Roberts Joins Majority, Deeming Mandate a Tax




Ruling Affirms a Key Provision of Law; Victory for Obama
By THE NEW YORK TIMES 32 minutes ago

The Supreme Court on Thursday largely let stand President Obama’s health care overhaul, in a striking victory for the president and Democrats, with the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obama’s term.


Target e*Studio™ Version 1.2 Being Released in July


Target e*Studio™, EDC Made Simple™, Version 1.2, Target Health’s technology transfer EDC builder is being released in July.


Free training is being offered August 14-16 at our offices in NYC to a limited number of companies, so let us know if you are interested. The major skill sets needed are experience in clinical data management and knowledge of C+ programming (for advanced programming needs only). We anticipate that for most studies, there will be minimal need for advanced programming, but it is built in with the overall design of the system


Using Target e*Studio will require a modest license fee and hosting fee (if we host), and comes with the following features which include:


1. “Pay-as-you-go” (you only pay by the study)
2. The basic system that has already been used for 24 EDC approvals since 1999
3. Full integration with
   a. Target e*Encoder®
   b. Target e*Pharmacovigilance™
   c. Target Drug and Device Supply Management
   d. Target Randomization
   e. Target Monitoring Reports
4. Built in libraries of:
   a. Studies
   a. Formats
5. Edit check and report builder
6. And more


Version 2.0 will be released in Q4 2012, with advanced features to reduce even further the need for computer programmers.


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at

Finding Public Health Solutions to Future Pandemics



Research put forth to find a timely vaccine must be tapered, moving efforts towards more effective flu pandemic control measures. Nature’s editorial section produced a convincing argument regarding the controversy over mammalian-transmissible flu research. The article, “Facing up to Flu,” claims that the world is ill-prepared for a flu pandemic of any sort, stating that we will not be prepared to produce and administer a 1) ___ in the event a flu pandemic were to occur. Although very true, we are ill prepared for a flu outbreak, we cannot rely on timeliness of vaccine creation and distribution, as this is merely a short-term solution to any flu outbreaks in the near future. We must find a preemptive solution aimed at stopping any flu outbreaks before they are uncontrollable.


Animal to human transmission of flu strains has become a pertinent issue in recent years. In the past century, we have witnessed 2) ___ flu pandemics, all stemming from animals. It is no longer a question of if we are going to deal with similar flu outbreak situations, but rather how we will respond to another pandemic. Each flu outbreak is a race to contain it, and with hundreds of unnecessary deaths this is a very critical procedure.


The biggest public-health efforts and concern has been towards the timeliness of developing, producing, and administering a flu vaccine during a pandemic. At current state, this process takes at least “3) ___ months after a pandemic emerges”. This initial production can only tend to small populations as well, and at current level is fairly ineffective in controlling a pandemic. Vaccinations during times of distress are merely a topical solution to the problem; the most effective measure is to stop the spread of the flu at the 4) ___.


Current flu research has aided in the surveillance of animals for mammalian-transmissible flu strains. Although this method is very labor intensive and cost-heavy, it has proven to be effective in 5) ___. The Chinese government surveyed wild birds in 14 provinces for strains of the H5N1 flu virus. The researchers found a prevalence of the strain of up to 4.38% in some species of wild birds. They were also able to create a protocol for poultry farms, by concluding “resident [wild] birds had a high risk of transmitting of bird flu virus between wild birds and poultries, [and] the chances of contact between poultries and resident birds should be reduced as many as possible”.


Flu research has also provided us with a basic line of defense against a flu pandemic. It’s what Kilbourne calls a “barricade vaccine.” He demonstrates that the next pandemic 6) ___ will contain a mutation of the “13 influenza A virus hemag-glutinin subtypes”. This vaccine could provide an initial line of 7) ___ against an outbreak, while strain-specific vaccine is created and administered.


