TelmedPak.com News

UNICEF Says 3.5 Million Pakistan Children at Risk of Water-Borne Diseases

8/28/2010 1:32:00 AM

More than 3 million children are at high risk of deadly water-borne diseases in Pakistan, making them the most vulnerable victims of one of the worst natural disasters in history, the United Nations Children’s Fund said.

As the waters continue to rise, the United Nations has warned of a “second wave of death” from the devastating monsoon floods in the days to come.
The World Health Organization has asked Pakistan’s government to investigate a reported case of cholera in the north-west Swat Valley, New York-based UNICEF said in a statement on its website yesterday.

WHO, the UN’s Geneva-based health agency, projects that as many as 1.5 million cases of diarrheal diseases –- including as many as 140,000 cases of cholera -- 150,000 cases of measles, 350,000 cases of acute respiratory infections, and as many as 100,000 cases of malaria could occur over the next three months, according to Unicef.

“UNICEF is currently providing enough clean water for 1.3 million people every day, but millions more need the same services,” said UNICEF’S representative in Pakistan, Martin Mogwanja, in the statement.

“We urgently need to scale up the distribution of water. If we are not able to do so because of lack of funding, water- borne diseases such as cholera, diarrhoea and dysentery will spread and begin killing affected populations, especially children, already weak and vulnerable to disease and malnutrition,” Mogwanja said.

Waist Circumference Linked to All-Cause Mortality in Older Adults

8/16/2010 12:27:00 AM

Waist circumference (WC) is a risk factor for mortality in older adults, regardless of body mass index (BMI).

Risk for mortality was more than doubled for very high levels of WC after adjustment for BMI and other risk factors. Among men, relative risk (RR) of mortality is 2.02 1 for WC 120cm or larger compared with WC less than 90cm. Among women, RR was 2.36 for WC 110cm or larger compared with WC less than 75cm.

Within all categories of BMI, WC is positively associated with mortality.

"Results from this large prospective study emphasize the importance of WC as a risk factor for mortality in older adults, regardless of whether the BMI is categorized as normal, overweight, or obese. Result suggests that regardless of weight, avoiding gains in WC may reduce risk of premature mortality.

Don't Sweat It

8/10/2010 6:46:00 AM

Experts share tips to help you cope with heavy sweating.
When the heat is on -- or emotions are high -- sweating can be a problem and a source of embarrassment.

First, it's crucial to first see your doctor and rule out whether your sweating is normal or due to some underlying cause -- a medical condition, a medication -- that can be corrected or changed.

Once that's done, there are simple steps to help reduce sweating and boost your comfort level. Here are ways to cope with heavy sweating at the gym, on the job, and everywhere you go.

Stopping Heavy Sweating
Here are some tips for stopping your heavy sweating:

Switch to higher-strength deodorants and antiperspirants. Some are prescription only, but you can also get higher strength products over the counter.

Save your skin. Applying deodorant at night reduces the chance of skin irritations and will keep you using it more faithfully.

Sweating During Exercise
There are several ways to deal with sweating during exercise:

Dress to thwart sweat. Choose lightweight, breathable fabrics, such as cottons.

Splurge on ''athletic" clothes. In recent years, clothing for athletes has improved, with new breathable fabrics. Look for those that wick away moisture. The labels typically feature the fabric characteristics prominently.

Wear it once. Don't put on a t-shirt or bike shorts that are soaked with sweat. You need to start out dry to stay dry. Your skin will thank you, too.

Change footwear often. If sweaty feet are a particular problem, be sure to change your shoes and socks often.

Dust away sweat. Use powders meant for the feet to keep foot moisture and sweat at a minimum.

Sweating on the Job
To cope with sweating on the job, experts recommend these steps:

Tote along deodorant or antiperspirants. Reapply them in the middle of the day -- or before a stressful meeting.

Dress in layers year-round. For men, wearing an undershirt can help soak up some of the sweat. Women could wear an absorbent camisole top or dress shields.

Choose clothing in looser weaves. ''The tighter the weaver, the hotter the clothes. Instead, select clothes with a looser weave such as linens. Silk is a fabric to avoid, because it makes you feel hotter.

Pocket a handkerchief. If you keep one in your pocket or purse, you can wipe off excess sweat quickly before you need to shake hands.

Skip the spicy lunches. Eating certain foods, such as hot peppers, can affect the amount of sweat you produce. Eating other foods, including onions and garlic, can make your sweat smell worse. So no matter how good that hot jalapeno pizza lunch special looks, try to pass.

Sweating Through Your Clothes
The right clothes can be an ally in the battle against heavy sweating. Experts' tips include:

Become a label reader. Look for clothing labels that say the fabric is the type that wicks away moisture. Or look for clothing with high cotton content.

Pick colors wisely. White will show more sweat. But it won't be as visible on other colors, nor on prints or patterns.

Buy ''breathable" shoes. That will reduce sweat, and it's important especially if your feet are generally sweaty.

Skip hats. Keeping your head cool is as important as keeping your feet cool in the anti-sweat war, Glaser says.

Tote a wardrobe change. If you carry an extra shirt or blouse to work or a social function, or always leave a quick change in your car, you can wipe and wash away sweat when necessary, then change to fresh clothes -- or at least from the waist up.

Nighttime Sweating
To combat nighttime sweating, follow these strategies:

Pick bed linens wisely. Look for breathable, lightweight fabrics for year round.

Skip the down comforter, even in winter. Opt for a lighter bedspread.

Pick sheets that are absorbent. The best fabrics are plain cotton, not silk or flannel.

Cleaning Products Linked to Breast Cancer?

8/10/2010 6:16:00 AM

Frequent use of household cleaning products may boost breast cancer risk, according to a new study that drew criticism from medical experts and the cleaning industry.

Air fresheners and products to control mold and mildew were particularly linked, says researcher.
The study is believed to be the first published report linking household cleaning products and breast cancer risk. "Many laboratory studies led them to be concerned about particular compounds in cleaning products and air fresheners. Others are not convinced. ''

What this study really shows is, when a study relies on people's memory of their exposure, and people are concerned about that exposure, you don't get reliable answers.

Study Suggests Household Cleaning Products May Raise Breast Cancer Risk, but Experts Disagree.

Adenoids

8/7/2010 5:44:00 AM

The adenoids normally play an important part in the body's immune defense against invading micro-organisms, but sometimes they can cause problems.

What are they?
The adenoids are lumps of lymphatic tissue (sometimes called lymph glands or lymph nodes) at the back of the nasal passages. They're rather like tonsils but found higher up above the throat.

Why causes enlargement?
A child may be born with large adenoids, which have developed in the womb.
More commonly, the adenoids become enlarged during the first few years of childhood. Repeated infections of the upper respiratory system cause the adenoids to become chronically inflamed and enlarged. The tonsils are also usually enlarged.

Who's affected?
Enlarged adenoids are common during childhood but in most cases are mild or only temporarily enlarged.
It tend to get better as a child reaches adolescence but occasionally problems persist into adulthood.

What are the symptoms?
Enlarged adenoids may block the breathing passages, making a child breathe through the mouth. Mouth breathing may at first only be a problem at night, but in severe cases the child may breathe through their mouth during the day, too. Mouth breathing causes a dry mouth and cracked lips.

There is often bad breath, caused by chronic infection in the adenoids and aggravated by the dry mouth. Enlarged adenoids may also alter the sound of speech.

Other problems include ear infections (because the drainage tubes from the middle ear may be blocked), snoring and sleep apnea. Disruption of sleep can interfere with a child's growth. In extreme cases, enlarged adenoids can put excessive strain on the heart.
It may be possible to see when tonsils are enlarged, but adenoids can only be seen using a special mirror or by putting a small flexible telescope called an endoscope into the nasal passages. This must be done by an ear, nose and throat specialist. Occasionally, x-rays or special sleep studies are necessary.

What's the treatment?
Antibiotics may be used to treat the adenoids when they're infected but may not have much effect on chronically enlarged adenoids.
An operation to remove the adenoids, called adenoidectomy, may be necessary in severe cases to prevent the long-term complications of airways obstruction, such as heart failure. Surgery may lead to improved growth and development because deep sleep is restored.

Summer Sun Protection for Kids

7/19/2010 6:51:00 AM

It only takes one severe sunburn to potentially double your child's chances of getting melanoma later in life.

Slather on the Sunblock – No Exceptions

Remember how much you marveled at your baby's smooth skin? Don't let the sun destroy that beautiful canvas. Ultraviolet sunlight damages the skin, and can lead to wrinkles and cancers later on. There is no such thing as a healthy tan; a tan is a sign of sun damage.

Always put sunscreen on your child before going outside, starting at 6 months of age. Make a fun game out of it. Teach your child to spell BEENS to help you remember to cover often-forgotten spots: Back of knees, Ears, Eye area, Neck, and Scalp.

Apply sunscreen 15 to 30 minutes before going outside, and reapply every 2 hours, sooner if the child has been swimming. Waterproof sunscreen wears off about 80 minutes after being wet; sooner if you've toweled off.

If your child attends school or daycare, make sure teachers are told to apply sunscreen before any outdoor activities.

Choose a Child-Friendly Sunscreen

Can't decide which sunscreen is best for your child
Their No. 1 tip: Choose a sunscreen that contains zinc oxide or titanium dioxide, because the compounds are less irritating than others and do not get absorbed into the skin. "These ingredients are probably the safest ones out there right now.

There is some concern that other sunscreen ingredients, particularly oxybenzone and retinyl palmitate (a form of vitamin A), may cause harm. However, both chemicals are FDA approved for use in sunscreens.

Other tips:
• Opt for a sunscreen with a sun protection factor (SPF) or 30 or higher.
• Make sure it's labeled "broad spectrum," which means it blocks both UVA and UVB sunlight. UVA rays cause sunburn. UVB rays are the main cause of wrinkles.
• Let your child choose a colored or scented sunscreen. Nix this idea if your child has sensitive skin or an allergic skin disorder, such as eczema.
• Sunscreen sticks are best for the face because they are sweat proof and less likely to drip.

Cover Up Head to Toe

Clothing can also help. "The best sun protection is something that completely blocks the sun from getting to the skin, which is clothing if you're not inside a building.

But forget about tossing on a flimsy, white tee. A white T-shirt has limited protective value. If you can see through the tee, the sun can shine through and burn you. Dark, tight-woven clothing that covers all exposed skin is best.

You can also buy clothing that is specially treated with chemicals that help protect against ultraviolet sunlight. sun-protective clothing, such as a kid's swim shirt or rash guard shirt, with an ultraviolet protection factor (UPF) of 30 or higher are also recommended. The clothing loses its UPF strength after several washings, so check the labels for care instructions.

Don't want to buy new clothes? The Skin Cancer Foundation recommends SunGuard, a laundry additive that contains a sunscreen called Tinosorb FD. Toss it in the wash, and your clothes instantly get a UPF of 30. The protection lasts about 20 washings.

Wear a Hat

Have your child take a tip from Barney and wear a silly hat outside. Take your child hat shopping, but be sure to purchase a hat with a wide brim that casts a shadow on the face. Too old for Barney? Look for a favorite sports team or school logo.
Another outdoors must-have: Sunglasses. They are an important part of sun protection and recommended for kids of all ages. Make sure they filter both UVB and UVA rays.

Soothing a Sunburn

If your child gets sunburn, and is active, playful, and does not have any blisters, here's how you can make him feel better.
• Place a cool compress to the sunburn.
• Apply aloe gel to the burned skin. Try placing the aloe in the fridge for a few minutes first before using.
• Give acetaminophen or ibuprofen. Check with your doctor for the correct dose.
• Give your child plenty of fluids.

Do not use over-the-counter pain relieving products containing benzocaine on sun-burned skin. (These are called topical anesthetics.) They can often make the pain worse, and some people are allergic to the ingredient.

If your child feels or looks ill, spikes a fever, or has blisters, seek medical attention

Rheumatoid arthritis

7/19/2010 6:20:00 AM

This is the most common type of inflammatory arthritis, affecting about one in 100 people.

Rheumatoid arthritis is an autoimmune disease in which the body's defense mechanisms go into action when there's no threat. In this case, the immune system attacks the joints and sometimes other parts of the body. It's not yet known why the immune system acts in this way in some people.

Who gets it?

Rheumatoid arthritis is a common disease affecting about one in 100 people. People of all ages have the condition, but it most commonly starts between the ages of 30 and 50. Three times as many women are affected as men.

What happens?

The joints become inflamed, particularly:
• the synovial membrane
• the tendon sheaths
• the bags of fluid that allow muscles and tendons to move smoothly over one another (bursae)

Inflammation sometimes becomes far worse - known as a 'flare-up' - when the joints become warm and red as blood flow to the area increases. The synovial membrane produces extra fluid, causing swelling and a stretching of the ligaments around the joint. The result is a stiff, swollen and painful joint.

In one in five cases, rheumatoid arthritis develops very rapidly but more often the symptoms develop over several months. For about one in 20 people with the disease the cycles of inflammation cause severe damage in many joints, but others have little or no damage. Treating inflammation as quickly as possible is vital because once joint damage has occurred it can't be reversed.
In a few cases, symptoms typical of rheumatoid arthritis come and go. These patients may have a different, but probably related, condition called palindromic rheumatism, which may be mistaken for rheumatoid arthritis. (There may also be other symptoms, such as certain skin rashes, which are not seen in rheumatoid arthritis.) Most importantly, the damage to bones or joints that occurs in rheumatoid arthritis is not seen in this condition. However, over time, as many as 50 per cent of patients will go on to develop rheumatoid arthritis.

What does it feel like?

Most people get fluctuating pain and stiffness that gets worse during flare-ups. Whereas in osteoarthritis morning stiffness wears off quickly, in rheumatoid and other forms of inflammatory arthritis it usually lasts more than 45 minutes. Many people find that the condition gives them flu-like symptoms and makes them tired, irritable or depressed.

Does it run in families?

There is no single gene to blame for rheumatoid arthritis, and when one family member develops the disease the risk to others in the family is small. However, although about 0.5-1.0 per cent of people in most populations will develop rheumatoid arthritis, it is much more common among the Pima Indians (5.3 per cent) and the Chippewa Indians (6.8 per cent) and far less common in China and Japan. This shows that genetics do play some part in predisposing to rheumatoid arthritis.

The main risk comes from a group of genes known as HLA-DRB1 alleles, but several genes appear to be involved, each of which exerts only small effects to different degrees in different people. In 2007, researchers in Manchester identified a genetic variant in part of chromosome 6 that is associated with rheumatoid arthritis. It’s thought that this variant, although not a gene itself, may affect the behaviour of a nearby gene called tumor necrosis factor associated protein gene (TNFAIP3), which is known to be involved in the process of inflammation.

What are blisters?

5/19/2010 8:51:00 AM

A blister is formed when fluid from blood vessels leaks into the skin. It then collects beneath the outer layer of skin, forming a raised bump.

As new skin grows beneath the blister, the fluid contained within it is slowly absorbed, and the skin on top dries and peels off. Hence the blister heals naturally and rarely needs treatment.

Causes and risk factors
Single blisters are usually caused by friction when something rubs against the skin. Poorly fitting shoes are a common example of this. Any kind of burn - including sunburn - can cause blisters, too.

Certain medical complaints cause blisters to appear on different parts of the body. These include eczema, chickenpox and the bacterial infection impetigo, where the blisters may be filled with pus rather than the usual clear fluids.

Blisters can also form as a reaction to certain medications, including some antibiotics, and there are a number of rarer blistering skin conditions, some of which are caused by an autoimmune reaction, where the body's immune system attacks cells in the skin.

Treatment and recovery
Never burst the blister to release the fluid because the skin acts as a barrier against infection. When the skin of the blister breaks of its own accord or as a result of minor trauma, a sterile dry dressing should be used to cover it, which protects the area from infection until it's healed.

If the blister becomes red, hot, filled with pus, or painful then medical advice should be sought, because treatment for possible infection may be needed. Recurrent blisters, blisters in a wide-spread rash unrelated to friction, or blisters accompanied by other unusual symptoms should all be checked by a doctor because they may a sign of a more complex condition that needs investigation.

Nutrition: Added Sugar and Cholesterol

5/19/2010 8:25:00 AM

People who eat and drink high amounts of added sugars have lower blood levels of so-called good cholesterol and higher levels of harmful triglycerides than those with diets lower in such sweeteners, a new study reports.

The researchers gathered data on 6,113 adults from the National Health and Nutrition Examination Survey, who were asked to recall their food intake during a single 24-hour period, then were grouped according to their consumption of added sugars, including refined beet or cane sugar and high-fructose corn syrup. Blood samples were analyzed for triglycerides and both types of cholesterol — good, or HDL, and bad, or LDL.

On average, 15.8 percent of participants’ calories came from added sugars. When the figure was 25 percent or more, good cholesterol averaged 47.7 milligrams per deciliter and levels of triglycerides were 114 milligrams. In contrast, those who consumed less than 5 percent of their calories in added sugars had higher levels of good cholesterol, with a mean of 58.7 milligrams, and lower levels of harmful triglycerides (105 milligrams).

“We looked specifically at sugars that are added during the processing and preparation of foods,” said the paper’s lead author, Jean A. Welsh, a graduate researcher at Emory University in Atlanta. “Soft drinks are the most commonly consumed example and provide 30 percent of added sugar in the United States.”

Lumps and bumps

2/4/2010 2:02:00 AM

Most lumps are benign, but it's important to be sure exactly what they are and find out whether they need treatment. Benign vs malignant

Lumps are usually referred to as tumours, and they may be benign or malignant. In a tumor, one particular type of cell (such as a glandular, fat or muscle cell) has escaped the normal controls on growth and started to multiply.

The most important characteristic is whether these tumor cells can invade other adjacent cell types, and spread around the body (i.e. they are malignant tumours) or not (in which case they are benign).

Benign tumours

Benign tumours include :

•    Cysts: lumps filled with fluid. Common types include sebaceous cysts on the skin, filled with greasy sebum, and ovarian cysts
•    Nodules: formed in inflammatory conditions such as arthritis, sarcoid and polyarteritis
•    Lipomas: lumps of fat cells
•    Fibromas and fibroademonas: lumps of fibrous or fibrous and glandular tissue
•    Haematoma: lump formed by blood escaping into the tissues - simply a large bruise
•    Haemangioma: lump formed by extra growth of blood vessels
•    Papilloma: formed from skin or internal membrane cells, for example warts
Benign tumours do not invade or spread. They can grow quite large without causing problems, although that doesn't mean they're totally harmless because their growth may start to damage the other tissues or organs around them.

This is a particular problem with a type of brain tumor called a meningioma, which grows from cells in the membranes that surround the brain (the meninges). Although benign, the pressure within the skull from the growing meningioma can cause severe headaches and may be life threatening if the tumor not removed.

Benign tumours can cause others problems, from simply looking unsightly to releasing excess hormones.

Malignant tumours

Malignant tumours are also known as cancers. They invade the tissues around them and spread to other parts of the body by sending out cancer cells into the lymphatic system or through the blood stream.

These cells are deposited in other areas of the body, particularly the lungs, liver, brain and bones, to start 'secondary' tumours (also called metastases) at the new sites. Most malignant tumours are life threatening.

Breast tumours

•    Benign: mostly happens at younger age. Usually a round smooth lump with a border that feels separate to the rest of the breast. Changes may occur in the lump with the menstrual cycle, being more obvious just before a period. The lump may be tender.
•    Malignant: mostly happens at older age. Usually a craggy or irregular lump, which may be seen to tether the skin There may be other symptoms such as discharge from the nipple. There may be a family history of breast cancer especially if at a young age.

Women are advised to be on the look out for lumps in their breasts. However, among younger women at least, lumps are far more likely to be benign - in women under 40, more than nine out of ten breast lumps are benign. But these lumps still cause a lot of anxiety until they are sorted out.

The most common benign breast conditions are fibrocystic change, benign breast tumours and breast inflammation. These are common problems, in fact fibrocystic change used to be known as fibrocystic disease but, as it affects more than 50 per cent of women at some point, it was thought it could no longer be considered a disease.

