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There’s a message for doctors, hospitals and communities in new guidelines for treatment of coronary disease and heart attacks: Get organized.

Every community should have an organized system of emergency care for heart attacks, including programs to identify patients before they get to hospitals and strategies for getting them to medical centers equipped to perform artery-opening procedures, say the guidelines issued by the American Heart Association, the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.

“The focus on integrated systems for patients with STEMI is important,” said Dr. Sidney C. Smith Jr., a professor of medicine at the University of North Carolina, a past president of the American Heart Association and co-chair of the group that wrote the guidelines. “It affects a large number of the population that have heart attacks and will improve their treatment for sure.”

STEMI is an acronym derived from the pattern seen on an electrocardiogram in the most severe form of heart attacks. The goal is to get a heart attack victim as quickly as possible to a medical center for what is formally called percutaneous coronary intervention (PCI) — insertion of a balloon-tipped catheter into a blocked heart artery to reopen the blood vessel, usually followed by implantation of a stent, a thin tube, to be sure it remains open.

“The general recommendation is to move a patient if at all possible directly to hospitals where they are able to do immediate angioplasty [PCI],” said Dr. Spencer B. King III, president of the St. Joseph’s Heart and Vascular Institute in Atlanta, a past president of the American College of Cardiology and co-chair of the guidelines group. “If that is not possible, then there should be very rapid transport to hospitals that do angioplasty.”

The guidelines include recommendations on changes in treatment of heart attacks and coronary disease based on new research findings. For example, stenting now is recommended in many cases where the left main coronary artery, which provides blood to the majority of the heart, is blocked.

“It was previously thought not advisable to do it, but to go directly to bypass surgery,” King said. “But evidence continues to build that for some patients with left main blockage, stenting should be considered.”

Several studies, notably one from Korea, found similar outcomes for stenting or surgery in treating left main artery blockage, King said.

Other technical issues covered by the guidelines include:
Recommendations on use of a powerful new clot-dissolving drug, prasugrel (Effient), as an alternative to clopidogrel (Plavix), commonly prescribed after PCI. The greater ability of the new drug to dissolve clots does carry an added danger of excessive bleeding.
Use of a wire threaded into the coronary artery to gauge whether build-up of plaque deposits are great enough to warrant PCI.
Use of aspiration thrombectomy, in which the clot causing a heart attack is sucked out before a stent is implanted.
Recommendations on use of blood thinners and clot-dissolvers before, during or after PCI.
Recommendations on the types of X-ray dye used to view the heart arteries during PCI in patients with chronic kidney disease.

“But the big recommendation is that we need to improve the system of how patients get into one hospital when they are having a heart attack and then get into another hospital, if necessary,” Smith said.

Your mother’s advice to slow down at meal time may have been wise after all: a new study suggests that shoveling down your food blocks the body’s natural appetite-control process.

“Most of us have heard that eating fast can lead to food overconsumption and obesity, and in fact some…studies have supported this notion,” Dr. Alexander Kokkinos, the lead researcher on the study, said in a written statement.

What has been missing, however, is biological evidence that a leisurely meal is better for appetite control, according to Kokkinos and his colleagues at Athens University Medical School in Greece and the Imperial College London in the UK.

To study the question, the researchers had 17 healthy men eat a generous portion of ice cream under two different conditions: in one, they ate the treat in two servings over 5 minutes; in the other, they ate it in small servings over 30 minutes.

Although the groups’ feelings of fullness and hunger did not seem to differ, the researchers found that when the men ate slowly, they showed higher blood levels of two hormones — peptide YY (PYY) and glucagon-like peptide 1 (GLP-1) — for roughly three hours after the meal.

Both PYY and GLP-1 are released from the digestive tract as a “fullness” signal to the brain, curbing appetite and calorie intake.

The findings, to be published in an upcoming issue of the Journal of Clinical Endocrinology & Metabolism, give more weight to the conventional wisdom that people should savor their food.

Some previous research has found that when people take the time to chew their food thoroughly and enjoy a meal, they tend to eat fewer calories than when they have that same meal at an eat-and-run pace.

The reasons for that have been unclear, however.

“Our study provides a possible explanation for the relationship between speed eating and overeating by showing that the rate at which someone eats may impact the release of gut hormones that signal the brain to stop eating,” Kokkinos said.