A 8) ___ flu vaccine may be closer than we think, with eyes set on this vaccine being available as early as the 9) ___ flu season. Inovio, a leader in medical vaccine innovation, has designed a vaccine which takes a similar approach as current HIV vaccine development. They have already “made and completed successful human tests for vaccines that protect against all H1N1 and H5N1 flu strains”. Preparing for unforeseen outbreaks of flu strains is still necessary, and should not be overlooked. Recent studies have shown success in creating “mutant isolates of H5N1 influenza A virus that can be transmitted via the 10) ___ route between ferrets”. There is also a rumor that laboratory scientists have created mutant isolates of H5N1 influenza A virus that are human-to-human transmissible.


Due to threats and the potential use of these strains as 11) ___ weapons, the National Science Advisory Board for Biosecurity has declared that any further research findings regarding mutant strains of influenza A virus can no longer be published to the general public. Further research should be put into the understanding of how mammalian-transmissible flu strains pass from animals to humans. If researchers have in fact found a mammalian-transmissible strain of the H5N1 influenza A virus, we could be very close to finding a solution to preventing the transmission of future mutant strains from animals to 12) ___. With a better understanding, we will be able to take more precautionary measures and educate those who are in primary contact with potentially threatening animals on proper handling and safety precautions.


ANSWERS: 1) vaccine; 2) three; 3) six; 4) source; 5) China; 6) virus; 7) defense; 8) universal; 9) 2013; 10) respiratory; 11) biological; 12) humans

Disease and the Fall of the Roman Empire


A map of the territories controlled by Eastern and Western Roman Empires as of 476 CE.



The Roman Empire suffered the severe and protracted Antonine Plague, CE 165-180, also known as the Plague of Galen, who described it, as an ancient pandemic, either of smallpox or measles,brought back to the Roman Empire by troops returning from campaigns in the Near East. The epidemic may have claimed the life of Roman emperor Lucius Verus, who died in 169 and was the co-regent of Marcus Aurelius Antoninus, whose family name, Antoninus, was given to the epidemic. The disease broke out again nine years later, according to the Roman historian Dio Cassius, and caused up to 2,000 deaths a day in Rome, one quarter of those infected.Total deaths have been estimated at five million.The disease killed as much as one-third of the population in some areas and decimated the Roman army.


Ancient sources agree that the epidemic appeared first during the Roman siege of Seleucia in the winter of 165-66.Ammianus Marcellinus reports that the plague spread to Gaul and the legions along the Rhine. Eutropius asserts that a large population died throughout the Empire. In 166, during the epidemic, the Greek physician and writer Galen traveled from Rome to his home in Asia Minor. He returned to Rome in 168 when summoned by the two Augusti and ended up being present at the outbreak among troops stationed at Aquileia in the winter of 168/69. Galen’s observations and description of the epidemic in the treatise Methodus Medendi is brief, and his other references to it are scattered among his voluminous writings. He describes the plague as “great” and of long duration and mentions fever, diarrhea, and inflammation of the pharynx, as well as a skin eruption, sometimes dry and sometimes pustular, appearing on the ninth day of the illness. The information provided by Galen does not clearly define the nature of the disease, but scholars have generally preferred to diagnose it as smallpox.


The severe devastation to the European population from the two plagues may indicate that people had no previous exposure to either disease, which brought immunity to survivors. Many historians believe that both outbreaks were of smallpox.This latter view seems more likely to be correct given that molecular estimates place the evolution of measles sometime after 500 AD.


In their consternation, many Romans turned to the protection offered by magic. Lucian of Samosata’s irony-laden account of the charlatan Alexander records that a verse of his “which he dispatched to all the nations during the pestilence – was to be seen written over doorways everywhere”- particularly in those houses which were emptied, Lucian remarked. The epidemic had drastic social and political effects throughout the Roman Empire: Barthold Georg Niebuhr concluded that “as the reign of M. Aurelius forms a turning point in so many things, and above all in literature and art, I have no doubt that this crisis was brought about by that plague. The ancient world never recovered from the blow inflicted on it by the plague which visited it in the reign of M. Aurelius.”Edward Gibbon and Michael Rostovtzeff assign the Antonine plague less influence than political and economic trends, respectively.