Fibro adenomas (sometimes called breast mice because they can be moved around) are particularly common in women in their 20s or 30s. They are benign and not cancerous.
In most cases these lumps are quite harmless, although now and then they may cause troublesome symptoms such as tenderness (especially as many are influenced by hormone levels and tend to get more swollen and painful along with other menstrual symptoms).

Malignant breast tumours mostly occur in older women, and tend to be accompanied by other symptoms such as discharge from the nipple. The lump may feel craggy or irregular.
Women who have a family history of breast cancer, especially breast cancer at a young age, have an increased risk of malignant tumours.

Is it cancerous?

Sometimes it's fairly clear that a lump is either benign or malignant, but further tests may be required, including x-rays, ultrasound or biopsy. Often the best way to get an answer is to remove the whole lump and send it to the laboratory for analysis.

Benign lumps may not need to be removed but this is usually the most effective way to reassure someone because, whatever the problem, it's gone.

If you find a lump

•    Get a doctor's opinion - no one minds checking hundreds of harmless lumps if it means that one malignant or cancerous lump is caught early.
•    Don't hide a lump or fret silently about it - if it does prove to be malignant the sooner it's dealt with the greater the chance of cure.
•    Bear in mind that most lumps, especially in younger people, are benign or relatively harmless.

New VA/DoD Guidelines for Concussion and Mild Traumatic Brain Injury

2/4/2010 1:41:00 AM

Now, a panel of experts has produced guidelines for TBI(Traumatic Brain Injury). Published in the Department of Veterans Affairs (VA) Journal of Rehabilitation Research and Development, the evidence-based VA/Department of Defense guidelines include tables and algorithms that walk the user through the identification, treatment, and management of concussions.

About 5% of soldiers in combat experience a concussion. To date, some 1.8 million military personnel have been deployed to Iraq alone, and they have experienced some 90,000 injuries, said Dr. Cifu.
The guidelines were developed to help identify and manage concussions in adults who complain of symptoms related to a head injury and who are treated at least 7 days after the initial injury. In addition to soldiers, they can be applied to hockey and football players, to other athletes, and to the general public.

"The guidelines were generated by the military and the VA for people who have experienced combat, but there's nothing unique about them," said Dr. Cifu. He added that the working group included sports medicine specialists, as well as neurologists, psychiatrists, and experts from other disciplines.

A concussion is caused by a force to the head or body that is accompanied by an alteration in, or loss of, consciousness, and sometimes also with memory deficits and/or confusion or disorientation. "You can't really remember that you were about to be hit by another hockey player or by a bullet," explained Dr. Cifu. "Your computer was kind of shaken up for a couple of seconds and lost its focus."

Reference Document

After reviewing the literature, the task force categorized the evidence into various levels of recommendations: A for a strong recommendation to provide the intervention to eligible patients, B for a recommendation to provide the service, C for no recommendation for or against providing the service, D for a recommendation against routinely providing the service to asymptomatic patients, and I for insufficient evidence to recommend for or against routinely providing the intervention.

The task force found "limited suggestive evidence" of an association between sustaining a mild TBI resulting in loss of consciousness or amnesia and the development of unprovoked seizures or ocular and visual motor deterioration. It found the same level of evidence of an association between mild TBI and Parkinson disorder and between mild TBI and dementia of the Alzheimer's type when the injury included loss of consciousness.

Psychiatric Symptoms

The initial assessment for concussion involves a screen for psychiatric problems, such as combat-related stress disorder or posttraumatic stress disorder, depression, and anxiety, that can either overlap with a brain injury or resemble one. Detection and management of these conditions are built into the algorithms. One algorithm is used to diagnose concussion, another to initiate the management of symptoms, and another to manage persistent symptoms.

The document stresses that treatment of a concussion is specific to the individual symptoms — for example, dizziness, nausea, numbness, or fatigue. The authors noted that headache is the most common symptom associated with brain injury and that assessment and management of headaches after concussion should be the same as those for other causes of headache.

Drugs to treat headaches, pain, and other symptoms should be carefully monitored because brain injured patients are more sensitive to medication adverse effects. Medications with an increased risk for suicide should be limited because the suicide rate is higher in post-TBI patients, said the authors.

However, most patients who experience a concussion require no specific medical treatment and recover within hours or days, the authors note. Up to 95% recover completely within 3 to 12 months.

Returning to Duty

In most cases, soldiers and others who experience a concussion should return to work or duty as soon as possible after a mild TBI, but resumption of activity should be gradual. If physical, cognitive, or behavioral symptoms reemerge, return to normal activity should be monitored, said the authors.

Because most people do not experience any long-term effects of a concussion, using the term brain damage should be avoided. "A positive prognosis, spinning it the right way, is the best treatment,” said Dr. Cifu.

However, a concussion can be serious, especially if it follows on the heels of another brain injury. Although there is no conclusive evidence, the consensus among experts is that patients who sustain a second concussion before the first has healed have more severe symptoms, said Dr. Cifu.

The standard recommendation is for a soldier to stay away from active duty for at least a year after sustaining more than 2 concussions, he said.

Because of the urgencies of war, soldiers often discount the severity of symptoms and delay seeking treatment for a head injury for weeks, even months, said Dr. Cifu. "If these guys don't go out on that mission, they feel they've disappointed themselves as well as others."

The authors stressed the importance of educating patients and their families in preventing or reducing the development of persistent symptoms.

To access the guidelines, visit http://www.healthquality.va.gov/management_of_concussion_mtbi.asp

What is insomnia?

1/11/2010 12:30:00 AM

Insomnia is repeated difficulty in getting to, staying or getting enough good quality sleep, despite adequate opportunity, which leads to some form of impairment of performance or well-being during the daytime. If it occurs regularly or over a long period of time, it's called chronic insomnia.

About one in three adults will have had some sort of problem with insomnia within the past 12 months. For most the problem is fairly short-lived but for as many as one in ten it becomes a chronic problem which significantly affects their life.

There are many different patterns of insomnia. For example, one in three people with insomnia have no problem getting off to sleep but then wake in the early hours and cannot get back to sleep.

Causes and risk factors

A common trigger for sleeping difficulties is stress and worry. Some people are particularly vulnerable because they are more likely to show a more extreme response to stress, such as people who are depressed, chronically ill or struggling with other difficult issues such as relationship problems.

Other common causes include physical illness that causes pain, environmental noise, depression, shift work, caffeine or alcohol consumption, and medication side-effects. Insomnia is much more common in older people.

Once triggered, sleep problems may then be perpetuated by the individuals beliefs and behaviours – they often worry excessively about the effect that inadequate sleep will have on them and so strive excessively hard to get to sleep, take daytime naps or sleep in late which can disrupt the natural rhythm, or turn to medicines or alcohol in the belief that this will help (most just induce unnatural patterns of sleep). A vicious cycle of poor sleep and stress is quickly set up and persists after the initial trigger has passed.
Insomnia contributes to excessive daytime tiredness, which in turn may be responsible for accidents, recurrent infections (inadequate sleep has been show to suppress the immune system), poor concentration, irritability, work and relationship problems and a general inability to cope. In children it may be linked to poor growth.

Treatment and recovery

Sleeping tablets may be prescribed for short-term use only, when the cause of insomnia has been identified as bereavement or jet lag, for example.

However, it's usually more important to address any underlying cause of the insomnia and attempt to restore a normal sleep pattern through changes in behaviour and lifestyle. For example make sure your bed is comfortable and your bedroom dark and quiet. Try to follow a set routine, going to sleep and getting up at the same time and avoiding daytime naps, and don’t work or watch TV in your bedroom.

You should also try avoiding stimulants such as caffeine, nicotine and alcohol. Getting more exercise during the day, having a warm milky drink before bed, and herbs such as valerian and chamomile can also help.

Nerve Pain Self-Care

12/8/2009 8:14:00 AM

Living with nerve pain can be a long-term proposition. Some neuropathic pain gets better with treatment or on its own, but that can take months or years. Other nerve pain stays the same for years or worsens slowly. Some nerve pain can't be reversed.
Your doctor can help you identify and treat your neuropathic pain with the best available therapies. But there are also plenty of things you can do on your own to take care of yourself and your pain.

What Causes Nerve Pain?

Neuropathic pain comes from nerve damage. Most commonly, this is caused by medical conditions such as diabetes, side effects from drugs or chemotherapy, or injuries.
Damaged nerves are more likely to misfire, sending pain signals when there is no cause for pain. They can also put you at risk for more serious problems such as foot infections.
All the causes of nerve pain are still largely a medical mystery. Researchers have identified several different ways nerves can misfire, and this has led to treatments that help many people.
Still, in surveys of people with nerve pain, most say they still have pain despite the best efforts of their doctors. If you're one of them, you may want to look beyond conventional medicine for relief. Almost half of those with nerve pain report trying complementary or alternative approaches to improve their pain.

Self-Care Strategies for Easing Nerve Pain

In addition to relieving pain, many self-care and home treatments can help prevent more serious problems and protect your overall health. And some of these strategies may even trigger the body's natural painkillers, having the added benefit of making you feel good.
Keep on top of diabetes. If you have diabetes, keep your blood sugar under control. Normal blood sugar levels are the best possible treatment for diabetic nerve pain.
Walk it off. Exercise releases natural painkillers called endorphins. Exercise also promotes blood flow to the nerves in the legs and feet. Researchers believe that regular exercise may create a long-lasting expansion in blood vessels in the feet, nourishing damaged nerves back to health. Start with a daily walk, gradually increasing your pace and distance.
Pamper your feet. If your feet are affected by nerve pain, it's time to focus on good foot care. Nerve pain usually means impaired sensation, making injuries and infections more likely. Reduce your risk by examining your feet daily, wearing comfortable shoes, and seeing a podiatrist regularly. No wound or injury to your feet is too minor for a consultation with your doctor.
Soak it away. A warm bath might be the easiest -- and least expensive -- home treatment for nerve pain. Warm water temporarily increases blood flow to the legs and can help ease stress as well. Avoid burns by measuring water temperature with your arm before stepping in.
Skip happy hour. Heavy alcohol use is toxic to nerves and can worsen nerve pain. There's no magic number for how many alcoholic beverages you can have and still avoid nerve pain, but some experts advise four drinks or less per week.
Sleep on it. Nerve pain can worsen at night, disrupting sleep and making it more difficult to cope with pain. Help break the cycle with good sleep habits. Limit afternoon caffeine intake, keep a consistent bedtime that allows for eight hours of sleep, and reserve the bedroom for sleep and sex.
Burn it out. Capsaicin cream, made from hot chili peppers, causes an uncomfortable burning sensation when initially applied. Some individuals find the burning sensation they experience when using capsaicin cream to be intolerable, especially when they are already suffering from a painful condition. But those who stick with it for weeks often report improvement in nerve pain (and less burning over time).
Numb it up. The anesthetic lidocaine -- in gel, ointment, or patches -- is available in prescription and over-the-counter preparations. The relief from lidocaine is satisfying, although temporary.
Rub it out. Some studies have shown that applying botanical oils such as geranium oil can reduce the pain of postherpetic neuralgia. Other oils, such as lavender oil, have been shown to help relax people, which may also help take the mind off nerve pain.
Meditate on it. Techniques such as guided imagery, meditation, biofeedback, and hypnosis help some people with nerve pain live better. Finding the right professional at a reasonable price can be challenging. Do your homework and ask for a referral from your doctor or someone whose advice you trust.

Glucosamine and Chondroitin

12/8/2009 8:10:00 AM

Glucosamine and chondroitin are part of normal cartilage. Cartilage acts as a cushion between the bones in a joint.

What are glucosamine and chondroitin used for?

People with osteoarthritis use glucosamine and chondroitin to relieve joint pain.

Glucosamine and chondroitin, taken alone or together, have not always been shown to relieve pain of osteoarthritis in all people. But glucosamine and chondroitin taken together may help reduce pain in some people with moderate-to-severe knee pain.1 Some studies show that chondroitin alone may relieve pain and improve function.

There are also some studies that indicate glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects.

Research indicates that glucosamine and chondroitin can help restore cartilage.

Are glucosamine and chondroitin safe?

It appears that glucosamine and chondroitin, in combination or separately, have few side effects.

If you are allergic to shellfish, do not take glucosamine unless you have discussed it with your doctor. Glucosamine is made from shellfish covering.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:
Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions.
The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

Carpal Tunnel Syndrome - Exams and Tests

12/8/2009 7:56:00 AM

Carpal tunnel syndrome is usually diagnosed from the results of a:

Medical history, including any medical problems or illnesses, prior injuries, current symptoms, or daily activities that may be causing your symptoms.
Hand diagram. You may be asked to help fill in a diagram of your hand to show where you have numbness, tingling, or pain.
Physical exam, including the tests for Tinel's sign, Phalen's sign, and two-point discrimination. Although many other tests have been developed for diagnosing carpal tunnel syndrome, there is no convincing evidence of their accuracy.

Additional testing
If your symptoms are severe, if nonsurgical treatment has not improved symptoms, or if your symptoms are not clearly caused by carpal tunnel syndrome, your doctor may recommend:

Nerve testing (electromyogram [EMG] and nerve conduction studies), to evaluate any loss of normal functioning in the median nerve. Nerve testing for carpal tunnel syndrome is used in specific situations, such as when surgery is being considered or the diagnosis is unclear.
X-rays, to check for bone problems caused by past injury, arthritis, recently broken or dislocated bones, or tumors. X-rays are not used to diagnose carpal tunnel syndrome, but they can be helpful for identifying signs of arthritis or an old or new wrist or neck injury that may be contributing to your symptoms.
Ultrasound, to look at the size of the median nerve. It is inexpensive, comfortable, and quick. But its use for carpal tunnel syndrome diagnosis is still unproved and relatively uncommon.
MRI (magnetic resonance imaging), to look for swelling of the median nerve, narrowing of the carpal tunnel, or problems with circulation of blood through the carpal tunnel.
Blood tests, which are sometimes done to check for a thyroid problem, rheumatoid arthritis, or other medical problem. If the cause of your symptoms is unclear and your medical history suggests other possible conditions, your doctor may order blood tests.

Autism and Asperger syndrome

11/15/2009 11:40:00 PM

To people with autism and Asperger syndrome the world can appear chaotic with no clear boundaries, order or meaning.
These disorders can vary from very mild, where the person can function as well as anyone else around them, to so severe that they are completely unable to take part in normal society.

"They affect more than 580,000 people in the UK"

People with autism are usually more severely disabled, while those with Asperger syndrome tend to be more able, although this isn’t always so. Because of the range of severity and symptoms the conditions are collectively known as autistic spectrum disorders. They affect more than 580,000 people in the UK.

Symptoms
The main three symptoms are:

Difficulties with social interaction - being unaware of what's socially appropriate, finding chatting or small talk difficult and not socializing much. People with autism may appear uninterested in others and find it very difficult to develop friendships and relate to others, while those with Asperger syndrome are more likely to enjoy or want to develop social contacts but find mixing very difficult.

Problems with verbal and non-verbal communication – those affected may be able to speak fluently or, more commonly in autism, may be unable to speak at all. There may also be difficulties understanding gestures, body language, facial expressions and tone of voice, making it difficult to judge or understand the reactions of those they are talking to, or to empathize with people's feelings. As a result they may unintentionally appear insensitive or rude to others. They may also take others comments very literally, and so misunderstand jokes, metaphors or colloquialisms.

Lack of imagination and creative play - such as not enjoying or taking part in role-play games. They may also find it difficult to grapple with abstract ideas. There may be overriding obsessions with objects, interests or routines which tend to interfere further with building social relationships (this is known as stereotyped or repetitive behaviour).

These behavioral difficulties can cause a great deal of stress for members of the family.
Babies who develop autism later may appear normal at first and reach the usual developmental milestones, including early speech. But as they grow into toddlers, they may fail to develop normal social behaviour and speech may be lost.

As a child grows, the typical difficulties of autistic spectrum disorders are:

Repetitive behaviour and resistance to changes in routine.
Obsessions with particular objects or routines.
Poor coordination.
Difficulties with fine movement control (especially in Asperger’s syndrome).
Absence of normal facial expression and body language.
Lack of eye contact.
Tendency to spend time alone, with very few friends.
Lack of imaginative play.

People with Asperger syndrome are usually more mildly affected than those with autism. In fact, many people with milder symptoms are never diagnosed at all, and some argue that Asperger syndrome is simply a variation of normal rather than a medical condition or disorder. Even so, many do find that it gives them particular problems getting on in the world and they may become aware they are different from others. This can result in isolation, confusion, depression and other difficulties, all of which could be defined as ‘disease’.

Some children with Asperger syndrome manage (or in fact even do very well) in mainstream schools especially if extra support is available. However, even when children cope well academically, they may have problems socializing and are likely to suffer teasing or bullying. More severely affected children need the specialist help provided by schools for children with learning disabilities.

With the right sort of support and encouragement, many with Asperger syndrome can lead a relatively normal life. Helping them develop some insight into the condition is an important step towards adjusting to, or at least coping with, the way the rest of the world works. Some do very well, especially in an environment or job where they can use their particular talents.

Autism tends to produce more severe symptoms. For example, a child with autism may fail to develop normal speech (the development of spoken language is usually normal in Asperger’s syndrome) and as many as 75 per cent of people with autism have accompanying learning disabilities.

Seizures are also a common problem, affecting between 15 and 30 per cent of those with autism.

Conversely, autistic children are sometimes found to have an exceptional skill, such as an aptitude for drawing, mathematics, or playing a musical instrument.

Causes and risk factors
The cause of autistic spectrum disorders is not yet clear. Genetics play an important role, and researchers are examining a number of chromosome sites that could be implicated. It's likely that autism occurs when a small number of genes interact in a specific way, possibly linked to some external event or factor.

This genetic link means there may be an inherited tendency, so autism and Asperger’s syndrome may run in families. Brothers or sisters of a child with the condition are 75 times more likely to develop it.

Doctors' ability to diagnose these disorders has improved in recent years, but older people, particularly with milder problems, may never have been diagnosed. When a child is diagnosed, parents often realize they've had the same problems themselves.

Boys are more likely to be affected than girls, though research suggests that when girls have the condition they may be more severely affected.

A variety of other environmental factors that affect brain development before, during or soon after birth, also play a part (possibly acting as a trigger). Despite reports suggesting a possible link between MMR vaccination and autistic spectrum disorders, scientific evidence has confirmed the vaccination does not increase the risk.

There's no specific test for autistic spectrum disorders. Diagnosis is based on a consideration of symptoms, and milder cases may be missed.

Treatment and recovery
There is no specific cure or particular medical treatment for autism, but much can be done to maximise a child’s potential and this is key to managing the condition Appropriate specialist education, speech, language and behavioral therapy are all important. There are many different approaches, some of which are based around theories about possible causes of autistic spectrum disorders (for example, the Son-Rise programme).

While many people feel they've achieved good results with some of these interventions, none of them is a cure-all, and many lack scientific evidence to demonstrate their benefits.

Others claim dietary changes or alternative remedies have helped, but these, too, are mostly unproven.

Medication is sometimes recommended when it's felt to be of benefit to the child, for example to control seizures, depression or other symptoms.

As the precise events that lead to autistic spectrum disorders aren't yet known, it isn't possible to prevent them. Neither is there yet a simple screening test to identify people carrying genes that might increase susceptibility to autism.

Kids Who Get Spanked May Have Lower IQs

10/26/2009 2:49:00 AM

Studies Show Link Between Getting Spanked and Poorer Scores on Intelligence Tests

Sept. 24, 2009 -- Parents who spare the rod just might end up with smarter kids.

Two new studies suggest that children who are spanked have lower IQs than children who aren't, regardless of where they live.

In one study, researchers analyzed the intelligence scores of roughly 1,500 children in the U.S. who took part in the National Longitudinal Survey of Youth. They found that these scores were slightly lower among children whose mothers reported using spanking as a form of discipline.

In the other study, national average IQ scores were found to be lower in countries where spanking is common.

The research was led by University of New Hampshire sociologist Murray A. Straus, PhD, who has studied the impact of corporal punishment on child development for decades. He is a vocal opponent of the practice.

Straus was scheduled to present his findings Friday in San Diego at the 14th International Conference on Violence, Abuse and Trauma.

"The best kept secret of American child psychology is that kids who are not spanked are the best behaved and do the best in life," he tells WebMD. "You won't find that in a single child development textbook, but it is true."

