News in brief - May 1, 2006

Mumps outbreak in the Midwest - Lifestyle changes lower heart risk - Age-related eye disease associated with cognitive impairment - Menopause linked to depression onset

Mumps outbreak in the Midwest

Iowa is experiencing a large mumps outbreak that began last December. As of April 10, a total of 515 possible mumps cases had been reported to the state's public health department, according to the Centers for Disease Control and Prevention. Cases are also being investigated in six neighboring states.

On April 11, the CDC noted in a Morbidity and Mortality Weekly Review dispatch alert that two people with mumps may have been infected during airline travel. The CDC is using new software to track and notify those passengers seated near the index cases. The flight numbers are available in the April 14 MMWR.

Until now, an average of 265 mumps cases had been reported each year in the United States. Mumps is asymptomatic in 20% to 30% of cases, but complications can include inflammation of the testicles or ovaries, meningitis/encephalitis, spontaneous abortion and deafness. Before 1967, nearly all Americans experienced mumps, and 90% of cases occurred among children age 15 and younger.

The first mumps cases in Iowa were reported in a university, and the median patient age in the first 219 cases was 21. Of the 133 patients investigated, 87 had received the full two doses of the MMR vaccine, 19 had received one dose and eight, no doses. Status could not be determined for the rest.

The Iowa Dept. of Public Health is asking all health care facilities to ensure that workers are immune by either checking documentation that two MMR shots had been received, or that there is serologic evidence of immunity or a worker is older than 65 and assumed to have natural immunity due to the disease.

Lifestyle changes lower heart risk

Men and women with elevated blood pressure who make healthy lifestyle changes and sustain them for up to a year and a half can substantially reduce their rates of hypertension and potentially decrease their heart disease risk, according to a study in the April 4 Annals of Internal Medicine.

More than one-third of participants in a National Heart, Lung and Blood Institute study had high blood pressure at the beginning of the study and 62% who followed exercise and diet guidance -- including the DASH, or Dietary Approaches to Stop Hypertension, diet -- were able to control their hypertension, said the researchers.

The rates of control were even better than the 50% control rates typically found when single-drug therapy is used, said the researchers.

A total of 810 men and women ages 25 and older with either prehypertension or stage 1 hypertension, who were not taking medication, participated in the study.

They were divided into three groups. One served as a control, two received counseling on weight loss and diet improvement, and one of the two was also provided guidance on the DASH diet. While all groups lowered their blood pressure, the greatest gain was seen in the group that had followed the DASH diet.

"This shows that people at risk for heart disease can successfully and simultaneously make multiple changes in lifestyle, for a substantial benefit," said Eva Obarzanek, PhD, a research nutritionist and co-author of the study.

Age-related eye disease associated with cognitive impairment

Elderly patients with vision problems related to their age are more likely to score lower on tests that measure cognition, according to a study published in the April issue of the Archives of Ophthalmology.

Researchers assessed the memory and learning skills of participants in the large multicenter Age-related Eye Disease Study. Those with vision worse than 20/40 were more likely to be determined as cognitively impaired according to the Modified Mini-Mental State Exam and the Wechsler Logical Memory Scale.

The authors theorize that this finding may indicate a common root cause for both problems. It could also mean, however, that a reduction in vision was leading to a decline in participation in activities that stimulate the brain leading to a loss in a person's ability to learn and remember.

"The lack of activity may exacerbate cognitive impairment indirectly if it predisposes a person to depression and social isolation," wrote the authors.

Menopause linked to depression onset

The hormonal changes associated with menopause increase a woman's risk of developing depressive symptoms or a diagnosable depressive disorder even if there is no history of this type of mental illness, according to two studies published in the April Archives of General Psychiatry.

One study, conducted by researchers at the University of Pennsylvania School of Medicine in Philadelphia, analyzed data from a subgroup of participants in the Penn Ovarian Aging Study who had no history of depression.

The authors found that during menopause, women were four times more likely to experience symptoms of depression and 2½ times more likely to be diagnosed with this disorder than during the premenopausal period.

The other, this one by researchers from Harvard Medical School in Boston, examined data from the Harvard Study of Moods and Cycles. They concluded that women without a history of depression were twice as likely to develop the disorder after beginning the transition to menopause as they were before menopause, and this risk increased if they experienced vasomotor symptoms.