In the view of the editors of ON TARGET, the confluence of so many forces, political, social, economic, military and religious, were all made weaker by the onslaught of these ancient plagues. Disease could have contributed the final pounding to an already disintegrating way of life in the ancient world


Some direct effects of the contagion stand out, however. When Imperial forces moved east under the command of Emperor Verus after the forces of Vologases IV of Parthia attacked Armenia, the Romans’ defense of the eastern territories was hampered when large numbers of troops succumbed to the disease. According to the 5th-century Spanish writer Paulus Orosius many towns and villages in the Italian peninsula and the European provinces lost all their inhabitants. As the disease swept north to the Rhine, it also infected Germanic and Gallic peoples outside the Empire’s borders. For a number of years, these northern groups had pressed south in search of more lands to sustain their growing populations. With their ranks thinned by the epidemic, Roman armies were now unable to push the tribes back. From 167 until his death, Emperor Marcus Aurelius personally commanded legions near the Danube, trying with only partial success to control the advance of Germanic peoples across the river. A major offensive against the Marcomanni was postponed until 169 because of a shortage of Imperial troops.


During the Germanic campaign, Marcus Aurelius also wrote his philosophical work ‘Meditations’. Passage IX.2 states that even the pestilence around him is less deadly than falsehood, evil behavior, and lack of true understanding. As he lay dying, Marcus uttered the words, “Weep not for me; think rather of the pestilence and the deaths of so many others.”


For about twenty years, waves of one or more diseases, possibly the first epidemics of smallpox and/or measles, swept through the Empire, ultimately killing about half the population. Similar epidemics, such as the Plague of Cyprian, also occurred in the 3rd century. It has been argued that the severe fall in population left the state apparatus and army too large for the population to support, leading to further economic and social decline that eventually killed the Western Empire. The Eastern half survived due to its larger population, which even after the plagues was sufficient for an effective state apparatus.


Archaeology has revealed that from the 2nd century onward, the inhabited area in most Roman towns and cities grew smaller and smaller. Imperial laws concerning “agri deserti”, or deserted lands, became increasingly common and desperate. The economic collapse of the 3rd century may also be evidence of a shrinking population as Rome’s tax base was also shrinking and could no longer support the Roman Army and other Roman institutions. Rome’s success had led to increased contact with Asia though trade, especially in a sea route through the Red Sea that Rome cleared of pirates shortly after conquering Egypt. Wars also increased contact with Asia, particularly wars with the Persian Empire. With increased contact with Asia came increased transmission of disease into the Mediterranean from Asia. Romans used public fountains, public latrines, public baths, and supported many brothels all of which were conducive to the spread of pathogens. Romans crowded into walled cities and the poor and the slaves lived in very close quarters with each other. Epidemics began sweeping though the Empire.


The culture of the German barbarians living just across the Rhine and Danube rivers was not so conducive to the spread of pathogens. Germans lived in small scattered villages that did not support the same level of trade as did Roman settlements. Germans lived in single-family detached houses. Germans did not have public baths nor as many brothels and drank ale made with boiled water. The barbarian population seemed to be on the rise. The demographics of Europe were changing. Economically, depopulation led to the impoverishment of East and West as economic ties among different parts of the empire weakened.


Increasing raids by barbarians further strained the economy and further reduced the population, mostly in the West. In areas near the Rhine and Danube frontiers, raids by barbarians killed Romans and disrupted commerce. Raids also forced Romans into walled towns and cities furthering the spread of pathogens and increasing the rate of depopulation in the West. A low population and weak economy forced Rome to use barbarians in the Roman Army to defend against other barbarians.