Spanking and IQ

In the U.S. investigation, Straus and colleague Mallie J. Paschall, PhD, of the Pacific Institute for Research and Evaluation analyzed data from 806 children who were 2 to 4 years old at enrollment and 704 children between the ages of 5 and 9.

The children were tested for intelligence when they entered the trials and again four years later.

Even after accounting for factors that could influence IQ scores, such as parental education and socioeconomic status, spanking appeared to have a negative impact on intelligence.

The IQs of the younger children who were spanked were 5 points lower on average four years later than those of children of the same age who were not spanked. Scores among the older children were an average of 2.8 points lower among spanked children than children who were not spanked.

Straus characterized the impact of spanking on intelligence in the study as small but significant.

"Many things influence a child's IQ," he says. "This is just one of them, but it is one that parents can do something about."

In the second study, Straus analyzed data from more than 17,000 university students in 32 countries who were polled about their parents' use of corporal punishment. The answers were then compared to national average IQ scores.

Straus says IQ scores were lower in countries in which spanking was more prevalent, with the strongest association seen when children were spanked from childhood through their teens.

Critics Say Evidence Is Weak

While numerous studies have linked corporal punishment to aggressive behavior, far fewer have examined the impact of spanking on intelligence.

But earlier this month, Duke University research scientist Lisa J. Berlin, PhD, and colleagues also linked early spanking to reduced intelligence in one of the most rigorously designed studies to ever address the issue.

The researchers questioned 2,500 racially diverse, low-income moms about their use of spanking as a discipline tool for their toddlers.

They found that children who were spanked at age 1 were more aggressive than those who weren't by age 2 and they scored lower on tests to assess mental development at age 3.

"The research as a whole really paints a picture of the detrimental long-term effects of physical punishment," Berlin tells WebMD. "The message to parents is find other ways to discipline your children."

A 2002 analysis of 88 spanking studies spanning six decades linked spanking to 10 negative behaviors including aggression, anti-social behavior, and mental health issues.

More than 90% of the studies found spanking to be detrimental, says developmental psychologist Elizabeth Gershoff, PhD, who conducted the analysis.

But critics say that research is highly suspect because it has largely been conducted by investigators like Straus, Berlin, and Gershoff who strongly oppose the practice.

In addition, the studies are often criticized for lacking scientific rigor -- a charge Gershoff acknowledges is hard to counter.

"We can't very well do experiments in which we tell some parents to spank their children and others not too," she says.

What Your Eyes Say About Your Health

10/26/2009 2:47:00 AM

Are the eyes “windows to the soul,” as the ancient proverb has it? Maybe. But they’re also portals through which one can glimpse signs of health problems -- not only eye disorders like cataracts and glaucoma, but also systemic illnesses like diabetes mellitus and cardiovascular disease. Sometimes the signs of these diseases are visible in, on, or around the eyes long before symptoms appear.

“The eyes truly are unique real estate,” says Andrew Iwach, MD, associate clinical professor of ophthalmology at the University of California at San Francisco and executive director of the Glaucoma Center of San Francisco. “They’re the only place in the body where you can see a bare nerve, a bare artery, and a bare vein without doing any cutting. And the disease processes we see occurring in the eye are probably occurring in the rest of the body.”

The list of systemic diseases that can have ocular manifestations is a long one; in addition to diabetes and cardiovascular disease, it includes aneurysms, HIV, cancer, and rare hereditary diseases. The list is one reason eye experts recommend periodic eye exams.

“Everyone should have a comprehensive eye exam by age 40,” says Ruth D. Williams, MD, an ophthalmologist and glaucoma specialist in Wheaton, Ill., and, like Iwach, a spokesman for the American Academy of Ophthalmology. “People who have a family history of eye problems should be seen earlier, and anyone who is having eye trouble should see a doctor right away. But people shouldn’t wait until they experience symptoms to see a doctor, because many eye problems are silent,” meaning they cause no symptoms.

Some ocular manifestations of systemic disease can be seen only by a trained specialist during the course of an eye exam. Others are plain for all to see. Here are 10 of the most common eye signs and what they might be saying about your health:

Things Anyone Can See

Bloody eye. The eye’s transparent outer layer, called the conjunctiva, is nourished by numerous tiny blood vessels. If these burst, blood may pool on the white of the eye (sclera). A subconjunctival hemorrhage, as it is known among doctors, can be caused by a blow to the eye but in most cases has no obvious cause. In rare instances, a subconjunctival hemorrhage can be a sign of severe high blood pressure or a platelet disorder, which can interfere with clotting, Williams tells WebMD.

Bulging eyes. Though prominent eyes may simply be a family trait, eyes that appear to bulge may be evidence of thyroid disease. Abnormal levels of thyroid hormone cause tissues surrounding the eye to swell, making it appear that the eye is bulging.

Droopy eyelid. This condition, known among doctors as ptosis, can be simply a sign of aging. But in rare cases it is evidence of a brain tumor or a neuromuscular disease known as myasthenia gravis (MG).

Pupil abnormalities. The pupils of healthy people are usually (but not always) symmetrical. They’re usually of the same size, and they usually show the same reaction upon exposure to light. If one pupil is bigger than the other, or if one pupil shrinks less, or more slowly, on exposure to light, there could be an underlying medical problem. Possibilities include stroke, brain, or optic nerve tumor, brain aneurysm, syphilis, and multiple sclerosis (MS). Finally, many medications -- including illicit drugs -- can cause the pupils to appear unusually small or large.

· Rings on the cornea. A rare hereditary disorder known as Wilson’s disease can cause copper to accumulate in various tissues, including those in the brain and liver. Copper deposits sometimes form on the inner surface of the cornea (though they appear to a casual observer to be on the iris, the colored disk that surrounds the pupil). These “Kayser-Fleischer rings” are themselves harmless. But without appropriate treatment, Wilson’s disease can be fatal.

· Thickened eyelid. In very rare cases, a thickening or deformation of the eyelid is a sign of neurofibromatosis, a rare hereditary disorder marked by the growth of tumors along nerve fibers (the tumors themselves are called plexiform neurofibromas).

· Yellow eyes. Diseases of the liver, including hepatitis and cirrhosis, can turn the scleras yellow. The color is caused by the buildup of bilirubin, a compound created by the breakdown of hemoglobin, the oxygen-carrying molecule inside red blood cells. The medical term for yellow eyes is scleral icterus -- even though it’s not actually the scleras that turn yellow, but the conjunctiva.

Things an Eye Doctor Can See

Arterial plaques. Atherosclerosis is the disease process that causes cholesterol plaques to form in arteries, including the carotid arteries in the neck and the coronary arteries. Bits of cholesterol (usually from the carotids) can break away from these plaques and travel via the bloodstream to the eye, where they lodge in small arteries in the retina, the delicate network of blood vessels and nerve cells at the back of the eye. Kastl explains that these minute yellowish blockages, known as Hollenhorst plaques, can be evidence of severe atherosclerosis
Optic nerve abnormalities. The optic nerve, which transmits visual information from the retina to the brain, is visible at the rear of the eye. It’s supposed to be pink. A pale optic nerve can be an early manifestation of MS, as well as evidence of a brain tumor or aneurysm.

Retinal defects. Various medical conditions, notably diabetes and high blood pressure, can damage the blood vessels and nerves in the retina (as well as elsewhere in the body). This retinal damage -- which can cause blindness -- can take several forms, including tiny hemorrhages, leaks of yellowish fluid, and puffy-looking whitish patches known as cotton wool spots. White patches on the retina can also be a manifestation of cytomegalovirus infection -- possibly a sign of AIDS. In some cases, the retina is overgrown with tangled and highly fragile blood vessels -- the result of a process known as neovascularization.

Unpopular in School, Unhealthy Later?

10/26/2009 12:11:00 AM

Students Shunned in Sixth Grade May Be More Likely to Be Hospitalized Later, Researcher Reports

Sept. 28, 2009 -- The kids no-one wants to work with in sixth grade may be at a health disadvantage as adults, a Swedish study shows.

The study, published in the advance online edition of the Journal of Epidemiology and Community Health, included about 12,500 Swedes born in 1953.

In sixth grade, the students were asked to name the three classmates they best liked working with at school.

"Favorite" students were named by at least seven of their classmates. "Popular" students got four to six nominations. "Accepted" kids were named by two or three of their classmates. "Peripheral" students were named by only one of their peers, and "marginalized" students weren't picked by anyone.

Decades later, when the students had matured into 50-year-olds, those in the "marginalized" and "peripheral" groups were more likely than their peers to have ever been hospitalized for certain conditions.

For instance, 559 men and 483 women had ever been hospitalized for mental or behavioral disorders. Those who had been in the "marginalized" group in sixth grade were about twice as likely to have been hospitalized for those reasons as people who were "favorites" in sixth grade.

Among men, hospitalization for alcohol abuse, accidents, injury, drug dependence, and endocrine, nutritional, or metabolic disorders were more common for those who had been "marginalized" in sixth grade.

Among women, hospitalization for disorders of the digestive system, musculoskeletal system, or connective tissue were among the conditions that were more common for those who had been in the "marginalized" group as girls.

The study doesn't show why the unpopular kids were more likely to be hospitalized -- or why they were unpopular in the first place.

First Human Trial of Cholecystectomy by NOTES to Launch This Year

9/2/2009 2:02:00 AM

July 16, 2009 — Members of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) recently announced that the first human trial of Natural Orifice Translumenal Endoscopic Surgery (NOTES) is scheduled to begin later this year.

NOSCAR, a collaboration between the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons, announced last week at the Fourth International Conference on NOTES in Boston, Massachusetts, that the first clinical trial should get off the ground this fall.

NOTES research thus far has been preclinical, including basic science and animal studies.
"NOSCAR is taking a big step forward later this year with the commencement of the first NOTES multicenter human trial in the United States," said NOSCAR Research Subcommittee cochair Michael L. Kochman, MD.

NOSCAR officials are planning a prospective multicenter trial of NOTES cholecystectomy vs conventional laparoscopic removal of the gallbladder. They will be granting funds to selected institutions to conduct the trial.

"We are delighted that the research and science to date has led us to the point where we can begin conducting human trials. The careful, responsible introduction of NOTES is our utmost concern; this study will provide the basis for such an introduction," said Steven D. Schwaitzberg, MD, NOSCAR Research Subcommittee cochair.

The trial will receive financial support from Ethicon Endo-Surgery, Olympus America Inc, and Stryker Medical. Data collection in the NOTES cholecystectomy trial will be conducted by ACI of Pennsylvania.

Burns and scalds

8/13/2009 8:58:00 AM

Scalds and burns account for about 6% of injuries in young children.

Spilt hot drinks cause most scalds. They are still hot enough to scald a child 15 minutes after being made.

Some burns can be treated with simple first aid, but others will need medical attention.

Types of burn

Superficial burns or scalds affect only the top layer of skin, such as those seen with mild sunburn.

The skin appears red and is mildly painful. The top layer may later peel off but the skin beneath is healthy.

Partial thickness burns cause deeper damage and tend to blister. However, some of the deeper skin is left undamaged.

They are often caused by hot water and are very painful to touch, but usually heal within two to three weeks with minimal scarring.

In some cases the damage will be deeper and there may be no pain and scarring is common. These may require surgical repair and skin grafting.

Full thickness burns, also known as third degree burns, involve the whole thickness of the skin, including the deeper sweat glands.

These can occur when the burning agent is hot oil, for example. The skin will be charred, leathery and pale and there will be no sensation of pain.

Such burns do not heal on their own and will need surgical repair and grafting and can leave substantial scarring.

In extreme cases the damage will go beyond the skin and involve the underlying structures such as subcutaneous fat, muscle and bone. These injuries can be life-threatening.

When to seek help

Minor burns and scalds can be managed using first aid.

Cool the burnt area immediately with cool water (preferably running water) for at least 20 minutes.

Remove any jewellery from around the infected area because there may be swelling.

After cooling, remove clothing from the burnt area, but do not try to pull off clothing that has stuck to the skin as this may cause more damage.

A cold compress such as a tea towel soaked in cold water may be soothing over a burnt area.

Mild burns heal quicker if left to fresh air.

It is best to see a doctor or nurse if you are unsure about what to do after a burn or the burn is more severe (if it has blistered for example) or complications such as infection develop.

Before going to hospital the burn can be loosely covered with cling film or a clean plastic bag.

Burns that will always require immediate medical attention include electrical burns, full thickness burns, partial thickness burns on the face, hands, arms, feet, legs or genitals and any burn that is larger than the size of the hand of the person affected.

People 'get happier as they age'

8/13/2009 8:54:00 AM

Most people get happier as they grow older, studies on people aged up to their mid-90s suggest.

Despite worries about ill health, income, changes in social status and bereavements, later life tends to be a golden age, according to psychologists.

They found older adults generally make the best of the time they have left and have learned to avoid situations that make them feel sad or stressed.

The young should do the same, they told the American Psychological Association.

Ageing society

The UK is an ageing nation - in less than 25 years, one in four people in the UK will be over 65 and the number of over-85s will have doubled.

And it is expected there will be 30,000 people aged over 100 by the year 2030.

According to University of California psychologist Dr Susan Turk Charles, this should make the UK a happier society.

By reviewing the available studies on emotions and ageing she found that mental wellbeing generally improved with age, except for people with dementia-related ill health.

Work carried out by Dr Laura Carstensen, a psychology professor at Stanford University, suggested why this might be the case.

Dr Carstensen asked volunteers ranging in age from 18 to mid-90s to take part in various experiments and keep diaries of their emotional state.

She found the older people were far less likely than the younger to experience persistent negative moods and were more resilient to hearing personal criticism.

They were also much better at controlling and balancing their emotions - a skill that appeared to improve the older they became.

Dr Charles explained: "Based on work by Carstensen and her colleagues, we know that older people are increasingly aware that the time they have left in life is growing shorter.

"They want to make the best of it so they avoid engaging in situations that will make them unhappy.

"They have also had more time to learn and understand the intentions of others which helps them to avoid these stressful situations."

Dr Carstensen said the young would do well to start preparing for their old age now.

This includes adopting a healthy daily routine and ensuring some social investment is spent outside of the workplace and family home.

Andrew Harrop, head of public policy at Age Concern and Help the Aged, said the findings were encouraging.

"For many people, older age and later life is often looked upon with dread and worry.

"Far too many younger people assume that getting older is a process that will inevitably mean sickness, frailty and lack of mobility and greater dependence. However, this is far from the truth in very many cases.

"Many older people lead active, healthy lives enriched by experience and learning.

"This positive advantage can be brought to bear across so many aspects of daily life which - in turn - hugely benefits our ageing society.

"It's vital that there is growing acceptance that just because someone is getting older, it doesn't mean they no longer have a significant contribution to make.

"This study is one of many which shows that later life can be enormously positive experience".

Healthier Hygiene

7/21/2009 7:23:00 AM

“It’s not in question that many consumer products contain toxins -- they do,” says Alan Greene, MD, clinical professor of pediatrics at Stanford University and author of Raising Baby Green. “Most are felt to be in too tiny of a quantity to pose any real risk. But sometimes, very small exposures can have large impacts.”

Spurred by recent research studies, some of which contradict established opinion about what’s safe, environmental advocates now have some of the most commonly used consumer products on their watch lists.

"The irony is, these products’ presumed safety has led them to be produced and consumed almost indiscriminately,” says Rebecca Sutton, PhD, senior scientist with the nonprofit Environmental Working Group. “We’re now all exposed to multiple chemicals on a continuous basis whose long-term health effects aren’t known.”

Certain personal care products have become so popular, they’re literally in our blood. The Centers for Disease Control (CDC) now monitors the levels of ingredients from cosmetics and other products in the bloodstream of random Americans, to help guide public health discussions.

As consumers become increasing aware of potential risks, many are asking: Just what’s in this stuff, anyway?

Antibacterial Soaps and Cleaners

If it’s antibacterial, it must be better at killing germs, right? That’s true for healthcare-grade antibacterial soaps – the kinds used in hospitals -- but not for the weaker concentrations in household products, according to Allison Aiello, PhD, assistant professor of epidemiology at the University of Michigan.

“Consumer antibacterial soaps don’t reduce bacteria or prevent disease spread any better than ordinary hand washing,” Aiello tells WebMD.

Worse, data suggest that long-term use may contribute to the emergence of antibiotic resistant “superbugs,” says Aiello. The risk is a potential one, but “that possibility is there, and needs to be considered in future discussions about these products,” she adds.

Other scientists are sounding an alarm over the environmental effects of millions of pounds of antibacterial chemicals in soap that get flushed and rinsed into waterways each year.

Research by Rolf Halden, PhD, associate professor at Arizona State University’s Biodesign Institute, demonstrates harm to algae and other aquatic life from the antibacterial chemicals deposited in the water. In his view, the risks to the environment are only likely to increase, as massive use of these products continues.

Antibacterial Soaps and Cleaners continued...

At last check by the CDC, 75% of adults and children’s urine tested positive for triclosan, the most common antibacterial ingredient. People in higher income brackets were more likely to have triclosan in their bodies.

Although the levels were generally low, Greene asks, “If there’s a potential harm to people, and proven environmental damage, without any benefits, why are we using these products?”

What you can do: Don’t buy products containing triclosan or triclocarban, the most common antibacterial chemicals. Not all products will list ingredients, but you can safely avoid any product that advertises itself as “antibacterial,” say experts. Wash hands -- and clean surfaces in your home -- with regular soap and water.

Phthalates

Pronounced “THAL-ates,” these chemicals are common ingredients in fragrances in consumer products. (They are also “plasticizers” used in plumbing, shower curtains, varnishes, vinyl floors, and many other products.)

“Some of the phthalates are known to function as hormones in the human body,” says Greene. In animal studies, high doses of phthalates disrupt hormone production.

It was believed that the smaller exposures people get from each product they use were safe. But the fact that phthalates are everywhere -- even in the indoor dust we breathe -- has created concern and led to closer monitoring. The CDC finds low levels of phthalates in most of our bodies.

Some recent evidence suggests that exposure to phthalates in humans may be related to low sperm count and quality in men. Exposures in pregnant women have been associated with subtle changes in genital formation in baby boys.

What you can do: Until more evidence is in about phthalates, “it makes sense to avoid them in your personal care products when you can,” says Greene. “That’s especially true for expecting moms and children.” Unfortunately, it’s often impossible to know which of your personal care products contain phthalates, because they’re only listed as “fragrance.” Opt for fragrance-free products or choose those that use essential oils, like lavender and citrus. Check products’ ingredients in the Cosmetics Database.

Parabens

Parabens are chemicals widely used as preservatives in cosmetics. They prevent microbes from growing, which ensures products don’t get contaminated with bacteria or fungi. Most makeup, moisturizers, hair care products, shaving products, as well as many foods and drugs, contain parabens.

Parabens act like the hormone estrogen in the body, although the effect is weak. Isolated studies have found parabens in tissue samples of breast cancer tumors, but haven’t shown that parabens cause breast tumors. FDA scientists say parabens seem safe, but more study is needed.

What you can do: Read the labels on your personal care products. Look for the words methylparaben, butylparaben, propylparaben, or other words with “paraben” included. Paraben-free products are available, if you choose to avoid this common preservative.

Musks

It seems we’ll put just about anything on our bodies that might make us more attractive -- even the scent of a male musk deer. For centuries, natural musk aroma was prized as a supposed aphrodisiac.

Today, musk scents come from chemicals synthesized in laboratories. So-called nitro musks and polycyclic musks are widely used in perfumes and as scents in laundry products. Some synthetic musks were shown in the 1990s to have the potential to build up to toxic levels in the body, causing tissue damage.

After these studies were published, many manufacturers reduced their use of musks. However, citing ongoing research showing the safety of musks, large U.S. companies continue to commonly include these chemicals in household products like fabric softeners, laundry detergent, and perfume.

What you can do: Tonalid and Galaxolide are two trade names for polycyclic musks, but musks usually hide inside the term “fragrance” on product labels. To avoid musks, write the manufacturer for a complete ingredient listing, or opt for fragrance-free products.

To find products nearly or completely free of any potential toxin, Greene recommends the Skin Deep web site maintained by the Environmental Working Group. Its searchable database lists products it suggests are safer, in each cosmetic category. Or check the Cosmetics Database for a list of ingredients.

