NEW YORK (Reuters Health) - Older people poorly understand most of the important warning signs of stroke and factors that increase risk for this medical emergency, researchers from Dublin, Ireland, have found.

Among 2033 older men and women, fewer than half knew that dizziness, numbness, weakness, and headache are common warning signs of stroke, report Dr. Anne Hickey, of Royal College of Surgeons in Ireland and colleagues.

Just 54 percent listed slurred speech as an indicator of stroke, the researchers report in the online journal BMC Geriatrics.

When asked to list the most common risk factors for stroke, about three-quarters of the men and women accurately listed high blood pressure. By contrast, 40 percent or fewer knew high cholesterol and smoking also increase stroke risk. Only about 10 percent knew diabetes and alcohol use are also risk factors for stroke.

These findings highlight the significant gaps in elders' understanding of early stroke warning signs and risk factors, Hickey and colleagues report. "As such, many older adults may not recognize early symptoms of stroke in themselves or others," they warn. Thus, they may lose "vital time" in getting help.

On average, the study sample was 74 years old and 57 percent female. Overall, 25 percent of the men and women had a history of heart disease and 6 percent reported a prior stroke.

Another 36 and 17 percent were past and current smokers, respectively, and this group was more likely to identify smoking as a stroke risk factor than never smokers.

However, consistent with the findings of other investigators, this study revealed the generally poor understanding elders have regarding factors leading to or indicative of stroke, Hickey and colleagues note.

Since effective stroke care requires rapid identification and medical intervention, Hickey's group suggests the need for substantially improved public education with regard to stroke prevention.

SOURCE: BMC Geriatrics, August 2009

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Binge drinking is usually seen as a problem of college campuses, but many older adults may be overindulging in alcohol as well, a study published Monday suggests.

Using data from a government survey of nearly 11,000 Americans age 50 and up, researchers found that 23 percent of men between the ages of 50 and 64 admitted to binge drinking in the past month, as did roughly 9 percent of women.

Among adults age 65 and older, more than 14 percent of men and 3 percent of women reported bingeing -- defined as having five or more drinks on one occasion, on at least one day in the past month.

Alcohol binges are often considered a problem of youth. One recent government study found that among U.S. college students between the ages of 18 and 24, 45 percent reported a recent drinking binge.

But the new findings, published in the American Journal of Psychiatry, show that older adults can be susceptible too.

"We feel that our findings are important to the public health of middle-aged and elderly persons as they point to a potentially unrecognized problem that often 'flies beneath' the typical screen for alcohol problems in psychiatry practices," lead researcher Dr. Dan G.

Blazer, of Duke University Medical Center in Durham, North Carolina, noted in a written statement.

Blazer and colleague Dr. Li-Tzy Wu based their findings on a national health survey conducted between 2005 and 2006. Along with binge drinking, the survey looked at so-called at-risk drinking -- drinking habits that could have negative effects on a person's health. In this study, that was defined as averaging at least two drinks per day.

Among 50- to 64-year-olds, 19 percent of men and 13 percent of women were at-risk drinkers. The figures among older men and women were 13 percent and 8 percent, respectively.

Binge drinking carries a number of risks, including accidental injuries, violent behavior, neurological damage and blood pressure increases. These hazards, Blazer and Wu write, "clearly present" greater consequences later in life, when people often have chronic health conditions that can be aggravated by heavy drinking.

Yet, the researchers note, most people who binge are not dependent on alcohol, so their problem drinking may go unrecognized.

The message for doctors, Blazer said, is that they should be asking their older patients specifically about binge drinking.

Patients who do report bingeing may also need to be screened for other types of substance abuse, according to the researchers.

In this study, men who reported binge drinking had a higher risk of illegal drug use than men who drank but did not binge, while female binge drinkers had a heightened likelihood of prescription drug abuse.

SOURCE: American Journal of Psychiatry, online August 17, 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - The Chinese herb Tripterygium wilfordii Hook F (TwHF) proved more effective than the anti-inflammatory drug sulfasalazine in a study of patients with rheumatoid arthritis.

"The mechanism of action (of TwHF) is not fully understood but seems different from currently available drugs," Dr. Raphaela Goldbach-Mansky, from the National Institutes of Health, Bethesda, Maryland told Reuters Health.

TwHF, the researcher added, "may become an addition to the currently available treatment options for rheumatoid arthritis in the future."

Doctors often prescribe sulfasalazine or other anti-inflammatory drugs for the initial treatment of rheumatoid arthritis. However, many patients discontinue the drugs due to lack of improvement or side effects.

The Chinese herbal remedy TwHF (also known as "lei gong teng" or "thunder god vine") has shown promise in treating other "autoimmune" disorders and inflammatory conditions.

In the current study, reported Tuesday in the Annals of Internal Medicine, Goldbach-Mansky and colleagues randomly assigned 121 patients with rheumatoid arthritis to take either TwHF three times daily or sulfasalazine two times daily for 24 weeks.