Culturally, the decline of Roman urban life and of the Roman educational system made it prohibitively difficult for rulers to maintain Roman civilization in its various manifestations. German barbarians were more easily able to integrate into the uneducated Roman aristocracy and demand land and, later, demand kingdoms of their own. This theory can also be extended to the time after the fall of the Western Empire and to other parts of the world.


Similar epidemics caused by new diseases may have weakened the Chinese Han Empire and contributed to its collapse. This was followed by the long and chaotic episode known as the Six Dynasties period. Later, the Plague of Justinian may have been the first instance of bubonic plague. It, and subsequent recurrences, may have been so devastating that they helped the Arab conquest of most of the Eastern Empire and the whole of the Sassanid Empire. Archaeological evidence is showing that Europe continued to have a steady downward trend in population starting as early as the 2nd century and continuing through the 7th century. The European recovery may have started only when the population, through natural selection, had gained some resistance to the new diseases.


Adding to the calamitous falling Roman Empire, the extreme weather events of 535–536 were the most severe and protracted short-term episodes of cooling in the Northern Hemisphere in the last 2,000 years. The event is thought to have been caused by an extensive atmospheric dust veil, possibly resulting from a large volcanic eruption in the tropics, or debris from space impacting the Earth.Its effects were widespread, causing unseasonal weather, crop failures, and famines worldwide.


This patient presented with symptoms of plague that included gangrene of the right hand causing necrosis of the fingers.

Drug May Reverse Huntington’s Disease Symptoms



Huntington’s disease (HD) afflicts approximately 30,000 Americans, whose symptoms include uncontrolled movements and progressive cognitive and psychiatric problems. The disease is caused by the mutation of a single gene, which results in the production and accumulation of toxic proteins throughout the brain. Currently, there is no effective treatment.


According to an article published online in the journal Neuron (12 June 2012), with a single drug treatment, researchers at the Ludwig Institute for Cancer Research at the University of California, San Diego School of Medicine have silenced the mutated gene responsible for HD, slowing and partially reversing progression of the fatal neurodegenerative disorder in animal models. The authors suggested that the drug therapy, tested in mouse and non-human primate models, could produce sustained motor and neurological benefits in human adults with moderate and severe forms of the HD.


For the study, mouse and primate models of HD were infused with one-time injections of an identified DNA drug based on antisense oligonucleotides (ASOs). These ASOs selectively bind to and destroy the mutant gene’s molecular instructions for making the toxic huntingtin protein. The singular treatment produced rapid results. Treated animals began moving better within one month and achieved normal motor function within two. More remarkably, the benefits persisted, lasting nine months, well after the drug had disappeared and production of the toxic proteins had resumed.


According to the authors, for diseases like HD, where a mutant protein product is tolerated for decades prior to disease onset, these findings open up the provocative possibility that transient treatment can lead to a prolonged benefit to patients, and that the finding raises the prospect of a ‘huntingtin holiday,’ which may allow for clearance of disease-causing species that might take weeks or months to re-form. If so, then a single application of a drug to reduce expression of a target gene could ‘reset the disease clock,’ thus providing a benefit long after huntingtin suppression has ended.


Beyond improving motor and cognitive function, the authors said the ASO treatment also blocked brain atrophy and increased lifespan in mouse models with a severe form of the disease. The therapy was equally effective whether one or both huntingtin genes were mutated, a positive indicator for human therapy.


The authors noted that the approach was particularly promising because antisense therapies have already been proven safe in clinical trials and are the focus of much drug development. Moreover, the findings may have broader implications for other “age-dependent neurodegenerative diseases that develop from exposure to a mutant protein product” and perhaps for nervous system cancers, such as glioblastomas.

Directing Attention Boosts Language in Young Children with Autism



According to an article published in the Journal of the American Academy of Child and Adolescent Psychiatry (2012;51:487-495), has confirmed that for young children with autism, pointing, gestures to focus attention improve later language. The intervention, in which adults actively engaged the attention of preschool children with autism by pointing to toys and using other gestures to focus their attention resulted in a long term increase in language skills. The study showed that by age 8, children with autism who received therapy centered on sharing attention and play when they were 3 or 4 years old, had stronger vocabularies and more advanced language skills than did children who received standard therapy. All of the children in the study attended preschool for 30 hours each week.