Solitude Speeds Effects of Aging

7/21/2009 7:20:00 AM

June 22, 2009 -- An active social life may help elderly people fight the effects of aging.

A new study shows that older adults who seldom participate in social activities experience a faster rate of motor function decline than those with an active social life. Researchers found that each point decrease in a person's social activity score was associated with a 33% faster rate of motor function decline.

Motor function decline such as decreased muscle strength, coordination, and dexterity is commonly associated with aging and related to dementia, potentially disabling falls, and even death.

Although motor function decline is a growing public health concern, researchers say little is known about factors that contribute to the problem or what interventions may help slow its progression.

Solitude Speeds Decline

The study, published in the Archives of Internal Medicine, analyzed the relationship between participation in social activities and motor function decline in 906 older adults followed for about five years. None of the participants had a history of Parkinson's disease, stroke, or dementia on entry into the study.

Researchers evaluated the participants' motor function by testing grip and pinch strength, balance on one leg, placing pegs on a board quickly, and walking in line heel to toe. The participants also filled out a survey to measure their social activity and used a five-point scale to assess their level of social activity. Examples of social activity included going to restaurants, playing bingo, volunteering, visiting friends or family, and attending religious services.

The results showed that elderly people with less social activity had a more rapid rate of motor function decline.

In addition, a one-point decrease in social activity was equivalent to being about five years older at the start of the study. Researchers say that translates to a 40% higher risk of death and 65% higher risk of disability. Researcher Aron S. Buchman, MD and colleagues at Rush University Medical Center in Chicago say the findings raise the possibility that social activity may slow motor function decline and the negative health effects associated with it in elderly people. But they say more study is needed to confirm this as a cause-and-effect relationship.

Missing Nutrients in Your Food

7/21/2009 6:44:00 AM

When it comes to eating healthy, some of us focus on the negative.

"A lot of people concerned about good nutrition are just watching for what they can't eat -- whether it's fat, or sugar, or whatever," says Tara Gidus, RD, a spokesperson for the American Dietetic Association.

But that attitude can blind us to all of those foods that we really should be eating more of. It also leads to missing nutrients in our food -- and dietary deficiencies -- for even the most conscientious eaters.

According to the most recent U.S. Dietary Guidelines, there are seven important nutrients in food that most Americans aren't getting in sufficient amounts:

Calcium
Potassium
Fiber
Magnesium
Vitamin A
Vitamin C
Vitamin E

Before you line your bathroom cabinet with supplements to fill the gaps, there's a simpler and healthier way. A few modest changes to your diet may give you all the nutrients you need.

Calcium

Back in elementary school, the basics were probably drummed into you: calcium is good for bones and teeth and it's in milk. But that might be about all you know.

Calcium does a lot more than keep your bones strong. It helps maintain your heart rhythm, muscle function, and more.

How much do you need? That depends on your age.

Adults up through age 50: 1,000 milligrams/day
Adults over age 50: 1,200 milligrams/day

However, if you have a higher risk of osteoporosis, check with your doctor, who might recommend a high dose of 1,500 milligrams.

Dairy is one of the easiest ways to get this nutrient in food. Calcium is especially well-absorbed when you take it with lactose, the sugar in milk and some milk products. But if you don't like milk -- or can't tolerate it -- don't assume that you'll have to rely on supplements. There are different ways to get this nutrient in food. Some good dairy and nondairy sources of calcium are:

Nonfat plain yogurt (8 ounces): 452 milligrams
Swiss cheese (1.5 ounces): 336 milligrams
Skim milk (8 ounces): 306 milligrams
Salmon (3 ounces): 181 milligrams
Cooked spinach (1 cup): 146 milligrams

Calcium is also in all sorts of fortified foods, like breakfast cereals, orange juice, and soy milk.

Potassium

"People don't know much about potassium," says Gidus. "They don't know how important it is, especially for maintaining healthy blood pressure." It's also key in maintaining fluid balance and the function of your nerves and muscles.

Adults should get 4,700 milligrams of potassium a day. "Potassium theoretically should be easy to get enough of, since it's in a lot of foods," says Lucia L. Kaiser, PhD, community nutrition specialist in the department of nutrition at the University of California, Davis. "But many people still don't, because they don't eat enough fruits and vegetables."

Bananas are a familiar source, Gidus says. But there are other ways to get this nutrient in food:

Baked sweet potato: 694 milligrams
Tomato paste (1/4 cup): 664 milligrams
Non-fat plain yogurt (8 ounces): 579 milligrams
Yellowfin tuna (3 ounces): 484 milligrams

Fiber

You've probably heard all about the health benefits of fiber over the years. But given all the emphasis on bowels and regularity, you might assume that you won't have to worry about fiber intake until after retirement.

"People think that fiber is just for old people," says Kaiser. "But it's really important at every age for promoting a healthy intestinal tract and guarding against diseases."

So what does fiber do? In addition to keeping your bowels working well, it reduces the risk of other intestinal problems. Good fiber intake may also help protect against heart disease, type 2 diabetes, and some forms of cancer. Since fiber is so filling and low on calories, it's often key in many successful weight loss programs.

The amount of fiber you need depends on your age and your sex.

Women, age 19-50: 25 grams/day
Women, age 51 and older: 21 grams/day
Men, age 19-50: 38 grams/day
Men, age 51 and older: 30 grams/day

Some good sources of this nutrient in food include:

100% bran cereal (1/2 cup): 8.8 grams
Cooked black beans (1/2 cup): 7.7 grams
Baked sweet potato, with peel: 4.8 grams
Small pear: 4.4 grams
Whole-wheat English muffin: 4.4 grams

Magnesium

Magnesium is involved in all sorts of bodily processes. It strengthens bones and keeps the immune system up to snuff. Magnesium also plays a key role in the function of your heart, muscles, and nerves.

The recommended daily allowance of magnesium is:

Women, age 19-30: 310 milligrams/day
Women, age 31 and older: 320 milligrams/day
Men, age 19-30: 400 milligrams/day
Men, age 31 and older: 420 milligrams/day

Good sources of this nutrient in food are:

Brazil nuts (1 ounce): 107 milligrams
100% bran cereal (1 ounce): 103 milligrams
Cooked halibut (3 ounces): 91 milligrams
Almonds (1 ounce): 78 milligrams

Vitamin A

Vitamin A is crucial for a lot of reasons. It's good for vision -- that's why your mother always told you to eat your carrots. It's also important for immunity and tissue growth.

How much do you need?

Adult men: 900 micrograms/day
Adult women: 700 micrograms/day

However, there are actually two types of vitamin A: retinol and carotenoids. The latter are the ones that are missing from too many American diets. There's no official daily recommended amount of carotenoids that you need. But you should try to get some of this nutrient in your food every day.

Foods that have carotenoids include:

Baked sweet potato, with skin: 1,096 micrograms
Cooked fresh carrots (1/2 cup): 671 micrograms
Cooked spinach (1/2 cup): 573 micrograms
Cooked winter squash (1/2 cup): 260 micrograms

Vitamin A is also in many fortified cereals and oatmeal.

Vitamin C

Vitamin C actually has several important roles in keeping you healthy. In addition to boosting the immune system, vitamin C is a powerful antioxidant that can prevent cell damage. It also helps make collagen, an important part of bone and cartilage.

How much do you need?

Adult men: 90 milligrams/day
Adult women: 75 milligrams/day

Good sources of this nutrient in food are:

Cooked sweet red pepper, 1/2 cup: 116 milligrams
Orange: 70 milligrams
Strawberries (1/2 cup): 49 milligrams
Cantaloupe (1/4 medium): 47 milligrams
Cooked broccoli (1/2 cup): 51 milligrams

Vitamin E

"I think a lot of people don't get enough vitamin E," says Gidus. The reason can be ironic: they're trying too hard to eat healthy.

Vitamin E tends to appear in foods with high fat content, like nuts, seeds, and oils. So in a quest to eat low-fat and slim down, many people cut out the foods that are important sources of vitamin E. That's a mistake. Vitamin E is a powerful antioxidant that helps protect your cells from damage.

So despite the fat, you should try to include some of these foods in your diet. While Kaiser stresses that a low-fat diet is still very important for good health, you need to distinguish between the so-called bad fats (saturated and trans fats) and the good ones (monounsaturated and polyunsaturated fats) which are in these foods. Keep in mind that even the good fats are still high in calories, so you need to eat them moderately.

The form of vitamin E that is most beneficial is called alpha-tocopherol vitamin E (AT). Adults need about 15 milligrams of AT a day.

Some good sources of vitamin E are:

Roasted sunflower seeds (1 ounce): 7.4 milligrams
Almonds (1 ounce): 7.3 milligrams
Peanut butter (2 tbsp): 2.5 milligrams
Tomato sauce (1/2 cup): 2.5 milligrams

Other Important Nutrients

Specific groups of people may need more of these important nutrients as well.

Vitamin D plays a crucial role in allowing your body to use calcium. Since vitamin D is manufactured in your body when you're exposed to sunlight, people who don't get outside much -- or who have darker skin, or never go out without sunscreen -- are at risk. Vitamin D doesn't occur in high quantities in foods naturally. So you may need to rely on fortified foods and supplements -- or just get some more sun every day.
Folic acid is key for women during pregnancy, since it can reduce the risk of birth defects. Good sources are lentils, spinach, and broccoli. Pregnant women generally need to take 600 micrograms/day of folic acid supplements.
Iron is important for younger women and pregnant women especially, Kaiser says. Good sources are meats -- like beef, turkey, and chicken -- as well as spinach, kidney beans, soy beans, and many fortified foods.
Vitamin B12 is key in the formation of red blood cells. As people age, it's harder for them to absorb it from food. So all people over 50 should seek out foods fortified with B12 -- like many cereals -- or to take B12 supplements, says Kaiser. The recommended daily amount is 2.4 micrograms/day.

Are Supplements as Good as Nutrients in Food?

It might seem a lot simpler to take supplements and avoid the hassle of hunting down nutrients in natural food. But experts feel that supplements should generally be a last resort.

"I always tell people to try to get nutrients from food first," says Gidus. As the name suggests, supplements are supposed to supplement a healthy diet -- not replace important nutrients. Besides, many studies of supplements have found that they don't offer as many health benefits as nutrients found naturally in food.

There are cases where your doctor might recommend a supplement. For instance, if you're at risk of osteoporosis, your doctor might want you to take calcium and vitamin D to keep your bones strong.

Gidus still doesn't have a problem with taking a daily multivitamin. "I tell people it's OK to use a multivitamin as a cheap insurance policy," she tells WebMD.

However, you should be careful not to get too much of some nutrients. More isn't always better. Some nutrients can become toxic in high doses. And since so many foods are fortified these days, it's easier to get too much of some nutrients than it used to be.

Whatever you do, don't take supplements willy-nilly. Take a look at your diet first to see if you really need them and then talk with your doctor.

Am I Getting Enough of These Nutrients in Food?

It's not easy to know if you're getting enough of the important nutrients lacking in the traditional American diet. You can look for some -- like fiber and vitamin C-- on nutrition labels. But you're not going to find all of them listed -- like magnesium and potassium, for instance.

What's the solution? Should you keep detailed records of your diet, and eat all meals with a scale and a calculator to tabulate your mineral intake? No, the experts say. "Don't get too worried about the exact amounts," says Gidus.

Instead, just try to eat a wide variety of foods, focusing on fruits, vegetables, and whole grains especially. It's the best way to cover your bases and get all these nutrients in food. Again, try not to get too focused on what you shouldn't eat. Don't scan the label looking for a reason to reject a food. Instead, look for reasons to include it.

"So what if a food has a little fat or a little sugar?" Gidus says. "It might have important nutrients that you really need too."

Muscle Cramps

6/22/2009 7:37:00 AM

Sometimes one get muscle cramps while sleeping or resting. In most cases, there is no apparent cause for hard knots in the muscles, usually in the calves, that are not associated with vigorous exercise, medical authorities say. Nighttime attacks of leg cramps are quite common, especially in older people, and can be very painful though usually not dangerous.

Most night cramps are not associated with serious underlying diseases, but diabetes and circulatory problems are among the conditions that should be ruled out by a doctor, especially if the cramps are frequent and severe. Cramping can also be a side effect of some prescription drugs.

One popular suggested explanation for the involuntary contractions involves overactive nerve networks in the large leg muscles, but there is no conclusive evidence as to whether this is true or what the cause may be.
Other researchers suggest that cramps are an effect of dehydration, which is known to be involved in spasms after exercise. Common sense suggests drinking enough water through the day and before going to bed, as well as avoiding heavy bed covers that keep the toes from pointing up. Gentle stretching exercises may help.

If you develop a cramp, you can help relax the knotted muscle with gentle stretching and massage; walking or standing if you can manage it; and perhaps a warm bath or shower.

Courtesy; BBC Health News

Hay fever

6/22/2009 7:20:00 AM

Hay fever is on the increase, but, as pharmacies stock up on a plethora of remedies, which should sufferers take? How can it be avoided? And what causes it in the first place? BBC News Online investigates.

The cause

Hay fever is an allergy to pollens - the male reproductive parts of plants - from grasses and trees.

When they come into contact with the tissue inside the nose, they trigger an immune reaction that can cause congestion, sneezing, itching, and a runny nose.

It is more common during the summer when the levels of pollen are highest.

It can also be triggered by moulds, which are likely to be found in rainy or humid areas.

The treatment

There are three types of treatment - anti-histamine tablets, nasal steroid sprays and anti-allergy injections.

Many anti-histamine tablets are available over the counter in chemists. They knock out the body's immune system, preventing the pollens from eliciting an uncomfortable response.

There are two types of anti-histamine - those that cause drowsiness and those that do not. The non-sedating type are more expensive.

Nasal sprays are only used on the affected area, and leave the rest of the immune system alone. They need to be applied twice a day.

Anti-allergy injections are only used in particularly severe cases and are given over a number of years. They offer long-term protection from allergies.

Which treatment should I use?

Muriel Simmons, chief executive of the British Allergy Foundation, said sprays are best for short-term protection.

However, it depends on the individual's needs, and that should be judged by a visit to a GP, she said.

"We advise hay fever sufferers to go to their doctors and discuss it with them," she said.

"There is a recognised link between hay fever and asthma so you need to monitor it.

"A lot of people who go on to develop asthma have nasal problems but they don't recognise it, they just think 'oh, I seem to go from one cold to another' but in fact they're suffering from rhinitis - which gives you the drippy nose in hay fever."

She said it was better to act sooner than later.

"The major problem is that people leave it too late - they wait until the symptoms start before they take the medication," she said.

"They actually need to take it from about three to four weeks before the season starts."

The pollen season varies by plant, with trees starting first then grasses then weeds. Its timing also depends on location - the further north, the later it comes.

In the UK, trees start in February with grasses running through the summer and mould spores present until October.

Some people say they have achieved relief from symptoms by using homeopathic remedies.

Why are more people getting hay fever?

The most likely explanation is a combination of summer starting early and the increasing rates of pollution.

Ms Simmons says pollution traps the pollen in the atmosphere and holds it there.

"Because we have so much pollution, that's holding it down, and we're all becoming that little bit more sensitive," she said.

The warmer weather has also been blamed, as it tricks plants into pollinating early.

Glaucoma

6/22/2009 7:04:00 AM

Eye tests can pick up glaucoma

Glaucoma occurs when the nerve at the back of the eye becomes damaged.
This can cause a person's sight to deteriorate and can lead to blindness.

What is glaucoma?
Glaucoma is the name given to a group of conditions that affect the eye.
There are four different types of glaucoma - acute, chronic, developmental and secondary.
In each case, the optic nerve behind the eye is damaged. This nerve carries information from the eye to the brain enabling us to see.
This damage can be caused by a weak nerve or more usually by the build-up of fluid in the eye. This occurs when fluid in the eye cannot drain properly.
Acute glaucoma can occur suddenly and can be painful. If left untreated, it can lead to blindness.
Chronic glaucoma is the most common form of the condition. The drainage channels from the eye become blocked over time and vision gradually becomes impaired.
Developmental glaucoma mostly affects babies and young children. It is rare but potentially serious and is caused by malformation of the eye.
Secondary glaucoma occurs when another problem in the eye causes fluid to build-up and eyesight to deteriorate.

How common is it?
By the age of 40, about one person in every 100 has some form of glaucoma.
However, the incidence rises steadily as people get older.
By the age of 70, about one person in every 10 has some form of glaucoma.
People who are of African origin are more likely to develop the condition.
People who are highly short-sighted, those with diabetes and those with a family history are also at increased risk.
In the UK people over the age of 40 and with a family history of glaucoma are entitled to free eye tests on the NHS every two years.

What are the symptoms?
Acute glaucoma can be painful. The sudden increase in pressure can make the eye red.
Eyesight can deteriorate and may even blackout. There may be nausea and vomiting.
Chronic glaucoma is less easily spotted. There is no pain and the deterioration in eyesight may be subtle.
Some people go for an eye test after noticing their sight is less good in one eye than the other.
The fact that this type of glaucoma can creep up on people is one reason why doctors advise regular eye tests.
How is it treated?
Glaucoma is treated by reducing pressure on the eyes.
Eye drops are a common first approach. However, if they fail to unblock the drainage channels then an operation may be needed.
These can take the form of laser surgery or a trabeculectomy - an operation to improve drainage of the eyes.

Can it be cured?
In many cases, the damage that has been caused by the glaucoma cannot be reversed.
However, early diagnosis and treatment can prevent further deterioration.

Allergy

6/22/2009 6:54:00 AM

What is an allergy?

An allergy is an adverse reaction to a protein in our environment, such as those found on pets, and in pollen or nuts. These proteins are called allergens and are normally harmless.

In people with an allergy, the body reacts to a specific allergen by releasing histamine from mast cells in the skin, lungs, nose or intestine. This causes inflammation and swelling.

Symptoms can include itchy skin, tissue swelling and wheezing. In severe cases it can lead to full-blown anaphylaxis or even death.

Common allergic diseases include hay fever, asthma, eczema and urticaria.

Some people get allergic conjunctivitis, while others react adversely to medication, insect stings or latex.

Food allergy and intolerance to food additives are relatively uncommon causes of allergic reactions

Allergens to be aware of:

Grass and tree pollens
Dust mites (living in and feeding on house dust)
Food (cow's milk, hen eggs, wheat, soya, seafood, fruit and nuts)
Fungal or mould spores (in the bathroom and other damp areas)
Medication (penicillin, aspirin, anaesthetics)
Nickel, rubber, preservatives and hair dyes (skin contact allergens)
Pet skin flakes or dander (cat, dog, horse or hamster)
Wasp and bee stings

What causes allergies?

Some families have a predisposition to allergies, known as atopy. This has shown an epidemic rise over the past four decades.

The reasons why are poorly understood. We know some families are genetically programmed to develop allergies, but this can't be the full story. Things that promote allergies must have been added to our environment, while others that previously protected us against allergies must have been removed.

There's growing evidence our fight against infectious diseases and increased personal cleanliness may have interfered with the workings of our immune system.

Global warming has also had an impact, with changing patterns of natural vegetation and more profuse pollen production.

How allergies develop

At birth, the immune system switches to be either allergy prone (TH2) or non-allergy prone (TH1), depending on genetics and environment.

TH stands for T helper type white blood cells. TH1 immunity is good for fighting bacteria and viruses, and protecting against allergies. TH2 immunity is good at fighting parasite infections, but makes us more vulnerable to develop allergies.

If there's a family history of allergies, a child is much more likely to switch on TH2 immunity.

This promotes the manufacture of excessive amounts of allergy-related immunoglobulin E (IgE) in the bloodstream.

This IgE latches on to harmless allergens and triggers allergic reactions.

If an inhaled pollen micro-particle gets attached to IgE in the nasal membranes, for example, this combined IgE/pollen complex causes mast cells to release naturally occurring defence chemicals called histamine.

This leads to profuse nasal itching, tickling, sneezing and a watery mucus discharge.

Who's affected?

Atopy in parents or siblings is a strong indicator of allergy risk. Allergies are likely to occur in atopic families where there's early childhood exposure to certain allergens.

Men are more likely to become allergic and an allergic mother who smokes puts a child at even greater risk.