The findings are particularly relevant in a time when many people are relying on fast food and regularly eating on the run, according to Kokkinos. The study suggests that slowing down at meal time could aid appetite control, and ultimately weight control.

They are a possible scientific explanation for “the warning we were given as children that ‘wolfing down your food will make you fat,’” Kokkinos said.

Pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. Globally, pneumonia causes more deaths than any other infectious disease, such as AIDS, malaria or tuberculosis. However, it can often be prevented with vaccines and can usually be treated with antibiotics or antiviral drugs.

Every 15 seconds, somewhere in the world, a child dies from pneumonia. Many of these deaths are preventable through vaccination and appropriate treatment.

What Is Pneumonia?

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia. This includes adults 65 years of age or older and children less than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia.

Causes

When bacteria, viruses or, rarely, fungi living in your nose, mouth, sinuses, or the environment spread to your lungs, you can develop pneumonia or other infections. You can catch the bacteria or viruses from people who are infected with them, whether they are sick or not.

Types of Pneumonia

You may have heard of community-acquired pneumonia (CAP). When someone who hasn’t recently been in the hospital or another healthcare facility develops pneumonia, it’s called community-acquired.

Pneumonia is associated with healthcare when someone gets the infection during or following a stay in a healthcare facility (like hospitals, long-term care facilities, and dialysis centers). These infections are labeled healthcare-associated pneumonias, which includes healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).

In the U.S., the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) and the most common viral causes are influenza, parainfluenza, and respiratory syncytial viruses. In children less than 1 year of age, respiratory syncytial virus (RSV) is the most common cause of pneumonia. Other common bacterial and viral causes of pneumonia in the U.S. include Staphylococcus aureus and adenovirus. Pneumocystis jirovecii, a fungus formerly known as Pneumocystis carinii, is a common cause of pneumonia in patients with AIDS.

Reduce Your Risk

Pneumonia can be prevented with vaccines. Following good hygiene practices can also help prevent respiratory infections. This includes washing your hands regularly, cleaning hard surfaces that are touched often (like doorknobs and countertops), and coughing or sneezing into a tissue or into your elbow or sleeve. You can also reduce your risk of getting pneumonia by limiting exposure to cigarette smoke and treating and preventing conditions like diabetes and HIV/AIDS.

In the U.S., there are several vaccines that prevent infection by bacteria or viruses that may cause pneumonia. These vaccines include:
Pneumococcal,
Haemophilus influenzae type b (Hib),
Pertussis (whooping cough),
Varicella (chickenpox),
Measles; and
Seasonal and 2009 H1N1 influenza (flu) vaccines.
National and Global Impact

In 2006, 1.2 million people in the U.S. were hospitalized with pneumonia and 55,477 people died from the disease.

Globally, pneumonia kills more than 4 million people every year – half of these deaths occur among children less than 5 years of age. This is greater than the number of deaths from any other infectious disease, such as AIDS, malaria or tuberculosis. Access to vaccines and treatment (like antibiotics and antivirals) can help prevent many pneumonia-related deaths. Pneumonia experts are also working to prevent pneumonia in developing countries by reducing indoor air pollution and encouraging good hygiene practices.

New research suggests that men — especially married white men — are much more likely to develop noise-induced hearing loss than women. But there’s some good news: Another study finds that older men who take high doses of folate can decrease their risk of hearing loss by 20 percent.

The figures regarding hearing loss in men and women come from a study of hearing-test data from 5,290 people aged 20 to 69. An estimated 13 percent of them will suffer from noise-induced hearing loss, which researchers think affects about 24 million Americans.

The condition, caused by exposure to loud noise, is preventable.

Among the subjects, men were two-and-a-half times more likely than women to develop this type of hearing loss. Married, non-Hispanic white men had the highest risk, the study authors pointed out.

In another study, researchers found that increased doses of antioxidant vitamins don’t improve a man’s chances of avoiding hearing loss. But folate — a type of vitamin B — reduced the risk by 20 percent in men older than 60.

The findings came from a study of 3,559 men with hearing loss. Higher doses of antioxidant vitamins, such as vitamins C, E and beta carotene, had no effect, the researchers said.

Foods with high levels of folate include leafy vegetables such as spinach, lettuce and asparagus; dried or fresh beans; peas; liver products; and fortified cereal products.

The researchers pointed out that their study is the largest to look into links between diet and hearing loss.