Active elderly women sleep more and better than their sedentary counterparts, according to a study published in the July issue of Sleep Medicine.

Brazilian researchers had 101 women, 53 who exercised and 48 who did not, keep a sleep log and record their sleep quality on a visual analog scale (VAS) for a 30 day period.

They found that the active women slept on average 7 hours, 12 minutes while the physically inactive women slept on average 6 hours, 24 minutes.  Those active women also scored their sleep quality at 8.3, which was 2.5 above the average score for sedentary women.

Researchers in Texas have identified a cell type believed to aid in controlling the early infectious process against the respiratory pathogen and bioterrorism agent that causes tularemia, also known as "rabbit fever."

The organism, Francisella tularensis, mostly is spread by bites or scratches from rabbits and rodents. When aerosolized, it causes severe respiratory illness and systematic infections. Illness resulting from the aerosolized bug have a 30 to 40 percent mortality rate. Tularemia is treated with antibiotics, and a vaccine currently is under review by the Food and Drug Administration, according to the Centers for Disease Control.

Mast cells, associated with allergic conditions and asthma, may be involved in adaptive immunity against tularemia, according to the study published by researchers from The University of Texas at San Antonio South Texas Center for Emerging Infectious Diseases and The University of Texas Health Science Center at San Antonio. Mast cells can interact with other cells and control the number of bacteria that replicate.

The findings are being published in a journal article in the Proceedings of the National Academy of Sciences.

The American Association of Homecare worked until the last minute to secure an administrative delay to the July 1 implementation of competitive bidding and allow Congress to complete action on the Medicare legislation, which includes important reforms to the bidding program. However, the Centers for Medicare and Medicaid announced the bidding program would begin as scheduled.

When the Senate returns on July 8 from its July 4 recess, one of its first priorities will be to reconsider the broad Medicare package that failed in a procedural vote last week. In a June 26 vote, Senate proponents of the House-passed Medicare package that included the "doc fix" failed to get the 60 votes needed to end debate and move to a vote. The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) includes provisions to reform the competitive bidding program.

Last week, H.R. 6331 passed the House of Representatives by a veto-proof margin of 355 to 59. This legislation would delay the implementation of the Medicare competitive bidding program to make improvements. The home care industry would pay for the delay through a nationwide 9.5 percent payment cut to the home care items and services subject to bidding.

The American Association for Homecare has asked providers, suppliers, patients, and referral agents who are having problems related to Round One of competitive bidding to contact the Association so it can document specific problems. A web-based form is posted at www.aahomecare.org.

The Centers for Medicare and Medicaid Services has proposed a rule to prohibit reimbursement for continuous positive airway pressure devices if the supplier or its affiliate performed the diagnostic sleep test. This rule would go a step further than existing regulations, which restrict only suppliers from performing the test.

The move is significant, considering CMS's recent decision to allow home testing for sleep apnea. The new rule also would cover in-lab polysomnography.

CMS will accept comments on the rule for 60 days after its official publication. Read the pre-publication notice here.  

Sleep deprivation in the elderly may further age brain cells by impairing the protective response to protein misfolding.

Protein misfolding is associated with diseases such as Alzheimer's and Parkinson's. In young, healthy cells, the unfolded protein response (UPR) is part of the quality control system for monitoring protein synthesis in the endoplasmic reticulum, part of the cellular machinery in which proteins are made.

Researchers from the University of Pennsylvania School of Medicine researchers found that the UPR was activated in 10-week-old sleep-deprived mice, which prevented misfolded proteins from accumulating in the endoplasmic reticulum of brain cells in the cerebral cortex.

The response differed in two-year-old mice after sleep deprivation. The UPR did not activate properly, and the misfolded proteins built up in the cerebral cortex cells. All of the older mice had impaired UPR to some degree, regardless of sleep deprivation.

Further studies will explore whether activating certain protective proteins delays the effects of aging and reduces sleep disturbances.

People who have never smoked but whose cells cannot efficiently repair environmental insults to DNA are at higher risk of developing lung cancer than those with effective genomic repair capability, according to researchers from the Department of Epidemiology at The University of Texas M. D. Anderson Cancer Center.