The 40 children who participated in the study were 8 and 9 years old. Five years earlier, they had been diagnosed with an autism spectrum disorder and received the intensive therapy program or standard intervention, as part of a separate study. The study assessed the children’s vocabulary, language, and other cognitive skills. They then compared the results of these assessments to those taken when the children were 3 and 4 years old. The earlier and later assessments also included measures of the child’s ability to initiate interactions with adults, the variety of the child’s play, and the quality of interactions with a parent.


Results showed that children who started the attention-focusing therapy earlier had more advanced linguistic skills at age 8. Those who learned to point or direct an adult’s attention to an object of interest at age 3 and 4 also developed more advanced language skills when they were 8. And children who showed greater flexibility in playing with objects at age 3 or 4 demonstrated better memory and other cognitive skills at age 8.


According to the authors, the findings show that therapy focused on such basic skills as pointing, sharing, and engaging in play can have considerable long-term effects as children with autism spectrum disorders grow and learn to express themselves with words.

Adding Nevirapine to HIV Regimen Halves Newborn Transmission Rate



Newborns are most susceptible to HIV in the two weeks following birth.


According to an article published in the New England Journal of Medicine (2012;366:2368-2379), adding the drug nevirapine to the regimen given to newborns of women diagnosed with HIV shortly before or during labor halves the newborns’ risk of contracting the virus. The study found that the rate of mother-to-child HIV transmission around the time of delivery was 2.2% among infants who received the standard drug zidovudine combined with nevirapine, compared with 4.8% among infants treated with zidovudine alone. The study also found a reduced rate of transmission (2.4%) among infants treated with a three-drug combination: zidovudine, nelfinavir and lamivudine. However, infants given the two-drug combination were less likely to have neutropenia than were those on the three drug regimen. (Neutropenia is a blood disorder consisting of low levels of neutrophils, a type of infection fighting white blood cell.) The two drug combination is also less expensive and easier to administer than the three drug combination.


The study included more than 1,600 infants born between 2004 and 2010. All had received one of three treatments:


— the standard twice daily zidovudine alone for six weeks,

— twice daily zidovudine for six weeks plus three doses of nevirapine in the first six days after birth

— twice daily zidovudine for six weeks plus two weeks of treatment with nelfinavir and lamivudine.


To reduce the risk of HIV transmission through breast milk, mothers were counseled to formula feed their infants.


Within 48 hours after birth, all infants were tested for HIV. Results showed that about 6% tested positive, indicating that infection occurred before birth. At three months, about 8% of all the infants were HIV positive. The authors then calculated the overall infection rates for all the infants in the study – those infected at birth, and later, after 6 weeks of treatment. In addition to acquiring HIV during their time in the womb, infants may also become infected during the labor and delivery process. The study evaluated the effectiveness of the treatments in reducing HIV transmission during this latter interval (intrapartum transmission). So the authors calculated the transmission rate around the time of delivery – that is, the proportion of infections among infants who tested negative at birth, but later tested positive after six weeks of treatment. In the different drug treatment groups, infection rates were 7.1% in the zidovudine-nevirapine group (which had a 2.2% transmission rate), 7.4% in the three-drug arm (which had a 2.4% transmission rate), and 11% in the zidovudine-only group (which had a 4.8% transmission rate).


The study also found that mothers with more severe HIV infections were more likely to transmit HIV to their infants than were other mothers in the study. Illegal drug use during pregnancy also increased the transmission rate.


According to the authors, the two-drug combination is relatively easy to administer and well tolerated by the babies, and now that this alternative has been shown to be effective, it is increasingly being adopted worldwide to prevent transmission in these high-risk situations.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area.