Statistically:

Children from non-allergic families have a 12 per cent risk of developing an allergy
If one parent has allergies, this risk increases to 20 per cent
If both parents have allergies, the risk is more than 40 per cent
If both parents have the same allergy (such as asthma, hay fever or eczema) the child has a 70 per cent risk of having the same allergy

Other factors that may promote allergies include:

Birth by caesarian section
Frequent courses of antibiotics
Coming from a smaller family, with just one or two children
Passive cigarette smoke inhalation
Being overweight - obese children are more prone to asthma

A baby's environment during the first year is important. Early low-dose exposure to dust mites, pollens, pets and certain foods increases the likelihood of becoming allergic.

On top of that, our relatively affluent lifestyles - centrally heated homes, regular use of antibiotics and processed or exotic foods in our diet - seem to encourage allergy.

Can it be avoided?

A number of factors reduce your risk of developing allergies:

Being born into a family with no history of allergies
Being breastfed exclusively for the first four months of life, with a mother who avoids egg, nuts and cow's milk while breastfeeding
Early exposure to good probiotic bacteria in the infant diet
Plenty of vitamins C and E, and omega-3 polyunsaturated oils
Having two or more older brothers and sisters
Living on a livestock farm and getting grubby playing in the farmyard

Although breastfeeding hasn't been convincingly shown to reduce inhalant allergies or asthma, it transfers protective IgA antibodies to the baby and delays the potential onset of cow's milk allergy by deferring the introduction of cow's milk formula.

Allergic march

The term 'allergic march' is used to describe the progression from one manifestation of allergy to the next over a period of time.

For example, many children under age three have eczema and food allergy. As this improves, they develop asthma. Then, as their asthma begins to settle down, they start to be troubled by allergic rhinitis and hay fever in their teenage years.

Multiple allergies

A small group of highly atopic individuals develop severe allergies from an early age. They may have infantile food allergies (commonly cow's milk, egg and nuts) usually associated with extensive eczema.

Many have cross-reactions to other foods - latex allergy may react with avocado, banana, kiwi and chestnuts, for example. They then develop childhood allergic asthma, allergic rhinitis and remain highly allergic to numerous foods and environmental allergens.

They need ongoing supervision at a combined allergy care clinic under the care of a consultant immunologist, dermatologist, dietician, chest physician, paediatrician and ear, nose and throat specialist.

The vast majority of people with allergies have only a few allergies, which are well controlled by specific allergen avoidance and regular long-term allergy preventer medication.

There's another group of people who apparently react to traces of everyday household and industrial chemicals, but their symptoms aren't typical of allergies.

Often non-medically qualified practitioners will confirm these 'sensitivities' using unproven testing methods.

People can become so incapacitated by fear of a reaction they're no longer able to work or leave their homes. In many instances, there's some past psychological trauma and what they're experiencing isn't an allergy.

Exercise is an important part of preventive health care

Physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis. Physical activity also helps the body use calories more efficiently, thereby helping in weight loss and maintenance. It can increase basal metabolic rate, reduces appetite, and helps in the reduction of body fat.

Eating Parsley Can Eliminate Bad Breath

People have long tried to freshen their breath with parsley. Its fresh, strong flavor would seem to make it a natural deodorizer. And its deep green color is a sign of ample chlorophyll, which is thought to have some antibacterial properties. (The sulfur compounds that give rise to bad breath are produced by various strains of bacteria that feast on food deposits and other debris in the back of the mouth.)

But researchers who have looked into this particular folk remedy have found little evidence that it works. Studies that have examined its effects in the mouth have found that while it may have some small initial effect on odor — mostly by masking it — it does little to reduce the concentration of volatile sulfur compounds.

One unlikely food that has been shown to reduce levels of sulfur compounds, however, is green tea, although the effect may be temporary, lasting no more than an hour or two.

Mouthwashes can be effective when they contain two ingredients in particular, zinc and chlorhexidine. But those that contain alcohol may make the problem worse by drying the mouth. Several studies have also identified a number of other factors that contribute to bad breath, including being overweight, drinking heavily and smoking.

Courtesy BBC Health.

New York Times Health News

Incorporation of Evidence-Based Medicine Into Daily Practice

6/22/2009 12:06:00 AM

Highlights From the 39th American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting; December 5-9, 2004; Orlando, Florida

One of the central tenets of current clinical practice -- the use of evidence-based medicine in the daily care of patients -- was discussed at the 39th American Society of Health-Systems Pharmacists Midyear Clinical Meeting, recently held in Orlando, Florida. Summaries describing its multifaceted characteristics and related issues were presented. As noted by Bruce Clayton, PharmD, Professor of Pharmacy Practice at Butler University (Indianapolis, Indiana), evidence-based medicine is "the integration of best research evidence with clinical expertise and patient values." Evidence-based medicine thus provides a framework that facilitates healthcare decision making. It uses research data and other evidence to assist healthcare professionals in answering complex clinical questions related to treatment options, screening programs, and risk management. The primary idea of evidence-based medicine is to consider the effectiveness, along with the possible harm, of different interventions before using them to treat individual patients.

Although professionals have always used personal or colleagues' experience or data from recent articles in evidence-based medicine, the evidence used is looked at in the most systematic and objective fashion possible. The concept of evaluating published research is not new, but evidence-based medicine expands to include the use of best-practice guidelines and databases, quality assurance systems, and research appraisal and commissioning processes to make healthcare decisions.

Through the evaluation of literature, practitioners are better able to answer the questions for which there are no intuitive answers or for which intuitive answers may prove ineffective or even harmful. Evidence-based medicine ensures up-to-date information about best clinical practices in a rapidly changing environment. It also reduces healthcare costs and time wasted on useless interventions by defining what is the best clinical practice at a given time.

According to Dr. Clayton, healthcare professionals must remember that evidence-based medicine does not promote "cookbook medicine"; rather, it encourages the use of best clinical practice. It also does not denigrate clinical experience, as this may prove essential in demonstrating that available research does not apply to the target population. Evidence-based medicine also differs from traditional care through the inclusion of patient preferences and values. By encouraging patient-focused care, the patient is given the opportunity to determine which treatment options are acceptable. Healthcare professionals and administrators must also consider that evidence-based medicine is not intended as a cost-cutting measure. Best clinical practice may, in some instances, prove to be more expensive than other alternatives.

Limitations to evidence-based medicine may include the lack of data to answer some clinical questions, difficulty in applying research results to the general population, the need for quick access to resources, and time limitations during clinical practice. Arguments against evidence-based medicine typically relate to the applicability of data to the general population. Although the randomized controlled design is considered the most desirable, the study designs often exclude patients with comorbidities or of a certain age. Clinical trials also provide for more medical and nursing care than the average patient usually receives. These exclusions and alterations in care sometimes beg the question of whether results can be generalized to every patient.

Dr. Clayton pointed out that there is no formal proof that evidence-based medicine is actually more effective – the only proof derives from results of population-based studies showing that patients who received evidence-based treatments fared better than those who did not. Currently, no studies exist that "validate or refute evidence-based medicine," he noted. This lack of research is due to the cost and length of time required for such studies, along with the ethical dilemma researchers face when knowingly withholding effective therapy from patients.

Asthma

3/13/2009 1:20:00 AM

A decline in aspirin use, exposure to household sprays and cleaners and lack of vitamin D may all help explain surging asthma rates in the past few decades.

For years the hygiene hypothesis has been used to explain stark differences in asthma rates around the world. In Western countries, asthma rates are about 50 times higher than in rural Africa, for instance. The hygiene hypothesis suggests that Westerners have less exposure to bacteria, viruses and parasites, altering the immune response and increasing risk for allergic diseases.

News Sources:

New York Times Health News

BBC Health News.

Common Cold

3/13/2009 1:17:00 AM

Curing the common cold, one of medicine’s most elusive goals, may now be in the realm of the possible. Because colds are mostly a minor nuisance, drug developers say, people would not be likely to pay for expensive drugs. And it would be hard to get the Food and Drug Administration to approve a drug with any serious downside for so mild a disease. There are at present no effective treatments for the common cold. Frequent hand-washing is the best preventive. Once a cold has started, washing out the nasal passages, warm drinks and rest is recommended.

Blowing your nose to alleviate stuffiness may be second nature, but some people argue it does no good, reversing the flow of mucus into the sinuses and slowing the drainage. Counter-intuitive, perhaps, but research shows it to be true.

The proper method is to blow one nostril at a time and to take decongestants; this prevents a buildup of excess pressure.

News Sources:

New York Times Health News

BBC Health News.

Nails and Health: Read the Signs

2/27/2009 4:23:00 AM

Did you know your nails can reveal clues to your overall health? A touch of white here, a rosy tinge there, or some rippling or bumps may be a sign of disease in the body. Problems in the liver, lungs, and heart can show up in your nails. Keep reading to learn what secrets your nails might reveal. Pale Nails

Very pale nails are sometimes linked to aging. But they can also be a sign of serious illness, such as:

Anemia
Congestive heart failure
Diabetes
Liver disease

MalnutritionWhite Nails

If the nails are mostly white with darker rims, this can indicate liver problems, such as hepatitis. In this image, you can see the fingers are also jaundiced, another sign of liver trouble.

Eyes Offer Clues to Age and Alertness

2/27/2009 4:22:00 AM

Study Shows Young People Make Judgments on Age by Looking Into Elders' Eyes

By Bill Hendrick
WebMD Health News

Reviewed by Louise Chang, MD

Feb. 6, 2009 -- The eyes have it when it comes to showing age, a new study suggests.

Researchers say younger people seem to make judgments about the age and alertness of older folks by looking into and around their eyes. The study is published in the February issue of Ophthalmology, the journal of the American Academy of Ophthalmology.

Forty-seven young adults took part in the study, each looking at the faces of older people on a computer monitor equipped with a camera that looked back at them with an eye-tracking device. It analyzed the direction and duration of the participants' gazes.

Huy Tu Nguyen, MD, from the Harvard department of ophthalmology and colleagues found that in rating age, the younger folks most often looked at the eye region, followed by the forehead and the nose region.

The eye region also was the most frequently selected in rating fatigue, followed by the forehead, and the nose region.

In the eye region, study participants looked at the brows and lower lids the most when asked to rate both fatigue and age.

The researchers say the young people looked at static, two-dimensional images of the older folks, rather than video or live images, and thus the study could not determine how much attention the mouths of the older people might have attracted as age and fatigue markers.

The researchers also say findings may be different with older people as participants.

The participants of this study were age 21 on average. In the first part of the study, the participants were presented with a digital image of an older adult's face on a monitor for five seconds at a time before having to guess the age of the person in the picture. The same 48 facial images were shown again for five seconds each time but in a different order for the fatigue assessment.

The researchers conclude that the results "demonstrate that the eye region is most important in making fatigue and age judgments [raising] the possibility that aesthetic surgery to the eye region may be an efficient, effective intervention to enhance an individual's attractiveness by possibly reducing how old or tired one appears."

Efforts to Reduce Unnecessary Antibiotic Prescribing: Are They Worth It? A Best Evidence Review

2/27/2009 4:20:00 AM

Interventions to Reduce Unnecessary Antibiotic Prescribing. A Systematic Review and Quantitative Analysis

Abstract

The study that this review is based on was selected from Medscape Best Evidence, which uses the McMaster Online Rating of Evidence System. Of a possible top score of 7, this study was ranked as 6 for relevance and 5 for newsworthiness by clinicians who used this system.

There is a public health crisis related to higher rates of bacterial antimicrobial resistance, and the overuse of antibiotics contributes to this problem. A new systematic review examines the efficacy of programs to reduce the unnecessary use of antibiotics. This information should be valuable to physicians, administrators, and public health officials as we enter the cold and flu season.

Clinical Pearls

In a study examining S pneumoniae resistance, the least effective agents were trimethoprim-sulfamethoxazole and azithromycin.
Interventions for reducing inappropriate antibiotic use that were assessed in the systematic review equated to a relative decrease of 25%. Overall, the collective interventions could reduce the rate of antibiotic prescriptions by 8.0 to 41.8 prescriptions per 1000 patient-years.
Although no invention strategy in the study was clearly superior, in general, active education for clinicians was more effective than passive education, and educational efforts targeting antibiotic prescribing habits for all acute respiratory infections were generally more effective than interventions for specific infections.
Interventions were not associated with an increase in medical services, and in nearly all trials there were no adverse effects regarding patient satisfaction.
Between 1996 and 2001, prescriptions for antibiotics for upper respiratory tract infections among children decreased by 5.1% and prescriptions for overall use decreased by 8.5%.

Family-Based Lifestyle Interventions May Help Obese Children Lose Weight

2/10/2009 6:27:00 AM

Laurie Barclay, MDJanuary 26, 2009 — Family-based lifestyle interventions that modify diet and physical activity and that include behavioral therapy can help obese children lose weight and maintain that loss for at least 6 months, according to the results of a Cochrane systematic review posted online January 21 in the Cochrane Database of Systematic Reviews.

"Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences," write Hiltje Oude Luttikhuis, from Beatrix Children's Hospital and University Medical Center Groningen, in Groningen, the Netherlands, and colleagues. "In order to support clinicians in determining the most appropriate form of treatment, paediatric weight management guidelines exist in many countries to promote best practice, but at present many of these recommendations are based on low grade scientific evidence."

Inclusion criteria for the review were randomized controlled trials of lifestyle interventions (eg, dietary, physical activity, and/or behavioral therapy interventions) and drug and surgical interventions to treat obesity in children younger than 18 years. The interventions could have been conducted with or without the support of family members. A minimum of 6 months of follow-up was required or 3 months for actual drug therapy.

The 64 randomized controlled trials identified that met criteria enrolled a total of 5230 participants. In 12 studies, lifestyle interventions were directed at physical activity and sedentary behavior, whereas 6 studies addressed diet and 36 evaluated behaviorally oriented treatment programs. Ten studies looked at drug interventions with metformin, orlistat, or sibutramine. None of the identified studies of surgical intervention met inclusion criteria. Intervention design, outcome measurements, and methodologic quality varied considerably in the included studies.

Meta-analyses showed that lifestyle interventions involving children and lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine were associated with a reduction in overweight at 6 and 12 months of follow-up. Randomized controlled trials of drugs showed a range of adverse effects.

Quick Screening Tools May Help Identify Postpartum Depression

2/10/2009 6:22:00 AM

January 23, 2009 — Two easily administered screening tools may help to identify postpartum depression at well-child visits, according to the results of a study reported in the January/February issue of Annals of Family Medicine.

"Postpartum depression affects up to 22% of women who have recently given birth," write Dwenda Gjerdingen, MD, MS, from the University of Minnesota in Minneapolis, and colleagues. "Most mothers are not screened for this condition, and an ideal screening tool has not been identified. This study investigated (1) the validity of a 2-question screen and the 9-item Patient Health Questionnaire (PHQ-9) for identifying postpartum depression and (2) the feasibility of screening for postpartum depression during well-child visits."

At 7 family medicine or pediatric clinics, English-literate mothers registering their 0- to 1-month-old infants for well-child visits were asked to complete questionnaires during these visits at 0 to 1 month, 2, 4, 6, and 9 months postpartum. Each questionnaire included the 2-question screen and the PHQ-9 to screen for depression. The depression component of the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was also completed at the first visit and repeated at a subsequent visit if either screening test result was positive for depression.

The response rate was 33%. Of 506 participants, 45 (8.9%) had major depression based on a positive result on the SCID. During the entire course of the study, the 2-question screen had 100% sensitivity and 44% specificity. With use of simple scoring, the sensitivity of the PHQ-9 was 82% and specificity was 84%; with complex scoring, these were 67% and 92%, respectively. Also during the course of the study, the corresponding values were 84% and 79% for the first 2 items of the PHQ-9.

Completion of the 2- to 6-month questionnaires took place during well-child visits (38%), by mail (29%), or by telephone (33%).

Limitations of this study include low initial rate of participation and failure to compare the validity of the 2-question screen or PHQ-9 vs other postpartum depression screens, such as the Edinburgh Postnatal Depression Scale.

"The 2-question screen was highly sensitive and the PHQ-9 was highly specific for identifying postpartum depression," the study authors write." These results suggest the value of a 2-stage procedure for screening for postpartum depression, whereby a 2-question screen that is positive for depression is followed by a PHQ-9. These screens can be easily administered in primary care clinics; feasibility of screening during well-child visits was moderate but may be better in clinics using a mass screening approach.

Dieting Is Out; Healthy Eating Is In

2/10/2009 6:20:00 AM

After years of obsessing about weight loss, first shunning high-fat foods and then high-carb ones, it seems Americans are giving up formal diets in favor of healthy eating and wholesome foods.

A recent report by the market research firm NPD, based on a survey of 5,000 people, found that the number of Americans on weight loss diets was at its lowest rate in decades. As of February 2008, 26% of women and 16% of men surveyed said they were following a weight-loss diet, down from 39% of women and 29% of men in 1990.

At the same time, a 2008 American Dietetic Association survey of nearly 800 adults found that 79% said they aren’t doing more to improve their diets because they're already satisfied with the way they eat; 73% said it's because they don't want to give up their favorite foods.

The good news? They don't have to, say the experts.

"All foods can fit into a healthy diet, as long as you exercise and practice moderation," says Jeannie Gazzaniga Moloo, PhD, RD,a spokeswoman for the American Dietetic Association.

Healthy Eating vs. Dieting

So why are fewer people going on weight loss diets? One reason, some experts say, may be that they have learned from past mistakes.

Diet books, low-calorie, fat-free, and sugar-free foods abound, but don’t appear to be making a dent in obesity statistics. Many dieters have been lured over and over again by promises of fast weight loss from the latest diet schemes, only to regain the lost weight -- and then some -- as soon as they go off the diet.

The truth is that if your weight loss plan is not sustainable for the long term, it's not worth following, says Michael Dansinger, MD, physician for the NBC reality show TheBiggest Loser.

Another reason, say other experts, may simply be that dieters are waiting for the next diet craze – the Atkins Diet or South Beach Diet of the moment.

There's no single, super-popular diet right now, says Cindy Moore, MS, RD, nutrition director for the Cleveland Clinic. "Even when the hot diet bursts onto the scene, just reading it is no guarantee you will lose weight," she adds.

Still another reason, some say, is that, with two out of three Americans overweight, overweight is fast becoming the new "normal." When your friends and family are overweight, your own extra pounds can seem less important.

Indeed, a 2007 study in The New England Journal of Medicine found that people tend to follow suit when their friends and family members become overweight, and likewise when they lose weight.

Better Food, Not More

Trends like the "slow food" movement, an interest in organic foods and in eating foods grown closer to home (being a "locavore") are further shifting the momentum away from foods to avoid to foods to enjoy.

"If you shop at farmers markets, you are going to be buying natural food, not junk food," says Moore.

K. Dunn Gifford, president of the Oldways Preservation Trust, a food issues think tank, says high-quality food is just more satisfying.

"We need to reduce our tendency toward over abundance and realize less food can be more satisfying when you choose foods with intense flavors and taste," Gifford says.

It can be a lot easier and more motivating to focus on what you can eat instead of what you should avoid, experts say.

A study published in The American Journal of Clinical Nutrition in 2007 reported that obese women who avoided high-fat foods and focused on eating more fruits and vegetables lost 20% more weight that those who only avoided high-fat foods.

So what exactly should you be adding to your diet? Go for more plant foods and whole, unprocessed foods that are rich in nutrients and naturally lower in fat, salt, and sugar, experts say.

Nancy Rodriguez, PhD, RD, a nutrition researcher at the University of Connecticut, says eating lean or low-fat protein at every meal will fill you up and make you less likely to overeat. Likewise, foods like whole grains, fruits, and vegetables -- high in fiber and water content -- are low in calories and help you feel full.

"When you fill up on nutrient-rich fruits, vegetables, whole grains, beans, low-fat dairy, and other lean protein, there is less room for empty-calorie foods," Rodriguez says.

And what about those foods that taste good but aren't exactly packed with nutrients (except maybe calories)?

"It's OK to enjoy a small serving of those foods once in a while," says American Dietetic Association president Martin Yadrick, MA, RD.