"About 15 percent of lung cancers occur in lifetime never smokers. Risk factors for lung cancer in people who have never smoked are poorly understood, but this study demonstrates that poor DNA repair capacity is an important predictor of lung cancer risk in never smokers," said the study's lead author, Olga Gorlova, Ph.D., an assistant professor in the Department of Epidemiology.

In the June issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research, the researchers say that, overall, nonsmokers with suboptimal DNA repair capacity (DRC) are almost twice as likely to develop lung cancer, compared with nonsmokers with normal DRC. Study participants with the lowest ability to repair their DNA had a more than a threefold increased risk, compared with individuals with efficient DRC.

Secondhand smoke exposure is another established risk factor; in participants with inefficient DRC who also reported such exposure, the risk of lung cancer was almost fourfold.

Pregnant women who receive treatment for substance abuse early in their pregnancy can achieve the same health outcomes as pregnant women with no substance abuse, according to a Kaiser Permanente study published online in the Journal of Perinatology.

The study, which is the largest to date, examined 49,985 women in Kaiser Permanente's prenatal care program and found that integrating substance abuse screening and treatment into routine prenatal care helped pregnant women achieve similar health outcomes as women who were not using cigarettes, alcohol or other drugs. This is also the largest study to examine multiple substances: cigarettes, alcohol, marijuana, methamphetamines, cocaine and heroin.

"This program can happen everywhere and should become the gold standard for women who are pregnant and using cigarettes, alcohol or other drugs," said study lead author Nancy C. Goler, M.D., an OB/GYN and Kaiser Permanente regional medical director of the Early Start Program for the organization's Northern California operations. "The study's big finding was that study participants treated in the Early Start program had outcomes similar to our control group, women who had no evidence of substance abuse."

Homemade spacers may be a practical option for metered-dose inhalers when commercially manufactured inhalers are unavailable or too costly for patients, according to a review published June 24 in the Cochrane Library.

A research team analyzed six randomized clinical trials of 658 children with acute exacerbations of wheezing or asthma who used commercial or homemade spacers. No significant differences were noted in peak expiratory flow rate, change in heart rate per minute, change in oxygen saturation or need for additional treatment or hospital admission.

The authors say equivalency of treatments can't be claimed because this is only a small sample population. "Selection of the spacer device for an individual patient should begin with a commercial spacer, with home-made spacers being used if a commercial device is not available," they concluded.

Sleep deprivation can provoke more risk-taking behavior, with more prominent effects seen in people with high levels of emotional intelligence, according to a study done by researchers from Harvard Medical School and Walter Reed Army Institute of Research that was presented at SLEEP 2008.

During the study, 20 healthy participants between the ages of 20 and 30 were kept awake for 77 hours. Nine participants received 800 mg of caffeine each night. Each participant completed the Iowa Gambling Task (IGT) after 55 and 75 hours of sleep deprivation.

Participants with higher emotional intelligence had greater changes in their IGT scores at both 55 and 75 hours. The subject's adaptability and stress management scores were negatively associated with changes in the IGT after 55 hours but had no association after 75 hours.

"Sleep deprivation appears to affect critical nodes in the emotion-cognitive processing system, producing greater deficits in those individuals with the most extensively developed EQ capacities," concluded the authors. "During periods of sleep deprivation, greater complexity may also mean greater vulnerability."

The average company loses the equivalent of 2.5 weeks of paid work from everyone it employs due to the effects of insomnia and sleep loss, a study suggests.

Researchers from Tufts New England Medical Center in Boston and private research company Alertness Solutions looked at the link between sleep problems and productivity in workers from four separate U.S. companies, including an airline, pharmaceutical company, manufacturer, and law firm.

More than 4,000 employees filled out a 55-item questionnaire designed to assess the prevalence of sleep problems and their effect on performance and safety. Results of the study suggest insomnia and disturbed sleep are common, and respondents frequently reported detrimental effects on performance, productivity, and safety.