FDA Approves New Combination Vaccine That Protects Children Against 2 Bacterial Diseases



Diseases caused by the bacteria Neisseria meningitidis (meningococcal disease) and Haemophilus influenzae type b (Hib disease) can be life-threatening. These bacteria can infect the bloodstream causing sepsis, and the lining that surrounds the brain and spinal cord causing meningitis. In young children, Neisseria meningitidis and Haemophilus influenzae type b are important causes of bacterial meningitis. Without vaccination, children younger than two years are susceptible to these serious illnesses. Meningococcal and Hib diseases are particularly dangerous because both diseases often progress rapidly and can cause death or serious, long-lasting health consequences such as blindness, mental retardation, or amputations. Early symptoms for both diseases often are difficult to distinguish from other common childhood illnesses.


The FDA has approved Menhibrix, a combination vaccine for infants and children ages 6 weeks through 18 months, for prevention of invasive disease caused by Neisseria meningitidis serogroups C and Yand Haemophilus influenzae type b.


The effectiveness of Menhibrix was based on immune responses in several hundred U.S. infants and toddlers vaccinated with Menhibrix. For the Hib component of the vaccine, immune responses in infants and toddlers following vaccination with Menhibrix were comparable to immune responses in infants and toddlers who received an FDA-approved vaccine against invasive Hib disease. For the meningococcal component, study results showed that the vaccine produces antibodies in the blood at levels that are considered to be predictive of protection against invasive meningococcal disease caused by serogroups C and Y.


The safety of Menhibrix was evaluated in about 7,500 infants and toddlers in the U.S., Mexico and Australia. Common adverse reactions reported after administration of Menhibrix were pain, redness and swelling at the injection site, irritability and fever.


Menhibrix is given as a four-dose series at 2, 4, 6 and 12 through 15 months of age. The first dose may be given as early as 6 weeks of age. The fourth dose may be given as late as 18 months of age.


Menhibrix is manufactured by GlaxoSmithKline Biologicals, based in Rixensart, Belgium.

Target Health Presenting at DIA 2012 – Visit Us at Booth #2542


Target Health will be presenting at the DIA Annual Meeting in Philadelphia on 26 June 2012 at 1:30 PM in room 109ab. The Forum is entitled: “Effective and Efficient Monitoring as a Component of Quality Assurance in the Conduct of Clinical Trials.


The forum will present data collected from the Clinical Trials Transformation Initiative (CTTI) survey on clinical trial monitoring and auditing practices used by organizations to address regulatory requirements, provide a rationale for the re-evaluation of these practices, and summarize new industry trends in the areas of monitoring and auditing of clinical trials.


Learning objectives: Describe, discuss, and evaluate the current state of monitoring and auditing in clinical research trials; Identify the current methods for determining the critical aspects of clinical trials; Discuss possible new approaches to clinical trial oversight.






1. Training, Site Selection, and Human Subject Protection: Factors to Consider When Developing a Monitoring Plan: Cynthia Kleppinger


2. Source Data Verification: Targeting Critical Elements: Cynthia Zacharias


3. Range of Practices for the Monitoring of Clinical Trials: Jennifer Giangrande


Panel: Jules Mitchel: Risk-Based and Centralized Monitoring, The Future is the Present


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at

The Tell Tale Heart


Q1: If you have a heart attack, you also have heart disease.
True or False


Explanation: If you have a heart attack, you have heart disease. Heart disease includes a number of conditions affecting the structures or function of the heart. Common forms of heart disease are coronary artery disease, arrhythmias, heart failure, and congenital heart disease, among many others that may lead to development of a heart attack. The correct answer is: True




Q2: What is meant by the term myocardial infarction?