Healthy Eating: Slow Down

Not only what you eat, but how you eat, is important when you're trying to eat healthfully and lose extra pounds, experts say.

One big step toward taking control of your diet is to eat more home-cooked meals.

"When you prepare it, you have total control over what is in the food, you can make it exactly how you like it, and better for you than in restaurants, where you have no idea what is in the food," says Ellie Krieger, RD, host of the Food Network’s Healthy Appetite and author of The Food You Crave.

Also, forget about eating on the run. You'll enjoy your food more and ultimately, eat less, if you eat slowly and savor the flavors, Rodriguez says. Enjoy the conversation at the table, and give your brain time to get the signal that you are comfortably full.

"If you sit down and taste the food, you are more likely to be satisfied with less," she says.

Spinal Surgery Superior to Exercise, Medical Therapy at 4 Years CME/CE

1/23/2009 12:43:00 AM

January 5, 2009 — A new study extends to 4 years the previously published 2-year results of research that found that spine surgery provides more rapid and greater relief in symptoms and a greater improvement in function than nonsurgical interventions for patients with lumbar disk herniation.

And while the surgery did not get patients back to work faster than nonoperative approaches, there is mounting evidence that surgery might be cost-effective.

"Patients, families, and insurance carriers or the government want to know how long this treatment effect is going to last. Is it short-term or does it have a long-term effect?" said 1 of the study authors, William Abdu, MD, from Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire. "The answer is that so far, out to 4 years, the surgical group still did much better than the nonsurgical group. There were no major adverse complications in either treatment group, and that hasn't changed out to 4 years."

The updated results of the Spine Patient Outcomes Research Trial (SPORT) appear in the December 1 issue of Spine.

All Patients Improved

But although patients receiving surgery did better than those treated with physical therapy, exercise, and pain relievers, all patients in the study improved, a finding that "provides patients with more information to make decisions," said Dr. Abdu.

SPORT compared outcomes of 1244 patients at 13 American spine clinics who had at least a 6-week history of a herniated disk in the lumbar spine causing back pain, leg pain, and other symptoms and who received either surgery (diskectomy) or nonsurgical treatments. Enrollment began in March 2000 and ended in November 2004. Surgery and nonsurgery cohorts were remarkably similar at baseline, and as of this current analysis, the overall mean age of subjects was 41.7 years.

The study includes 2 groups: 501 patients who were randomly assigned to either surgery (245) or nonsurgery (256), and 743 patients who chose between the 2 treatments (521 initially opted for surgery while 222 initially chose nonsurgical intervention).

Surgery consisted of a standard open diskectomy, while the nonoperative protocol included at least active physical therapy, counseling with home exercise instruction, and nonsteroidal anti-inflammatory drugs if tolerated.

Researchers used the Bodily Pain and Physical Function scales and a version of the modified Oswestry Disability Index to assess mean changes from baseline at 6 weeks, 3 months, and annually. Secondary outcomes included work status and patient self-reported improvements.

At 4 years, 59% of those randomized to surgery had undergone surgery, but so had 45% of those randomized to nonsurgery. In the observational cohort, 95% of those initially choosing surgery and 24% of those originally opting for nonoperative treatment had received surgery. In total, 805 patients received surgery by 4 years. That meant that a total of 112 patients (24%) crossed from nonoperative treatment to surgery, although another 89 patients (19%) crossed from surgery to nonoperative treatment. Researchers categorized the outcomes into "intent to treat" (the original randomization treatment) and "as treated" (the treatment actually received regardless of original categorization.)

This crossover from 1 cohort to the other could have underestimated the effectiveness of surgery in the intent-to-treat analysis, Dr. Abdu told Medscape Neurology & Neurosurgery.

Study Highlights

SPORT was conducted at 13 multidisciplinary spine practices in the United States. Patients eligible for study participation had symptoms of lumbar radiculopathy for at least 6 weeks as well as lumbar disk herniation consistent with the site of symptoms.
Study participants underwent open diskectomy with examination of the nerve root or nonoperative care. Nonoperative care consisted of active physical therapy, home exercise instruction, and nonsteroidal anti-inflammatory drugs.
The primary endpoints of the study were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-Item Short-Form Health Survey and the American Academy of Orthopaedic Surgeons/Modems version of the Oswestry Disability Index. These evaluations were completed annually after year 1 of the study.
The observational and randomized cohorts were generally similar in demographic and disease data at baseline. Therefore, the results from the 2 cohorts were combined in the final analysis.
501 patients in the randomized cohort were included in the study analysis, along with 743 patients in the observational cohort. Among participants randomly assigned to surgery, 59% had surgery by year 4. Meanwhile, 41% of subjects randomly assigned to nonoperative care had undergone surgery by year 1.
521 patients in the observational cohort chose surgery, and 95% of these patients underwent an operation. 222 participants chose nonoperative care, but 24% of these patients underwent surgery by year 4.
The mean age of participants was 41.7 years, and there were slightly more men vs women in the study.
Participants undergoing surgery were more likely to be younger, less likely to be working, and had more severe radiculopathy symptoms.
On intent-to-treat analysis of the randomized cohort, all outcomes favored surgery vs nonoperative care at 4 years, but none of these results was statistically significant.
In an analysis that focused on the actual treatment received during the study period, surgery was superior to nonoperative care in pain, physical function, and disability at 4 years.
Examining temporal trends in the main outcomes of the study, surgery promoted significant and progressive improvement during the first 6 months. The difference between the surgery group and the nonoperative group in these outcomes was then maintained through 4 years.
Surgery was also superior to nonoperative care in secondary outcomes, including bothersome degree of sciatica, satisfaction with care, and self-rated improvement.
However, surgery was not significantly superior to nonoperative care in the percentage of participants working at 4 years (84.4% vs 78.4%, respectively).
The most common surgical complication was dural tear, which occurred in 3% of participants undergoing surgery. Rates of reoperation were 10% at 4 years, and half of these procedures were for a repeated disk herniation at the same level.

Wernicke Encephalopathy After Bariatric Surgery: A Systematic Review

1/23/2009 12:38:00 AM

Abstract

Objective: To review the clinical essentials of Wernicke encephalopathy (WE) after bariatric surgery.
Summary Background Data: An estimated 205,000 bariatric surgical procedures were performed in the United States in 2007. Such procedures may potentially lead to severe nutritional complications.
Methods: Literature searches were performed in Medline, Embase, and abstract collections. Inclusion criteria were WE after bariatric surgery, diagnosed by the presence of two or more of the following signs: mental status changes, eye movement abnormalities, cerebellar dysfunction, and dietary deficiency.
Results: Of 104 reported cases of WE after bariatric surgery, 84 cases were included. Gastric bypass or a restrictive procedure had been performed in 80 cases (95%). Admission to hospital for WE occurred within 6 months of surgery in 79 cases (94%). Frequent vomiting was a risk factor in 76 cases (90%) and had lasted for a median of 21 days at admission. Intravenous glucose administration without thiamine was a risk factor in 15 cases (18%). Brain magnetic resonance imaging identified lesions characteristic of WE in 14 of 30 cases (47%). Incomplete recovery was observed in 41 cases (49%); memory deficits and gait difficulties were frequent sequela. The recent increase in the use of bariatric surgery in the United States was associated with an increase in reported WE cases.
Conclusions: The number of WE cases after bariatric surgery is substantially higher than previously reported. Surgeons, allied health providers, and patients need to be aware of the predisposing factors and symptoms to prevent and optimize the management of this condition.

Introduction

Nearly 7% of adult U.S. women presently have a body mass index above 40 kg/m².^[1] Bariatric surgery is presently the only treatment likely to yield substantial and durable weight loss, and has beneficial effects on medical conditions associated with severe obesity.^[2] As a result, more than 100,000 weight-loss procedures are performed annually in the United States alone, and numbers are rising.^[3] The sheer volume suggests that any physician involved in clinical medicine will meet patients who have been treated with obesity surgery. Practitioners will therefore need to familiarize themselves with the potential adverse effects linked with this therapy.

Anastomotic leakage and pulmonary embolism are feared complications of bariatric surgery procedures. However, acute nutritional disturbances may also occur in the early postoperative period. The numerous reports of severe thiamine (vitamin B1) deficiency after obesity surgery have led to the expression bariatric beriberi.^[4] Beriberi is derived from the Singhalese word beri meaning weakness and refers to the clinical spectrum of deficiency in thiamine, including affection of the peripheral and central nervous system.^[5] The most frequent central neurologic complication of thiamine deficiency is Wernicke encephalopathy (WE), a condition which needs immediate treatment to prevent death or permanent neurologic sequela. The classic presentation is that of mental confusion, eye movement abnormalities, and gait instability. Autopsy series indicate that WE is underdiagnosed.^[6] The general epidemiology, pathophysiology, and treatment of this condition was recently reviewed.^[6]

Patients have a limited capacity for food intake during the initial weeks after a bariatric procedure. The body's reserves of thiamine can be depleted after only 20 days of inadequate supply.^[6] Patients treated with bariatric surgery may thus still be frankly obese when presenting with symptoms caused by nutritional derangement. Such patients are a diagnostic challenge to physicians not familiar with WE as a potential complication of weight-loss operations. The aim of this paper is to review the clinical essentials of WE after bariatric surgery, with emphasis on presentation, findings on supplementary tests, and patient outcomes.

First US Face Transplant Patient Recovering

1/23/2009 12:36:00 AM

December 18, 2008 — The woman who recently got the first face transplant in the U.S. is "doing well," her doctors at the Cleveland Clinic told.

The woman, who wishes to remain anonymous, had 80% of her face replaced within the last two weeks with facial tissue from a deceased donor. The patient had suffered severe facial trauma several years ago, leaving her blind in one eye and without a nose or upper jaw.

The patient is recovering at the Cleveland Clinic and hasn't shown any signs of tissue rejection, says Maria Siemionow, MD, PhD, director of plastic surgery and head of microsurgery training at the Cleveland Clinic.

The patient hasn't seen her still-swollen face yet, but she has run her hands over it and is "happy" that she now has a nose, jaw, and a "full face" Siemionow says.

About the Face Transplant Patient

The patient's doctors won't say what had caused the patient's facial trauma. She had already tried conventional reconstruction and suffered because of how people treated her.

"She was called names and children were afraid of her" says Siemionow, calling the woman "brave".

Few other details about her have been released, except that she's a U.S. citizen, and that she wanted the operation not only for herself but to pave the way for other people like her. No images of the patient are being released, in keeping with her and her family's wishes.

Few details are available about the donor, except that she's a woman. Donors have to match the patient's gender, race, approximate age, and blood type.

About the Face Transplant Operation

The operation took 22 hours and involved replacing most of the woman's face, except for her upper eyelids, forehead, lower lip, and chin. That meant working with layers of tissue -- skin, muscles, bones, arteries, veins, and nerves.

It took four years to find the right patient and donor, and 20 years of work on techniques leading up to the surgery, Siemionow notes.

What's Next for Face Transplant Patient

The patient will need to take immune-suppressing drugs for the rest of her life to help prevent her body from rejecting the donated tissue.

The Cleveland Clinic predicts that the patient's facial swelling will ease in a few months, that she'll get feeling in her face within the next six months or so, and that about a year from now, most of her face should be functional.

She won't look like her donor.

"Even though some bone was transferred from the donor to the recipient, the underlying facial structure of any two people is very different", states a Cleveland Clinic fact sheet about the face transplant.

More Face Transplants Ahead?

Siemionow says her team has gotten a grant from the U.S. Department of Defense and is evaluating severely disfigured veterans who might be candidates for the procedure.

The procedure is risky. There's the risk of tissue rejection, the lifelong need for immune-suppressing drugs, and the possibility that if the transplant doesn't take, a patient might need to undergo a skin graft using skin from their own body. Patients also need to be psychologically stable, resilient, responsible, and self-reliant, and to have exhausted all other treatment options, notes the Cleveland Clinic.

Surprising Ways to Reduce Wrinkles

1/13/2009 7:29:00 AM

Sleep on your back.

The American Academy of Dermatology (AAD) cautions that sleeping in certain positions night after night leads to "sleep lines" -- wrinkles that become etched into the surface of the skin and don't disappear once you're up. Sleeping on your side increases wrinkles on cheeks and chin, while sleeping facedown gives you a furrowed brow. To reduce wrinkle formation, the AAD says, sleep on your back.

Eat more fish -- particularly salmon.

Not only is salmon (along with other cold-water fish) a great source of protein -- one of the building blocks of great skin -- it's also an awesome source of an essential fatty acid known as omega-3. Yale dermatologist Nicholas Perricone, MD, tells WebMD that essential fatty acids nourish skin and keep it plump and youthful, helping to reduce wrinkles.

Don't squint -- get reading glasses!

The AAD says repetitive facial movement -- like squinting -- overworks facial muscles, forming a groove beneath the skin's surface. This groove eventually becomes a wrinkle. Keep those eyes wide: Wear reading glasses if you need them. And get savvy about sunglasses, which can protect skin around the eyes from sun damage and keep you from squinting.

Slather on alpha-hydroxy acids (AHAs).

These natural fruit acids lift away the top layer of dead skin cells, reducing the appearance of fine lines and wrinkles, particularly around the eyes. New evidence shows that in higher concentrations, AHAs may help stimulate collagen production.

Trade coffee for cocoa.

In a study published in a 2006 issue of the Journal of Nutrition, researchers found that cocoa containing high levels of two dietary flavonols (epicatchin and catechin) protected skin from sun damage, improved circulation to skin cells, affected hydration, and made the skin look and feel smoother. Delicious!

Don't over-wash your face.

According to dermatologists at the University of Maryland Medical Center, tap water strips skin of its natural barrier oils and moisture that protect against wrinkles. Wash them off too often, and you wash away protection. And unless your soap contains skin-protecting moisturizers, use a facial cleanser instead of soap.

Try topical vitamin C.

Studies at Tulane University, among others, have found that vitamin C can increase collagen production, protect against damage from UVA and UVB rays, correct pigmentation problems, and improve inflammatory skin conditions. The key, however, may be the type of vitamin C used. To date, most research points to L-ascorbic acid as the most potent for wrinkle relief.

Eat more soy.

Research shows that soy may help protect against or heal some of the sun's photoaging damage. One study, published in the European Journal of Nutrition, reported that a soy-based supplement (whose ingredients also included vitamins, fish protein, and extracts from white tea, grape seed, and tomato) improved the skin's structure and firmness after just six months.

Practice good skin care basics.

If you really want to keep your skin looking young, start with the essentials. You've heard these recommendations before, but they bear repeating:

Avoid the sun
Wear sunscreen
Don't smoke

Use moisturizer

4 Natural Cold Remedies: Do They Work?

12/2/2008 7:45:00 AM

You're sneezing. You're sniffling. You're miserable with the cold that won't go away.

And nearly everyone within arm's length is suddenly describing their ''miracle'' cold remedy. They want to tell you all about how you can squash that cold -- maybe overnight! -- If you just pop some vitamin C, take echinacea or zinc, or heat up some chicken soup. And they may mention that taking their secret remedy before the first sniffle may have helped you avoid the cold altogether.

Never mind the fervor with which these cold remedies are offered. Do they actually work?

First, the really bad news: "You can't cure a cold," says David A. Blandino, MD, chairman of family and community medicine at the University of Pennsylvania Medical Center Shadyside Hospital in Pittsburgh.

But you may be able to shorten one. Here's the scorecard on whether natural cold remedies such as vitamins and supplements get a thumbs up or thumbs down.

Natural Cold Remedies: The Rundown

1. Zinc. The mineral zinc, available in over-the-counter lozenges, nasal sprays, and gels, may work by preventing the formation of proteins needed by a cold virus to reproduce.

Despite the hoopla about zinc for treatment of colds, scientific studies are scarce, says Jack M. Gwaltney, MD, professor emeritus of internal medicine at the University of Virginia and a longtime cold researcher. Gwaltney tells WebMD that he and his colleagues could find only 14 published studies that looked at zinc the scientific way, with both placebo and treatment groups. Zinc lozenges, they conclude, have no effect. One well-designed study reported a positive effect on treating a cold with zinc nasal gel. But the study results have not yet been replicated, Gwaltney says.

2. Vitamin C. For decades, believers in vitamin C have said taking this vitamin supplement can nip a cold in the bud. The claim is partially triggered by lab studies that find vitamin C affects resistance to virus in animal studies.

But in people? Experts disagree on this slightly but lean toward the negative. Some, including Blandino, say vitamin C has not been proven to shorten the duration of a cold. One 2007 study showed that if vitamin C is taken after a cold begins, it doesn't shorten the cold or make it less severe. But when it is taken daily as a preventive treatment -- not just after that first sniffle -- it can very slightly shorten cold duration, by about 8% in adults and by about 14% in children.

Very highly fit people -- marathon runners, for instance -- might cut their risk of a cold in half by taking the vitamin, the study also showed.

But Gwaltney does not agree. "The weight of scientific evidence and the well-done studies indicate vitamin C does not prevent colds," says Gwaltney. "It may have some mild effect on treating colds."

3. Echinacea. The herbal supplement echinacea, like Vitamin C, sparks controversy among cold experts. Advocates say it's an immune booster with antiviral properties and other benefits, so it's good at preventing colds. However, two recent studies on the natural remedy have yielded conflicting conclusions. In one 2007 study, University of Connecticut researchers concluded that echinacea decreases the odds of developing a cold by 58% and reduces its duration by 1.4 days. But a previous study, conducted by Gwaltney's colleagues at the University of Virginia and published in 2005 in The New England Journal of Medicine, showed no benefit from the herb in either reducing the severity of a cold infection or preventing a cold.

Echinacea drew a "no" vote from our three experts -- Gwaltney, Blandino, and Owen Hendley, MD, professor of pediatrics in the division of infectious diseases at the University of Virginia, Charlottesvile.

4. Chicken Soup. Advocates of hot chicken soup, long offered as a cold remedy, say it may help soothe inflammation that can make the symptoms worse.

The problem with proving scientifically that chicken soup works, says Gwaltney, is finding a legitimate placebo food to study against it in a scientific way.

That's despite the well-publicized report published in 2000 in which researchers reported that chicken soup, which they studied in the laboratory, may have an anti-inflammatory effect on easing symptoms of upper respiratory infections. But the report doesn't prove chicken soup does anything for cold symptoms, Gwaltney says, because it didn't include a test of people nor include a placebo for comparison.

Although chicken soup may not actively fight a cold, it can help fight dehydration that can occur when you have a cold or the flu.

Preventing a Cold: Does Anything Really Work?

Hand washing has long been touted as a way to prevent a cold during cold and flu season, and experts agree that is wise.

But here's the newest twist: Paying attention to where you put your hands -- and scheduling your hand washing around where your hands have been, rather than the clock -- appear to be important, too. That's because cold viruses may linger on surfaces longer then suspected, Hendley and his colleagues have discovered.

Hendley and other University of Virginia researchers did a study published in 2007 of people with a cold who stayed overnight in a hotel. "We went in the next day and swabbed 10 sites they had touched," Hendley says.

Preventing a Cold: Does Anything Really Work? continued...

"We found about 30% or 40% of the sites had virus on them." He's talking about surfaces such as light switches and TV remote controls. "A third of the time, the virus was still there," Hendley says of the site samples. "Now we are trying to figure out, is it still infectious?" The hotel study didn't go there, but that study is under way.

Until more research is in, Gwaltney suggests hand washing after touching potentially germy surfaces, rather than adhering to the often-suggested advice of hand washing throughout the day no matter what you've touched.

Rhinoviruses cause about half of all colds in adults, Hendley says. You acquire the virus by getting it on your hand and then touching your nose or eyes, he says. "The virus doesn't usually go through the air," Hendley says. "You usually get it on the finger and you inoculate yourself. Just being in the air space [with an infected person or the virus] is not enough."

Besides hand washing, breathing in humidified air and increasing your fluid intake may also help, Blandino says.

Whatever natural remedy you use, the effects on the cold will be minimal, cautions Gwaltney. Of natural cold remedies, he says: "They're not as effective as commercial cold remedies" such as decongestant, antihistamines, and nonsteroidal anti-inflammatory drugs.

Patience could pay off, too, Blandino says. "You can't cure the cold," he says. "[But] most of them are gone within 10 days."

