally thought the bed bugs might prefer red because blood is red and that’s what they feed on,” McNeill said. “However, after doing the study, the main reason we think they preferred red colors is because bed bugs themselves appear red, so they go to these [hiding places] because they want to be with other bed bugs, as they are known to exist in aggregations,” she explained.

They may avoid yellows and greens because those colors resemble brightly lit areas.

The findings may eventually help lead to better ways to control bed bugs, McNeill suggested.

More information

The U.S. Centers for Disease Control and Prevention has more on bed bugs.


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Healthy Breakfasts for Kids: It’s All About Balance

Healthy breakfasts are a must for kids and help keep them going strong all day. This article and short video provide tips on making it happen.

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A healthy breakfast is a must for kids. Skip it and your kids will be playing nutritional catch-up for the rest of the day, says Carole L. Adler, M.A., R.D., a dietitian at the Food and Drug Administration (FDA).

When kids skip breakfast, they don’t get what they need to be at their best, says Adler. “Growing bodies and developing brains need regular, healthy meals,” she says. According to the Academy of Nutrition and Dietetics, studies show that school children who eat breakfast perform better in the classroom.

As with other meals, it’s a good idea for your kids (and you) to eat a healthy balance of fruits and vegetables, proteins, grains and dairy—not just for breakfast but throughout the day.

Here are Adler’s seven quick and easy breakfast tips to ensure your children start their day off right.

Breakfast doesn’t have to mean traditional breakfast foods.

Anything goes, as long as you maintain a healthy balance. So if your kids want a change from cereal and eggs, think about serving left-overs from last night’s dinner. There’s nothing wrong with tuna fish with celery on a whole wheat English muffin or a turkey sandwich to start the day.

Give kids foods they like.

It’s neither necessary nor effective to feed them foods they dislike. Do your kids turn up their noses at vegetables but love pizza? Left-over pizza with a whole-grain crust and veggies works for breakfast, too. Or make muffins with zucchini and carrots, and spread with peanut butter or almond butter for protein with a glass of milk. Your kids love sugary cereal? Mix a little bit of that cereal with a whole-grain, nutrient-packed healthier brand of cereal. “Nothing has to be off the table altogether, and sometimes just a taste of something your kids like is enough to keep them happy,” Adler says.

Make healthy trade-offs.

Keep in mind that nutritional balance is key—not just for one meal but for foods eaten throughout the day. Not enough vegetables in the morning meal? Prepare extra carrot, celery, and broccoli sticks with a hummus dip as an afternoon snack.

Take growth and activity levels into account.

Growing bodies need nourishment. And if your kids are physically active to boot, they need plenty of calories to keep them fueled. Adler says that having a breakfast that contains protein, fat and carbohydrates helps children feel full and stay focused until lunch. Protein choices might include an egg, some nuts, a slice of deli meat or cheese, or a container of yogurt.

Help your children make healthy choices, even if they’re on the run.

When time is short, hand your kids something healthy as they head out the door, like a piece of fruit, a bag of nut-and-fruit trail mix, or a whole-wheat tortilla spread with peanut butter or almond butter, and a carton of milk. “A fruit-filled shake with milk or yogurt takes only a couple of minutes to drink,” Adler says.

Prep the night before.

Morning is a busy time for everyone—you included. So take ten minutes to think ahead and prep for breakfast the night before. Chop up fruit to layer in a yogurt parfait or add to cereal. Cut up vegetables for an omelet. Mix up muffin or whole-grain waffle batter, cover, and put in the fridge. Get out a pan for pancakes or a blender for smoothies. Put a bowl of nut-and-fruit trail mix on the table for kids to grab a handful as they walk out the door.

Use the Nutrition Facts label and ingredient statement when you shop.

“The label makes it easy to determine the amounts of nutrients your kids are getting and to compare one product to another,” Adler says. Make sure your children get nutrient-dense foods that are low in salt and added sugars.