A. Heart failure; B. Heart attack; C. Brain aneurism; D. All of the above

Explanation: Myocardial infarction is the medical term for heart attack. The correct answer is: B Heart attack



Q3: Sudden cardiac arrest means that the heart


A. Stops beating; B. Beats dangerously slowly; C. Has a cycle of beating and stopping; D. Skips beats



Explanation: Cardiac arrest is the sudden loss of cardiac function, when the heart abruptly stops beating. Unless resuscitative efforts are begun immediately, cardiac arrest leads to death within a few minutes. This is often referred to by doctors as “sudden death” or “sudden cardiac death” (SCD). The correct answer is: A. Stops beating



Q4: Symptoms of heart disease can include


A. Dizziness, weakness, arm pain, pressure in the chest; B. Heart palpitations, shortness of breath, weakness; C. No symptoms at all; D. All of the above


Explanation: Because there are many forms of heart disease, there are many symptoms, including dizziness; weakness; pain that radiates to the arm, jaw, or throat; nausea; vomiting; shortness of breath; heart palpitations; chest pain, discomfort and heaviness. There are some forms of heart disease that produce no symptoms at all. The correct answer is: D. All of the above



Q5: Heart disease is the leading cause of death of American women over the age of 25


True or False


Explanation: According to the American Heart Association, cardiovascular disease is the leading killer of women over the age of 25. It kills nearly twice as many women in the United States than all types of cancer, including breast cancer. The correct answer is: True



Q6: Risks for heart disease include


A. High blood pressure and high cholesterol; B. Smoking; C. Lack of exercise; D. All of the above. Explanation: High blood pressure and high cholesterol, smoking, and lack of exercise are contributors to heart disease, but it is necessary to include: diabetes and prediabetes, being overweight or obese, a diet high in fats, emotional stress, and excessive alcohol consumption as well as uncontrollable risk factors such as age, gender, and family history. The correct answer is: D. All of the above



Q7: In the heart, a clogged artery causes a heart attack. In the brain it causes a ___________.


A. Migraine; B. Mental illness; C. Stroke; D. Seizure


Explanation: A stroke occurs when blood flow to a part of the brain is interrupted because a blood vessel in the brain has been blocked. This is called an ischemic stroke. Cerebral hemorrhagic strokes occur when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. The correct answer is: C. Stroke



Q8: When heart trouble is sensed, who waits at least two hours before help is called?


A. Men; B. Women; C. Both men and women; D. Children


Explanation: When it comes to heart trouble, Americans (males and females) typically wait at least two hours before calling for help. Know the warning signs and always call 911 within 5 minutes of when symptoms begin because waiting may allow heart trouble to become much worse. The correct answer is: C Both men and women



Q9: The term “heart failure” means the heart has stopped working.


True or False


Explanation: The term “heart failure” does not mean the heart has “failed” or stopped functioning. It means the heart does not pump as well as it should. This then leads to salt and water retention, causing edema (swelling) and shortness of breath, which are the primary symptoms of heart failure. The correct answer is: False



Q10: People can be born with heart disease.


True or False


Explanation: People born with heart structure and function problems are said to have “congenital heart disease.” Congenital (present at birth) heart disease refers to abnormal heart development before birth. It is the most common type of birth defect. The correct answer is: True



Q11: Has heart disease ever been responsible for half of the deaths in America?


True or False


Explanation: By the late 1940s, cardiovascular disease was responsible for half of all U.S. deaths. Only six decades ago, we didn’t know what caused cardiovascular disease, and many Americans died of heart attacks in their 50s or 60s. The correct answer is: Yes



Q12: The most common type of heart disease in the U.S. is:


A. Coronary artery disease; B. Atrial fibrillation; C. Mitral valve prolapse; D. Arrhythmias


Explanation: Coronary heart disease is usually caused by a condition called atherosclerosis, the narrowing of coronary arteries by cholesterol deposits, called plaques. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina. The correct answer is: A Coronary artery disease



Q13: The medical term for chest pain is _________________.


A. Angina; B. There is no medical term for chest pain; C. Flutter; D. Arrhythmia


Explanation: Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle. The correct answer is: A. Angina

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