Chicken Soup, Ginger Tea, and Other Soothing Recipes for Colds

We still have a lot to learn about the healing powers of food. But this much we know:

Chicken soup does help clear nasal clog. Ginger seems to settle stomachs. Dark greens such as spinach are loaded with vitamins A and C. And salmon is a great source of omega-3 fatty acids, which have an anti-inflammatory effect. Quite simply, a well-nourished immune system is better able to ward off infections.

So eat healthy this winter. And enjoy these recipes from the kitchen of Dr. Charlotte Mathis.

Charlotte's Chicken Soup

1 chicken, cut into 8-10 pieces (remove skin, leave bone in)

8 cups of chicken broth (homemade is preferable, but unsalted, low-fat canned is fine.**)
3 large cloves of garlic, chopped
1/2 cup chopped onion
2 carrots, peeled, thinly sliced
2 celery stalks, sliced

(If your children won't eat the above vegetables, you may leave them out.)
8 ounces dried wide egg noodles or 1 cup uncooked long grain rice
1/2 cup finely chopped fresh parsley
2 tablespoons fresh thyme or 2 teaspoons dried thyme

Pat chicken parts dry. Season pieces with salt and pepper. Brown chicken parts in a heavy Dutch oven with 1 teaspoon of canola oil over medium-high heat for about 6-8 minutes, turning once.

Add chicken broth to the pot. Bring to boil. Reduce heat; cover partially and simmer until chicken is cooked through, about 20 minutes.

Using tongs, transfer chicken to large bowl. Cool chicken and broth slightly. Discard bones from chicken. Cut or pull apart chicken meat into bite-sized pieces and reserve.

Spoon fat off top of chicken broth. Return broth to simmer. Add onion, carrots, celery, and thyme. Simmer until vegetables soften, about 8 minutes. (Can be prepared 1 day ahead, but be sure to store broth and meat separately in the fridge.)

Stir in noodles, parsley, and reserved chicken. Simmer until noodles are tender, about 5 minutes. If using rice, simmer until rice is done. Season soup to taste with salt and pepper. Ladle into soup bowls and garnish if you like with parsley.

** Canned soup can be made to taste more homemade by simmering it for about 45 minutes with a couple of celery stalks, carrots, half of an onion chopped, a bit of garlic, some peppercorns, and a bay leaf. Strain before using.

Ginger Cinnamon Tea

(Ginger is also purported to soothe an upset stomach.)

1/2 cup thinly sliced fresh ginger
6 cups water
2 cinnamon sticks
2 tablespoons honey or brown sugar
lemon wedges for garnish if desired

In a saucepan, simmer ginger, cinnamon, and water 20 minutes, or more for stronger tea. Add honey or sugar and strain tea through a sieve.

Hot Lemonade

(Great for a sore throat.)

4 lemons
several slices of ginger root
honey to taste

Juice several lemons, then scrub the peel well. Slice it thinly, and add to the juice.
Cover all with plenty of boiling water, cover, and steep until cool.
For added benefit, add several slices of ginger root before covering with water.
Strain off the liquid, add honey and additional water to taste. Drink hot.

Mixed Greens and Fennel With Ginger Dressing

(Ginger is purported to be great for a cold. So is fennel.)

1 bag of fresh spinach or mixed salad greens
2 fennel bulbs (cleaned, cut in half lengthwise, and sliced thinly crosswise

For the dressing:
2 scallions, finely chopped
1 garlic clove, minced
2 tablespoons oriental sesame oil
2 tablespoons soy sauce
2 tablespoons rice vinegar
1 tablespoon chopped, peeled fresh ginger
1 tablespoon honey
1/4 cup canola oil

Blend first seven dressing ingredients in food processor. With machine running, gradually add oil and process until well blended. (Can be prepared 1 day ahead. Cover and refrigerate. Let stand 30 minutes at room temperature before using.)

Toss fennel and greens with dressing. Enjoy!

Slow Roasted Salmon With Fennel Orange Salsa

4 Salmon filets with skin on
salt, pepper to taste
3 tablespoons fresh herbs (Dr. Grayson recommends chives, rosemary, or thyme.)

For the salsa:
1 fennel bulb finely diced, plus 1 tablespoon minced fennel leaves
1/2 cup finely diced oranges
10 green olives pitted and minced
1 tablespoon fresh orange juice
1 teaspoon fresh lemon juice, or to taste

Preheat oven to 250 degrees. While it's heating, make the salsa.
In a medium bowl, stir together the fennel bulb and leaves, the diced orange, the olives, the juices, and salt and pepper to taste.

Then, place salmon skin side down on a baking sheet sprayed with olive oil. Brush fish with a bit more olive oil, sprinkle salt and pepper, and press the herbs into the flesh. Set aside.

When the oven is hot, "slow-roast" the salmon for 17 minutes. It may not look done, but it is! Serve salmon with salsa on the side.

WebMD Health News

Reviewed by Louise Chang, MD

Nov. 10, 2008 (New Orleans) -- If you're worried about your blood pressure, you may want to follow the British custom of regularly "sipping a cuppa" -- tea, that is.

In a new study, drinking three cups of herbal tea containing hibiscus each day lowered blood pressure.

"Most of the commercial herbal tea blends in the United States contain hibiscus," says Diane L. McKay, PhD, of Tufts University in Boston. She tells WebMD that people with the highest blood pressure at the start of the six-week study benefited the most.

McKay presented the study of 65 healthy men and women with modestly elevated blood pressure at the American Heart Association (AHA) meeting here.

Overall, drinking hibiscus tea blends lowered systolic blood pressure -- the top number in the blood pressure reading -- by an average of 7 points. That was significantly more than the 1-point drop observed in people who were given a placebo in the form of hibiscus-flavored water, McKay says.

While a 7-point drop in blood pressure might not seem like much, she says studies have shown that "even small changes in blood pressure ... when maintained over time ... will reduce the risk of stroke and heart attack."

Past AHA president Robert H. Eckel, MD, says that more study is needed to determine whether herbal tea's blood-pressure-lowering effect can actually be sustained over the long haul.

The degree of blood pressure lowering associated with tea drinking in the study was as much as would be expected with standard blood pressure drugs, he says.

Sore Throat - Topic Overview

12/2/2008 7:42:00 AM

Sore throats can be painful and annoying. Fortunately, most sore throats are caused by a minor illness and go away without medical treatment.

Several conditions can cause a sore throat.

Viral infections

Many sore throats are caused by a viral illness, such as:

The common cold, the most common type of viral infection.
Infection of the voice box (laryngitis)
Mononucleosis (mono, "the kissing disease"), a viral infection that tends to cause a persistent sore throat.
Other viral infections, such as mumps, herpangina, or influenza.

Bacterial infections

A bacterial infection may also cause a sore throat. This can occur from:

Strep throat, which usually does not occur with congestion or a cough.
An inflammation or infection of the tonsils (tonsillitis) and sometimes the adenoids (adenoiditis).
Inflammation of the epiglottis (epiglottitis).
Inflammation of the uvula (uvulitis).
In rare cases, a sexually transmitted disease (STD), such as gonorrhea or chlamydia. If you have engaged in high-risk sexual behavior, consider whether gonorrhea or chlamydia may be present. For more information, see the topic Exposure to Sexually Transmitted Diseases.

Irritants and injuries

A sore throat that lasts longer than a week is often caused by irritants or an injuries, such as:

Throat irritation from low humidity, smoking, air pollution, yelling, or nasal drainage down the back of the throat (postnasal drip).
Breathing through the mouth when you have allergies or a stuffy nose.
Stomach acid that backs up into the throat, which may be a symptom of gastroesophageal reflux disease (GERD). Although this often occurs with heartburn, an acid taste in the mouth, or a cough, sometimes a sore throat is the only symptom.
An injury to the back of the throat, such as a cut or puncture from falling with a pointed object in the mouth.
Chronic fatigue syndrome, a condition that causes extreme tiredness.

Treatment for a sore throat depends on the cause. You may be able to use home treatment to obtain relief.

Because viral illnesses are the most common cause of a sore throat, it is important not to use antibiotics to treat them. Antibiotics do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Are You Too Sensitive?

11/19/2008 4:41:00 AM

No, we're not picking on you - just trying to make you feel better. Seven tips to help you roll with the punches this season.

There was a carpool mix-up: I thought it was my night to pick up the kids outside the gym; another parent thought it was his. "What happened?" he snarled, shaking his head. "Why are we both here right now?" As chauffeuring snafus go, this was small potatoes. It isn't like we left our boys standing in the snow. So why am I still smarting over his tone of voice — five days later?

I admit, I can take things too personally. It's even worse during the holidays when I'm in high-stress mode and every difficult-to-deal-with relative rolls into town. I spend far too much time anguishing over a friend's remark at a Christmas party, or fretting about what I should or shouldn't have said.

The hamster wheel in my head runs something like this: First, my feelings get hurt. (For example, I think, Why hasn't my sister called in two weeks?) Then I begin to imagine all the reasons she might be mad at me. (Was it something I said? Shoot — I forgot her anniversary and now she's upset.) Next, I get mad at her — and myself. (She always forgets my anniversary! Why am I worrying about this kind of nonsense?) After hours of circular thinking, I usually discover that nothing was wrong: My sister just got busy and didn't have time to call.

I consider myself a sane, logical person, yet I fall into this cycle again and again. What gives? I'm happy to report that genetics may be to blame — scientists report that sensitivity runs rampant in certain family trees. And I'm not alone: 15 to 20 percent of the population is thin-skinned. The upside is that we're highly in tune with people's feelings. We're the go-to gurus when friends are wrestling with a relationship problem or a sticky situation at work.

The downside: By reading too much into what others say or do, we can over-react to innocuous remarks. Some of us lash out, which just compounds the problem, while others (like me) say nothing but endlessly analyze. What's more, brooding, which shrinks officially label "ruminating," is linked to depression. While only a few of us get the "supersensitive" label, it doesn't mean the rest of the world isn't susceptible, too: "We're all more vulnerable in areas that touch on how we define ourselves," says Elaine Aron, Ph.D., a psychotherapist in San Francisco and author of The Highly Sensitive Person. So if your self-esteem is connected to your work performance, you'll likely be more upset if a colleague jokes about your presentation than if your mother-in-law mentions your dusty window blinds.

In evolutionary terms, being sensitive to criticism could be a lifesaver. "Back when we were hunter-gatherers, being excluded from the group was very dangerous," explains Aron. "You might've starved, or even gone insane from being ostracized. We are very social animals." Our sensitivity to the negative opinions of others is so strong, she says, that we record these emotional wounds in the same part of the brain as actual physical pain.

Despite this primal instinct, people may be growing less sensitive over time, says Jerome Kagan, Ph.D., a psychology professor whose lab at Harvard has studied traits like sensitivity for decades. "That's because so many more people live in cities today, which breeds anonymity and insensitivity to what others think. We have more rudeness in our society than people in the 18th century could've ever imagined."

I'll say. Today, Simon Cowell is considered a straight-shooting superstar for skewering performers on American Idol. Internet users and bloggers routinely lambaste other people's posts for all to read, and road ragers feel entitled to humiliate people for neglecting to signal a lane change. Hurting people's feelings has almost come to stand for honesty and authenticity. And you wonder why I'm so sensitive.

It turns out that my gender doesn't help matters, either. "In general, women are taught to think about other people's feelings much more than men are," says Paul Wink, Ph.D., a professor of psychology at Wellesley College, who has researched gender and sensitivity (among other personality traits). "So while it's OK for men to be blunt, women are often expected to be warmer, more agreeable, and more invested in relationships. Because they're more tactful, they're also more likely to overreact to minor problems and remarks."

So will I ever be able to get through a week without thinking, Was it something I said? Yes, says Kagan. "Sensitivity to others' opinions of us is the most adjustable type of sensitivity," he explains. (The two other varieties — reaction to external stimuli, such as noise and light, and to internal sensations, such as heart rate — are far more fixed.) Next time your feelings get hurt, try these retrain-your-brain strategies.

Find the Nearest Exit

When a comment stings you, breathe deeply several times, and then figure out a way to excuse yourself from the conversation (even if that means you have to make something up). Aron says this works because it incorporates the two main principles of anger management: Focusing on your breath distracts you from the initial surge of temper that follows a barb, and leaving the situation gives you time to form an appropriate response. "Most of us make poor word choices when our pulse goes above 100," says Aron. She's a big believer in the 24-hour rule — waiting a full day before responding, if at all. "In some cases, especially at work, revealing that a remark makes you feel defensive can really hurt you, by making you seem insecure."

Look Who's Talking

Suppose a colleague implies that you're careless to let your 20-year-old daughter go on a road trip with her friends. Before you take the remark to heart, consider the source. How much does this person actually know about raising kids? How well does she know you or your daughter? Is she an over-parenter? "Then run the comment by someone who really knows what kind of a mother you are," says Aron. "Maybe your critic has a point, and you're reacting defensively because you agree with her. Or maybe she just doesn't have a clue."

Just This Once, Don't Call a Friend

Researchers from the University of Missouri at Columbia tracked children and adolescents who shared their hurt feelings with friends, and came to a startling conclusion: The girls who "co-ruminated" the most had more supportive friendships, but also greater levels of anxiety and depression. "Excessive focus on problems probably makes them seem even bigger and harder to resolve," says Amanda Rose, Ph.D., the lead author. "And it likely gets in the way of finding positive, healthy distractions," such as reading a good book or going for a walk.

Check Your Ego

Supersensitivity is sometimes the result of "it's all about me" syndrome. I confess, this is sometimes my issue. When my neighbor doesn't wave back, I automatically start a mental checklist: Did my dogs get loose recently? Have my kids been blasting music? My close pals rib me about this. "Get over yourself, Sarah," they'll say. "Everything can't be your fault." Maybe my neighbor is simply lost in thought.

Meditate, Don't Ruminate

Researchers from San Diego State University and the University of California at San Diego found that mindfulness meditation, which has been shown to treat stress, anxiety, and depression, is especially good at helping brooders stop replaying a hurtful remark over and over. I tried this strategy the other night after a heated spat with my 16-year-old. She had yelled, "You're so sensitive, Mom! It makes it hard to tell you things." Despite just writing an entire story on the subject, I shouted back, "That's not true at all!" Feeling hurt, I slunk into the bedroom, dusted off an old meditation CD, and listened to the soothing music and gentle bells. Sure enough, after 15 minutes, I had regained enough composure to snicker at myself. I went back to the living room, tossed a pillow at her, and said, smiling, "OK, maybe I am a little sensitive."

Sing Your Own Praises

Make a list of your strong suits. The more conscious you are of them, the less likely you'll be to crumble when criticized. "Sensitive people often make the mistake of taking an insult as a criticism of their entire personality instead of just one tiny aspect of it," says Aron. When I drove to my next carpool pickup, I road tested this technique. I thought to myself, I regret that I mixed up the dates last time — I wish I hadn't wasted that father's time. On the other hand, I'm pretty competent as a mother, wife, and wage earner. I compost. I vote. I floss. And I have to say, my Christmas decorations look pretty darn good this year. I felt better in seconds.

Choose Your Words Wisely

Keep these comebacks in your arsenal, for when you can't resist responding to a zinger.

"Excuse me?" Asking someone to repeat a thoughtless comment is a graceful way to make them think twice about what they just said — and may help you catch their meaning in case it's you who misunderstood.

"I wonder why you would say that." This toned-down version of "What the heck was that supposed to mean?" challenges the person to reflect on his motives.

"Can you elaborate on what you said?" Asking people to spell out their opinion can prevent miscommunication and clear the air.

"Ouch! That hurts my feelings." This lets someone know you've taken a comment personally, and lets her retract, amend, or apologize.

When you're tempted to beat yourself up for being too sensitive this season, remember that it's a strength, too. "When there are tensions that make everyone at the holiday party squirm," says Helen Fisher, Ph.D., an anthropologist and author of Why We Love, "often, it's the sensitive people who save the day by saying exactly the right thing."

Hypertension: The DASH Diet

11/19/2008 4:40:00 AM

One step to lower high blood pressure -- incorporate the DASH diet into your lifestyle. Doctors recommend:

Eating more fruits, vegetables, and low-fat dairy foods
Cutting back on foods that are high in saturated fat, cholesterol, and total fat
Eating more whole grain products, fish, poultry, and nuts
Eating less red meat and sweets
Eating foods that are rich in magnesium, potassium, and calcium

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is an example of such an eating plan. In studies, patients who were on the DASH diet reduced their blood pressure within two weeks. Another diet -- DASH-Sodium -- calls for reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon). Studies of patients on the DASH-Sodium plan significantly lowered their blood pressure.

Implementing the DASH Diet

The DASH diet calls for a certain number of servings daily from various food groups. The number of servings you require may vary, depending on your caloric need. When beginning the diet, start slowly and make gradual changes. Consider adopting a diet plan that allows 2,400 milligrams of salt per day (about 1 teaspoon) and then once your body has adjusted to the diet further lower your salt intake to 1,500 mg per day (about 2/3 teaspoon). These amounts include all salt consumed, including that in food products, used in cooking, and added at the table.

Here are some tips to get you started:

Add a serving of vegetables at lunch and at dinner.
Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use.
Use only half the butter, margarine, or salad dressing, and use low-fat or fat-free condiments.
Drink low-fat or skim dairy products three times a day.
Limit meat to six ounces a day. Try eating some vegetarian meals.
Add more vegetables, rice, pasta, and dry beans to your diet.
Instead of typical snacks (chips, etc.), eat unsalted pretzels or nuts, raisins, graham crackers, low-fat and fat-free yogurt and frozen yogurt; unsalted plain popcorn with no butter, and raw vegetables.
Read food labels carefully to choose products that are lower in sodium.

Staying on the DASH Diet

The following is a list of food groups and suggested serving amounts for the DASH diet:

Grains: 7-8 daily servings
Vegetables: 4-5 daily servings
Fruits: 4-5 daily servings
Low-fat or fat-free dairy products: 2-3 daily servings
Meat, poultry and fish: 2 or less daily servings
Nuts, seeds, and dry beans: 4-5 servings per week
Fats and oils: 2-3 daily servings
Sweets: try to limit to less than 5 servings per week

How Much Is a Serving?

When you're trying to follow a healthy eating plan, it may help to know how much of a certain kind of food is considered a "serving." The following table offers some examples.

SERVING SIZES

Food/amount

1/2 cup cooked rice or pasta

1 slice bread

1 cup raw vegetables or fruit

1/2 cup cooked vegetables or fruit

8oz. of milk

1 teaspoon olive oil

3 ounces cooked meat

3 ounces tofu

Diabetic Nerve Pain: It's Not Just in Your Feet

11/19/2008 4:37:00 AM

For people with diabetes, nerve pain can be a serious problem. Would you recognize the symptoms of diabetic nerve pain?

Nearly 21 million Americans have diabetes, and at least six out of 10 of them have some kind of nerve damage, called diabetic neuropathy, says the American Diabetes Association (ADA).

Nerve pain or numbness can happen in anywhere in your body - not just in your feet - although that's a common spot if you're over 40.

Nearly one in three people over age 40 with diabetes have lost some feeling in their feet, says the ADA. A little numbness sound like a minor problem? Actually, it's major. Amputation, having a toe, foot, or lower leg surgically removed, is 10 times more likely in people with diabetes.

Just as dangerous are symptoms of neuropathy that go unnoticed, dismissed, or simply aren't seen as diabetes-related. "A good example is when a person is at rest, perfectly calm and comfortable, and yet the heart's racing," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. "Or people lose sensation - this is probably what we fear the most - and can't tell they're having chest pain."

If you can no longer feel the symptoms of a heart attack or blood sugar drops, it can be a sign that the autonomic nerves that send signals to and from your organs have been damaged by diabetes. "When I tell people about this, I talk about the involuntary nervous system," says Trence. "Either the signaling is overly disrupted, as with pain, or it goes in the other direction, where you no longer appreciate any pain or sensation whatsoever."

You may wonder: If you have peripheral neuropathy, is it typical to have some autonomic neuropathy, too? "There isn't anything typical about it at all," Trence tells WebMD. You could have one or the other, or you could have both." That's why knowing the range of symptoms of neuropathy is a key step in taking care of yourself and managing your diabetes.