This article appears on the FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Updated: August 17, 2017

Published: August 13, 2015

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For 'Ironman' Athletes, Study Shows Danger of Too Much Water

By Alan Mozes
HealthDay Reporter

WEDNESDAY, March 9, 2016 (HealthDay News) — Long-distance triathletes who drink too much water during competition may end up with dangerously low blood sodium levels, new research warns.

Researchers in Germany who tested nearly 1,100 competitors in the annual Ironman European Championships found more than 10 percent had developed this condition — called hyponatremia.

In its most severe form, hyponatremia can be life-threatening, experts say.

“Hyponatremia among athletes is not a new issue,” said study co-author Dr. Stefan Braunecker, of the department of anesthesiology and intensive care medicine at University Hospital of Cologne. But the 2015 death of an athlete who developed hyponatremia during an Ironman competition underscores the “still urgent importance of the topic,” he added.

The condition occurs in a “considerable percentage” of long-distance triathletes, Braunecker and his colleagues said in the March 10 issue of the New England Journal of Medicine.

A dramatic dilution of sodium (salt) causes an athlete’s internal water regulation to go out of whack. Cellular swelling ensues, often accompanied by nausea, headache, a drop in blood pressure and energy, weakness, and even seizures, according to the National Kidney Foundation.

For this study, the authors tracked hyponatremia cases among nearly 1,100 triathletes who participated in the annual Ironman European Championships between 2005 and 2013. More than 900 were men.

The competition includes a 2.4-mile swim, 112-mile bike ride and a 26.2-mile run.

Racers took about 10 to 15 hours, on average, to finish, and blood samples were collected within 20 minutes of completion.

The investigators found that 115 athletes had developed hyponatremia. Seventeen cases were deemed serious and three critical. These findings led the authors to conclude that hyponatremia is a significant and serious health concern among triathletes.

The highest risk for hyponatremia was among female athletes and/or those who took comparatively longer to finish the competition, the research team found.

Some marathon runners also develop hyponatremia, Braunecker said. A previous study found that 12 to 13 percent of marathon participants had the condition, the authors noted.

“Marathon runners do a ‘short’ run of just 2.5 to 3 hours, and do not plan their nutrition as much as triathletes do,” explained Braunecker.

The emphasis triathletes place on making sure their caloric intake will sustain them through the race appears to exert “a regulating influence” on sodium levels during competition, he said.

But both marathoners and Ironman participants struggle with extreme fatigue, alongside a temporary inability to reliably gauge true thirst. The result: “Amateur athletes tend to overestimate their water deficit and over-drink,” Braunecker said.

He suggested that race organizers offer athletes pre-competition information programs on the subject. Also, on-site emergency physicians should be prepared to screen for the condition and treat it, he said.

Athletes, meanwhile, should rigorously plan out their nutritional needs in advance, making sure to consume beverages that contain increased sodium levels, he suggested. Sodium tablets and measuring for water loss while training can also be helpful, he added.

But Dr. Lewis Maharam, chairman of the board of governors for the International Marathon Medical Directors Association, said that as safety precautions go, meal-planning comes in a distant second to simply listening to your own body.

“The big problem with all the marathons and Ironman competitions is that sponsors of fluids and electrolyte drinks stage fluid stops very close together, almost every mile,” Maharam explained.

“Inexperienced runners or Ironman athletes see these tables and think, ‘Oh . . . I should drink,'” he said. “But often that’s not the case. In fact, it’s been shown that if an athlete actually stops and drinks at all these stops, they will for sure become hyponatremic by the end of the race.”

His advice? “We tell our athletes to drink for thirst,” said Maharam. “It’s the very best way to reduce risk.”

The notion that by the time you’re thirsty you’re already dehydrated is an old wives’ tale, he added. “Thirst is the absolute best way to determine how much to drink.”

More information

There’s more on hyponatremia at the National Kidney Foundation.


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