Is Your Student Safe?

The beginning of another school year means the beginning of school sports including football, soccer, cross country and swimming. All too often, school sports result in injuries to athletes and, in some cases, incidents of sudden cardiac arrest (SCA). Although SCA in athletes makes the headlines, it’s important to know that SCA can happen to anyone including a seemingly healthy child.

Sudden cardiac arrest in a young person usually stems from a structural defect in the heart or a problem with the heart’s electrical circuitry. The most frequent cause, accounting for about 40% of all cases, is hypertrophic cardiomyopathy or HCM.

HCM is a genetic heart condition that affects 1: 500 individuals, including men, women and children of all ages. HCM is characterized by a thickening of the heart muscle and can lead to sudden cardiac arrest.

Approximately 50% of individuals with HCM experience no symptoms, and don’t even know they have the condition, until tragically, sudden cardiac arrest occurs.  In 9:10 cases the outcome is fatal, resulting in unimaginable grief for families and fellow students.  Yet better outcomes can be achieved with early electrical stimulation of the heart – delivered by a small, fully automated, easy to use box.

Given that educational institutions house more than 20% of the American population every day, you’d think they would be fully prepared for this eventually. But sadly, they are not.

At the time of writing, only 19: 50 states in the U.S. require that at least some of their schools have automated external defibrillators [AED’s].  In some states, AEDs are required in public, but not private schools. In other states, AEDs are required in high schools, but not elementary schools. Some states require AEDs only in schools offering athletics. Only two states – Hawaii and Oregon – require AEDs in colleges.

To find out whether your state requires AEDs in schools, click here to view an interactive map.

Although schools and colleges are ideal and obvious locations for AED deployment, concerns regarding legal liability and litigation have been perceived as a barrier to purchasing and deploying AEDs.  Fortunately this is slowly changing.  Recognition of the need to protect youth from sudden cardiac arrest is gaining momentum in many states:

In Pennsylvania, Sen. Andrew Dinniman has sponsored Senate Bill 606, Aidan’s Law, named for Aidan Silva, a seven-year-old Chester County resident who succumbed to SCA in September 2010.  Aidan had no symptoms of a heart condition prior to his death. Aidan’s Law will help ensure that every public school in Pennsylvania has an AED that is up to date and ready to use.

Rep. Connie Pillich, of Cincinnati, has introduced a bill focused on SCA in student athletes. House Bill 180 requires the Ohio Department of Health and the Ohio Department of Education to jointly develop guidelines and materials to educate students, parents and coaches about SCA. The measure bans a student from participating in a school-sponsored athletic activity until the student submits a signed form acknowledging receipt of the guidelines and materials created by the health and education departments. Individuals would not be allowed to coach a school-sponsored athletic activity unless the individual has completed, within the previous year, a sudden cardiac arrest training course approved by the health department.

John Ellsessar, whose son Michael died during an Oxford High School football game in 2010 from cardiac arrest, believes automated external defibrillators should be as readily available at school settings as fire extinguishers.

Ellsessar, is pushing for legislation to require all schools to have defibrillators, said he and his wife were horrified when they learned that at most schools that have the medical devices, but they are locked away in nurses’ offices, instead of being ready for emergencies.

And in Rhode Island, high school seniors will be required to be trained in CPR and the use of a defibrillator before they can graduate. Under the legislation signed into law by Gov. Lincoln Chafee, students will receive training that includes a hands-on course in cardiopulmonary resuscitation and an overview of the use of an AED.

The National Parent Teacher Association has also adopted a resolution calling for public schools to develop emergency response plans that include summoning help, performing CPR and using automated external defibrillators to save lives. The PTA also called for ongoing CPR-AED training in schools and legislation that would fund placement of AEDs in every school, while providing immunity for people who use the lifesaving devices in good faith.

To learn more about sudden cardiac arrest and how you can help please visit http://www.sca-aware.org

Ho Ho Ho: health hazards for Santa

After weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

But even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Then there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

Fend off a 2nd Heart Attack with Fruit and Fiber

Each year, at least 20 million people worldwide survive a heart attack or stroke. Most of them, will then be prescribed a veritable cocktail of drugs including lipid-lowering agents, beta blockers, aspirin, anti-platelet medications, and angiotensin modulators.

In the misguided belief that this polypharmacy will guard against future catastrophic cardiovascular events, many patients think they don’t need to follow a healthy diet.

However a new, 5-year study of almost 32,000 patients in 40 countries showed those who ate a heart-healthy diet rich in fruits, vegetables and fish had an average:

• 35% reduction in risk for cardiovascular death
• 14% reduction in risk for new heart attacks
• 28% reduction in risk for congestive heart failure
• 19% reduction in risk for stroke

Researchers from McMaster University were able to demonstrate, for the first time, that while drug treatments, substantially lower the risk of another heart attack, a high quality diet also significantly lowers the risk.

Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute (PHRI) and his team assessed the association between diet quality and the risk of cardiovascular disease using information collected from men and women who participated in two major McMaster-led global studies: ONTARGET, and TRANSCEND.

Participants with cardiovascular disease were asked how often they consumed milk, vegetables, fruits, grains, fish, nuts, meat and poultry over the past 12 months. They were also asked about lifestyle choices such as alcohol consumption, smoking and exercise. A healthy diet was indicated by a high intake of fruits, vegetables, whole grains and nuts as well as a high intake of fish compared to meat, poultry and eggs.

The results showed that a heart-healthy diet offered a “consistent benefit” over and above the benefits of taking medications to reduce the risk of heart attack and stroke.

Globally, healthy eating was associated with a lower risk of cardiovascular disease by more than 20% in all regions of the world and across all income groups.

“Physicians should advise their high-risk patients to improve their diet and eat more vegetables, fruits, grains and fish,” Dehghan said. “This could substantially reduce cardiovascular recurrence beyond drug therapy alone and save lives globally.”

Be Still My Beating Heart! – Monty Python and the Holy Grail

Look up the term myocardial infarction (MI) in any medical dictionary and the definition will be something along the lines of –  the changes to the myocardium (heart muscle) that occur due to the sudden deprivation of circulating blood. The main change being necrosis, or death of myocardial tissue. Death of myocardial tissue.  As in dead, as in non-viable, as in beyond repair. Kind of reminds me of the infamous Monty Python Dead Parrot sketch… “Passed on! No more! Ceased to be! Expired and gone to meet ‘is maker!”….but I digress.

Fast forward from the British humor of December 1969 to an astonishing paper presented in Britain in April 2012  at the Frontiers in CardioVascular Biology meeting. In a keynote lecture, Dr Deepak Srivastava outlined results that have been described as a “game changer” with the potential to revolutionize the treatment of MI.   Srivastava used viral vectors to deliver genes directly into the hearts of adult mice that had experienced an MI. In his original “proof of principle” study, Srivastava was able to show that all that was needed for the direct  reprogramming of fibroblasts (a major component of scar tissue) into myocytes (the heart muscle cells responsible for  beating)  was the delivery of three genes.  The work , which took place in a Petri dish, was considered groundbreaking since it showed for the first time that unrelated adult cells could be reprogrammed from one cell type to another without having to go all the way back to a stem cell state. “Our ultimate hope is that, during the acute period following MI, patients will be able to receive direct injections of factors that transform the existing fibroblast cells in the “scar” into new myocytes. The resulting increase in muscle mass should help MI survivors to live more normal lives,” explained Srivastava.

Healthy heart tissue is composed of a mixture of several kinds of cells, including cardiomyocytes, which provide beating muscle and cardiac fibroblasts that provide architectural support to the myocytes. “When heart muscle cells become injured and die following an MI, patients have the major problem that these cells have little or no capacity for regeneration,” says Srivastava.  Part of the process of remodelling that occurs following the injury is that fibroblast cells migrate to the site and create the scar. At first, the process can be considered beneficial since without fibroblasts adding structural support damaged hearts would rupture. But later, difficulties arise when the fibrotic scar doesn’t contract like the muscle it has replaced. “Reduced global contractility means the heart has to work much harder, and the extra stress can ultimately lead to heart failure and even death,” said Srivastava.

One of the Holy Grails of cardiovascular research has been to replace these lost myocytes and return functionality to the heart.  Some of the first approaches to be investigated were the introduction of stem or progenitor cells to the sites of injury.  But many hurdles have been encountered including getting cells to integrate with neighboring cells in the heart, and there have been concerns that residual “rogue” cells could persist with the potential to keep dividing and give rise to tumors.

Srivastava, a pediatric cardiologist, explained how he got ahead of the game by “leveraging” knowledge from his work in embryo hearts. Over the past 15 years the focus of Srivastava’s lab has been to identify genetic factors responsible for the formation of embryonic hearts. From this work, his team identified 14 key genes that they felt were the major “on/off” switches for cardiac genetic programming. In this original study they were able to whittle things down to the three factors that were indispensible. The team then injected fibroblasts that had the three genes inserted directly into the scar tissue of mice.  They were able to show the fibroblasts differentiated into cardiomyocyte-like cells. In the latest study  they were able to take the process one step further by injecting a viral vector encoding the  3 genes directly into the scar tissue of mice who had just experienced an MI. “With these studies we’ve obtained even better results showing that the fibroblasts become more like cardiomyocytes and functionally couple with their neighbors. They could beat in synchrony and improve the function of the heart,” said Srivastava.

The next step will be to test the direct injection approach in a larger animal, such as a pig, whose heart is similar in size to a human.  But a big question remains “will the same combination of genes work in human hearts?” SRxA’s Word on Health will be watching and waiting. In the meantime…it’s back to Monty Python!