Many patients in both groups discontinued treatment, the researchers report. However, among those who continued treatment for 24 weeks, improvement in joint symptoms was greater with TwHF (67%) than with sulfasalazine (36%) and adverse effects were similar.

The rapid improvement in joint symptoms may make TwHF extract an attractive and affordable alternative to anti-inflammatory drugs, the researchers conclude.

SOURCE: Annals of Internal Medicine, August 18, 2009.

Copyright © 2009 Reuters Limited.

CHICAGO (Reuters) - A slight difference in a person's genetic code could determine whether they respond to a grueling round of treatment for hepatitis C infection or not, U.S. researchers said on Sunday.

Tests looking for that deviation could be used to help decide which patients are most likely to benefit, they said. The finding may also explain why some racial and ethnic groups fare more poorly on standard treatments than others.

"This discovery enables us to give patients valuable information that will help them and their doctors decide what is best for them," genetics researcher David Goldstein of Duke University in Durham, North Carolina, said in a statement.

Hepatitis C is a blood-borne liver disease that can lead to chronic liver problems, liver cancer, cirrhosis and death. The virus affects an estimated 3.2 million people in the United States alone and 170 million worldwide.

Treatment typically involves 48 weeks of interferon plus the antiviral drug ribavirin. Some patients develop such taxing side effects that they stop treatment. Blacks are less likely to respond than whites.

Until now, no one has known why.

'SPELLING MISTAKE'

According to Goldstein's study, published in the journal Nature, it may be because of a "spelling mistake" -- a one-letter error in the genetic code near the Interleukin-28B or IL28B gene, which plays a role in fighting off infections.

"If you look at individuals with the good response genotype, about 80 percent of them will be cured. If you look at individuals with the poor-response genotype, about 30 percent of them will be cured," Goldstein said in a telephone interview. "That is just a huge, huge difference."

The discovery came from a clinical trial of 1,671 people with the most common form of the disease in the United States and Europe who were taking the two most common hepatitis C therapies.

It was funded by Schering-Plough, maker of one of two standard hepatitis C regimens -- a combination of Pegintron and the antiviral ribavirin. Roche Holding AG makes the other, known as Pegasys.

They found having a favorable genotype made a significant difference in treatment response across all populations in the study, but because it occurs most often in whites of European ancestry, it helps explain why blacks fare less well on standard treatments.

Goldstein said few discoveries involving inherited genetic variations are specific enough to guide treatment decisions, but he thinks this is one.

"It is very difficult for me to imagine this wouldn't be something that both the patient and the clinician would want to know about in deciding on a course of treatment," he said.

"Right now, absent genetic information, if a patient comes into the clinic and they have no signs of liver damage, a decision is often reached to postpone treatment because the treatment is unpleasant and it often doesn't work."

He said the finding does not mean poor responders should not be offered therapy but it may alter their decision-making.

Goldstein said patients who are poor responders to standard treatments who have no liver damage might want to wait for the arrival of a new class of drugs called protease inhibitors.

The drugs are now in mid-stage development by Schering-Plough and Vertex Pharmaceuticals Inc.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - The death of Wolfgang Amadeus Mozart at the age of 35 may have begun with a bad sore throat, according to a study published Monday.

In the more than two centuries since the famous composer's death, there have been various theories about the cause of his untimely end -- from intentional poisoning to trichinosis infection from eating bad pork.

But research into the question has generally been based on less-than-reliable evidence, like accounts from people who witnessed Mozart's final days, written decades after his death.

For the new study, reported in the Annals of Internal Medicine, researchers used information from official death registers for Vienna in the winter of 1791 to place Mozart's death in its wider context.

"Our findings suggest that Mozart fell victim to an epidemic of strep throat infection that was contracted by many Viennese people in Mozart's month of death, and that Mozart was one of several persons in that epidemic that developed a deadly kidney complication," lead researcher Dr. Richard H. C. Zegers, of the University of Amsterdam in the Netherlands, told Reuters Health in an email.

This "minor epidemic," he and his colleagues say, may have begun in the city's military hospital.

Based on witness accounts, Mozart fell ill with an "inflammatory fever," which is consistent with strep throat, Zegers and his colleagues note in their report.

The composer eventually developed severe swelling, "malaise," back pain and a rash -- consistent with the idea that the strep infection led to kidney inflammation known as poststreptococcal glomerulonephritis.

It's also possible that Mozart had scarlet fever, which, like strep throat, is caused by infection with streptococcal bacteria.

But this is less likely, Zegers and his colleagues say, because witness accounts suggest that Mozart developed a rash near the end of his illness. With scarlet fever, the rash appears early on.

This latest theory on Mozart's death is stronger than previous ones, Zegers said, because it is not limited to "scanty information" from lay person accounts.

SOURCE: Annals of Internal Medicine, August 18, 2009.

Copyright © 2009 Reuters Limited.