Those with sleep problems were about 40 percent more likely to suffer impaired ability to concentrate at work than those who slept well or those that did not meet the criteria for insomnia or insufficient sleep syndrome. Those who got insufficient sleep were twice as likely to "nod-off" while driving. About 11 percent of those questioned reported using prescription drugs to deal with disturbed sleep or insomnia, while nearly 25 percent said they used over-the-counter treatments.

Children with Down Syndrome have more fragmented sleep and frequent nighttime awakenings compared with typically developing children, according to University of Michigan researchers.

Researchers examined sleep study results in 38 children with Down Syndrome and 38 typically developing children with the average age of seven in both cohorts.

Children with Down Syndrome experienced less sleep time overall, spent more time awake after sleep onset, experienced more time in the lighter first stage of sleep, and had less REM sleep.

The findings suggest that children with Down Syndrome may have an altered sleep architecture with less total sleep time, less REM, and more stage 1 sleep, according to the investigators who presented their research at SLEEP 2008 in Baltimore. Poor sleep quality and decreased amounts of REM sleep may impair cognitive, physical, and behavioral growth in this patient population, according to researchers.

Insomnia is nearly three times more prevalent in cancer patients than the general population and persists throughout treatment and remission despite antidepressant therapy, according to a study presented at SLEEP 2008.

Researchers from the University of Rochester Medical Center performed a secondary analysis of 823 cancer patients participating in the Rochester Cancer Center Community Clinical Oncology study.

They found that 76 percent of cancer patients reported insomnia during their first cycle of chemotherapy, 59 percent during and after the second cycle, and 45 percent after their fourth cycle of chemotherapy. Subjects with insomnia also reported greater depression and fatigue.

Insomnia occurred most in patients with lung cancer and least in patients with colon cancer. Younger subjects reported more occurrences, contrary to trends in the general population. The rate was not influenced by patient gender.

Low serum magnesium levels in people with chronic obstructive pulmonary disease increases the risk for hospital readmission for acute exacerbations, according to a study in the June issue of Respiratory Medicine.

Researchers from Bethlehem, Pa. followed for one year 100 subjects who had previously been admitted to a tertiary care center with a diagnosis of acute exacerbation of COPD. Nearly a quarter of subjects had at least three readmissions during that period.

Serum magnesium levels were the sole predictor of frequent readmission in subjects. The frequently admitted group showed an average level of 1.77 mEq/I versus a level of 1.86 mEq/I in those not frequently admitted.

Further studies involving magnesium supplementation are needed to determine if this can indeed alter the course of the disease in a selected cohort, the study authors wrote.

The International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention is urging health care providers to address the link between Type 2 diabetes and obstructive sleep apnea in a consensus statement published in Diabetes Research and Clinical Practice.

Up to 40 percent of people with OSA will have diabetes, according to the statement. The task force also notes that the prevalence of some form of sleep-disordered breathing may be as high as 58 percent among diabetes patients. The link between OSA and diabetes may be independent of overweight/obese status, they say.

IDF supports the need for further research into the links between OSA and diabetes and strongly recommends that health professionals adopt clinical practices to ensure a patient presenting with one condition is considered for the other.

The U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency announced the Libby Amphibole Health Risk Initiative, a series of projects totaling $8 million designed to understand the health effects of exposure to lower levels asbestos in Libby, Montana.

The five-year initiative will focus on determining whether exposure to lower levels of Libby asbestos is associated with increased risk of lung disease, cancer, chronic illnesses, autoimmune diseases, or other adverse health outcomes. It already is known that long-term exposure to high levels of asbestos is associated with lung cancer, serious lung disease, and upper respiratory health conditions.

The initiative will include studies that compare the health status and conditions of people who were exposed to Libby asbestos in childhood to those who did not have such exposure. It also will assess whether the adverse health effects of Libby asbestos exposure extend beyond lung disease. In addition, it also will strengthen existing public health tracking systems such as the State Cancer Registry and patient health record databases in order to better link exposure information to health conditions and outcomes.

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