Symptoms of Peripheral Neuropathy In Your Feet and Hands

If you have diabetes, you may be all-too-familiar with nerve pain and damage in your feet, legs, and hands, called peripheral neuropathy. Your peripheral nerves serve the farthest reaches - the periphery - of your body.

The nerves to your feet are the longest in your body, and they're often the first to be affected. (Nerve pain, numbness, and muscle weakness can also appear in your hips, thighs, and buttocks, called proximal neuropathy, making it hard to walk.

Do you have:

Tingling or burning in your toes, feet, legs, fingers, hands, or arms?
A "pins and needles" feeling?
Pain or cramping?
Numbness or loss of sensation?
Insensitivity to heat and cold?
Extreme sensitivity to even the lightest touch?
Muscle weakness in your hands or feet?
Loss of coordination or balance that makes it harder to walk

Symptoms of Autonomic Neuropathy: Throughout Your Body

Autonomic nerves play a key role in controlling a wide range of basic body functions, most of them involuntary: your heart rate, blood pressure, sexual response, bowels, bladder, sweating, and your ability to sense the signs of high blood sugar or a heart attack.

Most people feel weak or shaky when their blood sugar levels drop below 70 mg/dL, but people with this kind of neuropathy have a hard time feeling these sensations. A vicious cycle can result, since being unaware that your blood sugar's too high (hyperglycemia) or too low (hypoglycemia) makes it harder to keep your blood sugar leveled out throughout the day.

Your social life can be affected, too. If nerves in your urinary tract are damaged, you may not be able to feel or control your bladder and may have incontinence. If nerves in your digestive system are damaged, you may have chronic constipation or a stomach that empties too slowly, resulting in bloating, nausea, even vomiting. If nerves leading to sex organs are damaged, men may have difficulty maintaining an erection, called erectile dysfunction or ED, while women may no longer enjoy their usual sexual response. For both men and women, orgasm may be out of reach.

Do you have:

Trouble feeling when your blood sugar is low?
Chronic constipation or diarrhea?
Frequent indigestion, nausea, or vomiting?
Problems with urination?
Problems with sex or orgasm?
Faintness or dizziness when you stand up?
Trouble seeing well enough to drive at night?
Changes in sweating, either much more or less than usual?

Other Kinds of Neuropathy

Slow stomach emptying. Other common neuropathies can be caused by diabetes, such as the inability to empty the stomach, called gastroparesis, says Trence. "People may notice fluctuations in blood sugar that don't seem to correspond to anything related to food, medication dosing, or activity," she says. "They often report feeling very full, having just a few bites of food. And it's not unusual, when they get up in the morning, to feel full before they've eaten. They can actually throw up, and it's last night's dinner."

Diabetic diarrhea. Another common problem is diabetic diarrhea, Trence says, which is diarrhea that can come at any time. "Socially, it's a major concern," she says. "You can't predict it. It's a rapid transit problem that can occur where there are abnormalities in how fast food is absorbed or how well it's absorbed, so it can cause chaos with blood sugars."

Cardiovascular nerve damage. If nerves in your circulatory system are damaged, your body may lose its natural ability to adjust heart rate and blood pressure. You may frequently feel light-headed or dizzy when you stand up after sitting for awhile, or your blood pressure may stay high too long after exercise, rather than dropping to normal levels after resting.

Focal neuropathy. You can think of this type of nerve pain and damage as suddenly "focusing" in one part of your body with sudden, severe pain or weakness. It can show up as sudden pain in your feet, or sharp pain in one eye, double vision, or trouble focusing one eye. Or you may suddenly be unable to move the muscles on one side of your face.

Why Does Diabetes Cause Nerve Pain?

What's the current theory of why glucose damages nerves? It all boils down to two main theories, says Trence. Both target the protective covering of nerves, called the myelin sheath.

"One theory is that it's either glucose directly, or a byproduct of the metabolism of glucose - something that chemically irritates the nerve sheath," Trence says. When this sheath is destroyed, a bare nerve is exposed - just as you'd expose an electrical wire if you stripped off its plastic coating. "The bare nerve is very painful," she says, "and then over time, the sensation is completely lost."

The other camp thinks the problem lies in the vascular system and a cutting-off of the blood supply to the nerves. If the tiny blood vessels that feed the nerve are destroyed, Trence tells WebMD, then you see a "starvation" of the nerve sheath. "There's some evidence for one or the other theory, and there's some evidence that both may be going on, too," says Trence. "It's a question that has not yet been resolved."

So while modern medicine doesn't yet know for sure what causes nerve pain, one thing is certain: Keeping your blood sugars at your target level is the first step in protecting the health of your nerves. And be open and talk with your doctor at the first sign of unusual nerve pain, numbness, or sensation -- no matter where they may happen in your body.

Treating Depression With Botox

10/22/2008 12:20:00 AM

Pilot Study Says It Works, but Experts Critical.

By Salynn Boyles
WebMD Health News

Reviewed by Louise Chang, MD

May 16, 2006 – It is a treatment that brings new meaning to the phrase, "When you look good, you feel good."

Researchers say depressed female patients in a small, pilot study showed dramatic improvement when given Botox injections, with nine out of 10 no longer meeting the clinical standards for depression two months after the treatments.

But looking good actually had little to do with it, according to the Maryland dermatologist and cosmetic surgeon who led the study and hopes to patent a botulism treatment for depression.

Eric Finzi, MD, PhD, says the injections prevented the patients from frowning, which, in turn, helped to lift their depression.

"I think there is direct feedback between the facial frown muscles and the depression center of the brain," Finzi tells WebMD. "If you can prevent the negative signals that occur when someone frowns, the brain interprets this as meaning that things are better."

A Patient's Story

Kathleen Delano was skeptical when she entered the study. But after battling depression for more than 20 years, with conventional treatments offering little relief, she thought it was worth a try.

The 45-year-old marketing director and single mom tells WebMD that she gradually began to feel better after receiving the five injections that left her unable to frown.

"There was no dramatic cosmetic change, so that wasn't it," she says. "But I began to feel more like doing the things that I had been avoiding."

Delano says she soon began exercising more and re-established ties with friends. She also became more spiritually active.

"It is ironic that the very things that can help alleviate depression are the things that people want to do the least when they are depressed," she says, adding that she believes the Botox injection put her on the path to recovery.

Study Highly Flawed

The 10 female patients were recruited from Finzi's group dermatology practice, but none had been treated with Botox prior to entering the study.

All the women met the standards for ongoing major depression, based on their responses to standardized depression surveys. Seven of the 10 patients had tried one or more antidepressants, and four had been treated with psychotherapy.

Five Botox injections were given into the frown muscles (between the eyebrows) above the bridge of the nose, which had the effect of keeping the patients from frowning. Two months later, self-reported surveys indicated that nine of the 10 patients were no longer depressed, and the tenth had improved mood but was still depressed.

The study was published in the May issue of Dermatologic Surgery, the official journal of the American Society for Dermatologic Surgery (ASDS).

In an accompanying commentary, ASDS president-elect Alastair Carruthers, FRCPC, cited a series of flaws with the study and concluded that its finding must be considered anecdotal.

Specifically, Carruthers expressed concerns about the study's brief follow-up period, small number of participants, and lack of a comparison group. An even bigger concern was that depression assessments were based on reports by the patients themselves.

University of Michigan professor of psychiatry Michelle Riba, MD, was even more critical. Riba is immediate past president of the American Psychiatric Association.

She says the study's lack of a comparison group and small size could have easily influenced the findings. She was especially concerned that the study participants were recruited from Finzi's own group dermatology practice.

"There is no way to know if these findings are real or if they are due to a placebo effect in a study of this design," she tells WebMD.

Finzi acknowledges that the study was limited by fact that he had no outside funding. He hopes that the findings will interest others in doing larger, more rigorously designed clinical trials.

"I came up with this idea and wanted to see if it warranted further testing," he says. "And my conclusion is that it absolutely does."

Alzheimer's Warning Signs

9/12/2008 3:15:00 AM

The Seven Warning Signs of Alzheimer's Disease

The purpose of this list is to alert the public to the early warning signs of one of the most devastating disorders affecting older people — Alzheimer's disease. If someone has several or even most of these symptoms, it does not mean they definitely have the disease. It does mean they should be thoroughly examined by a medical specialist trained in evaluating memory disorders, such as a neurologist or a psychiatrist, or by a comprehensive memory disorder clinic, with an entire team of expert knowledge about memory problems.

The seven warning signs of Alzheimer's disease are:

1. Asking the same question over and over again.

2. Repeating the same story, word for word, again and again.

3. Forgetting how to cook, or how to make repairs, or how to play cards — activities that were previously done with ease and regularity.

4. Losing one's ability to pay bills or balance one's checkbook.

5. Getting lost in familiar surroundings, or misplacing household objects.

6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.

7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

Depression: Recognizing the Emotional Symptoms

9/12/2008 1:32:00 AM

Common symptoms of depression can make work and daily life almost impossible. Depression can skew your view of the world, making everything seem hopeless. Depression can make you feel utterly alone.

But you're not. About 19 million Americans are living with depression right now. And the good news is a lot of treatments work to reduce depression symptoms, and some experts claim depression can be "cured" as well. This guide will help you recognize the symptoms of depression and learn how to treat them.

You may already know some of the emotional and psychological effects of depression. They include:

· Feeling sad, empty, hopeless, or numb. These feelings are with you most of the day, every day.

· Loss of interest in things you used to enjoy. You might no longer bother with hobbies that you used to love. You might not like being around friends. You might lose interest in sex.

· Irritability or anxiety. You might be short-tempered and find it hard to relax.

· Trouble making decisions. Depression can make it hard to think clearly or concentrate. Making a simple choice can seem overwhelming.

· Feeling guilty or worthless. These feelings are often exaggerated or inappropriate to the situation. You might feel guilty for things that aren't your fault or that you have no control over. Or you may feel intense guilt for minor mistakes.

· Thoughts of death and suicide. The types of thoughts vary. Some people wish that they were dead, feeling that the world would be better off without them. Others make very explicit plans to hurt themselves.

Video Games Enhance Skills of Laparoscopic Surgeons

9/12/2008 1:27:00 AM

NEW YORK (Reuters Health) Aug 18 - Laparoscopic surgeons who play video games requiring spatial skills and dexterity are faster and less prone to error when performing advanced surgical procedures, researchers reported on Sunday at the Annual Convention of the American Psychological Association in Boston.

In two separate studies, "gaming ability was a better predictor of advanced surgical skills than years of experience or number of surgical procedures performed," Dr. Douglas Gentile told Reuters Health in an interview prior to his presentation.

Dr. Gentile at Iowa State University and colleagues first studied 33 laparoscopic surgeons participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program. The participants were asked about their video game use.

The researchers found that surgeons who played video games in the past for at least 3 hours/week were 27% faster at surgical procedures and made 37% fewer errors compared to surgeons who did not play video games.

"Normally speed and errors don't go hand in hand like that," Dr. Gentile said.

They confirmed these findings in a second trial involving 303 laparoscopic surgeons.

The Top Gun Program was embedded in video games that required fine motor skills and reaction time, non-dominant hand dexterity, two-handed choreography, targeting, and 3-dimensional depth perception from 2-dimensional information.

The 123 surgeons who played the games for about 20 minutes prior to the Cobra Rope Drill performed significantly faster at the first attempt and overall across 10 trials.

"These studies show the untapped potentials that video games offer" to medical training, Dr. Gentile said. "They're inherently motivating -- just look at how hard it is to get kids to stop playing - plus we now know how to design games to have maximum benefit."

"It's clear to me that the closer we get to reality, the greater learning and transfer to real world situations should take place," he added. "That's why I think lap surgery is the perfect starting place, because so much is done by looking at a screen rather than needing a body in front of you."

He foresees the time when medical students will be required to purchase and "play" a video game simulator several hours a week during their surgical rotations.

"Surgical training is based on the model, 'see one, do one, teach one', " he added. "But that only teaches you three times."

By contrast, he said, an effective program could be developed by "opening 200 cadavers and scanning them into a computer, programming in the 50 most common surgical errors and the 50 most common complications. Then students would 'play' until they've gone through all of them."

Running Slows the Effects of Aging

8/21/2008 2:54:00 AM

Study Shows Older Runners Have Fewer Disabilities Than Non-Runners

Aug. 11, 2008 -- Regular running slows the effects of aging, according to a new study from the Stanford University School of Medicine that tracked 500 older runners for more than 20 years.

Older runners have fewer disabilities, remain more active as they get into their 70s and 80s, and are half as likely as non-runners to die early deaths, the study shows.

"If you had to pick one thing to make people healthier as they age, it would be aerobic exercise," James Fries, MD, an emeritus professor of medicine at the medical school and the study's senior author, says in a news release.

Researchers tracked 538 runners over age 50, comparing them to a similar group of 423 non-runners. The runners were part of a nationwide running club.

The participants, now in their 70s and 80s, answered yearly questionnaires about their ability to perform everyday activities such as walking, dressing, grooming, getting out of a chair, and gripping objects. The researchers used national death records to learn which participants died and why. Nineteen years into the study, 34% of the non-runners had died, compared with only 15% of the runners.

At the beginning of the study, the runners ran an average of about four hours a week. After 21 years, their running time declined to an average of 76 minutes per week.

Everyone in the study became more disabled after 21 years, but for runners the onset of disability started later. Perhaps not surprisingly, running was linked to lower rates of cardiovascular deaths from causes such as stroke and heart attack. However, it also was associated with fewer early deaths from cancer, neurological disease, infections, and other causes, according to the findings.

Are Cell Phones Safe? Questions & Answers

8/13/2008 2:31:00 AM

University of Pittsburgh Cancer Expert Urges Limited Use; Get Answers to Questions About Cell Phone Safety

July 24, 2008 -- Confused about cell phone safety? Many people were after seeing headlines about a controversial memo issued by a prominent cancer expert to his staff recommending limiting cell phone use, especially in kids, because of possible cancer risk.

The memo was reportedly sent yesterday by Ronald B. Herberman, MD, director of the University of Pittsburgh Cancer Institute, to his staff. Media reports about the memo sparked concern among cell phone users and criticism from the wireless industry.

Here are answers to questions about Herberman's memo, the science on cell phone safety, and whether you should set limits for your kids -- and yourself -- to minimize risk.

What was in the cell phone memo?

A University of Pittsburgh Medical Center spokeswoman tells WebMD that Herberman was not available to comment on the memo and that the memo wasn't available for her to forward.

According to the Associated Press, Herberman's memo recommends that children use cell phones only in emergencies because their brains are still developing, and that adults should keep cell phones away from their head, using the speakerphone or a wireless headset. Similar advice is also posted in an article on the web site of the University of Pittsburgh Cancer Institute's Center for Environmental Oncology.

What was the memo based on?

Herberman's memo reportedly acknowledges that his concern is based on early, unpublished data -- not published studies -- and on caution that science moves slowly and that it's better to be "safe rather than sorry later," the Associated Press quotes Herberman as saying.

What does the FDA say?

The FDA hasn't posted a specific reply to Herberman's memo, but the FDA's web site has lots of information on cell phones and health.

"The available evidence does not show that any health problems are associated with using wireless phones. There is no proof, however, that wireless phones are absolutely safe," states background information on the FDA's web site.

The FDA explains that wireless phones emit low levels of radiofrequency (RF) while being used and very low levels of RF in standby mode.

"Whereas high levels of RF can produce health effects (by heating tissues), exposure to low-level RF that does not produce heating effects causes no known adverse health effects," the FDA states. "Many studies of low-level RF exposures have not found any biological effects. Some studies have suggested that some biological effects may occur, but such findings have not been confirmed by additional research. In some cases, other researchers have had difficulty in reproducing these studies, or in determining the reasons for inconsistent results."

What does the American Cancer Society say?

Michael Thun, MD, is the American Cancer Society's vice president for epidemiology and surveillance research.

"The first thing we say is that if someone is concerned about the risk of cell phones, you can virtually eliminate your exposure by using a headset or a speaker phone or having the phone farther from your ear," Thun tells WebMD.

"With respect to the science ... we, and the epidemiologists who I respect who are involved in this, find the evidence to be much, much weaker than it's being presented by some proponents," says Thun, noting that cell phone emissions are "not ionizing radiation that damages DNA" and that of the 17 studies on cell phone use and brain cancer, only two have suggested an association, and those studies' methodologies are "weaker than some of the larger, better studies."

Thun points out that in Sweden, one of the countries where cell phones caught on early, up to 25 years of data show no signs of increased brain cancer rates. He also says that the American Cancer Society is "seriously considering" convening an independent group of scientists to look at the epidemiologic data.

But Thun notes that cell phones are widely used and that "the evidence is quite extensive, but incomplete in important ways." For instance, he says more studies are needed on the long-term effects of children's cell phone use.

"On the one hand, it's important to be prudent and have an appropriate level of caution, and on the other hand, it's important not to sound false alarms, because they, too, have unintended consequences. If you sound too many of them, nobody believes anything you say, and if there is not a problem, they distract attention away from real problems, of which we have a lot."

What does the American Academy of Pediatrics say?

Paul Fisher, MD, MHS, leads the American Academy of Pediatrics' committee on neurology. He's also an associate professor of neurology at Stanford University and the Beirne family medical director of the Center for Children's Brain Tumors at the Lucile Packard Children's Hospital at Stanford.

The American Academy of Pediatrics doesn't have an official stance on kids' cell phone use, Fisher tells WebMD.

"There is no established cancer risk in children from cell phones, nor in adults," Fisher says. He notes that researchers from the largest study, which is ongoing in Scandinavia and other parts of Europe, and includes children as well as adults, "all agree there is really no compelling evidence there whatsoever that cell phones are associated with brain tumors or other tumors in children."

"We're not seeing any increased risk, not seeing any association; we're not seeing any new tumors; we're not seeing any changes in tumor patterns" in the research, Fisher says.

As for concerns about salivary gland tumors or behavioral problems in kids whose moms used cell phones during pregnancy, Fisher says, "these are all small studies here and there and there's really nothing to indicate a health risk."

"As scientists, we certainly keep our minds and eyes open," Fisher says. "But there's just nothing out there, and parents should be reassured that there is no established risk, and they should feel good about the choices they make for their children."

Should parents limit kids' cell phone use?

Fisher, who spoke to WebMD via cell phone, says he sees good reason to limit kids' cell phone use -- just not out of cancer fears.

"I restrict my own kids' use of cell phones. We don't sit in bed and talk on our cell phones at night, and we don't get to use them when we're 5 years old. But that's more about good parenting and parental choice than about science," Fisher says.

"Common sense should prevail," he says, noting that kids can get distracted by cell phones. "I don't think kids should be given unrestrained access 24-7 to cell phones. It should be limited. But it shouldn't be done because of paranoia or fear of perceived risks that aren't established."

Setting limits "out of your own philosophy and life choices, that's very different than doing it out paranoia. That's why I'm disappointed by the statement from the folks in Pittsburgh ... it's not an appeal to healthy living and happy development for children, it's an appeal to people's paranoia about modern living."

What does the wireless industry say?

Here's what Joe Farren, assistant vice president for CTIA -- the Wireless Association (the industry group for wireless communication, including cell phones), says.

"We have always believed this issue must be guided by science. And when you examine the overwhelming majority of studies that have been peer-reviewed and published in scientific journals, you'll find no link between wireless usage and adverse health effects," Farren tells WebMD.

"This isn't just our opinion. This is the view of leading global health organizations such as the American Cancer Society, the World Health Organization, and the U.S. Food and Drug Administration."

Farren notes that Herberman's views "are not based on scientific evidence."

What does the research say?

No studies have proven that cell phones cause brain cancer or other health problems. But none has ruled out health risks once and for all, either.

Here's a quick recap of recent studies on cell phone use and cancer. These studies don't directly test cell phones to see if they cause cancer; rather, they're observational studies in large groups of people. Observational studies don't prove cause and effect.

In February 2008, Israeli researchers reported no overall increase in the risk of tumors in the parotid gland (a salivary gland) with regular cell phone use, with a possible (but not confirmed) increase in risk in people who use cell phones a lot more than normal. That contradicts a Swedish study published in 2006 that showed no increased risk of parotid gland tumors for any amount of cell phone use.

In 2007, French and Norwegian studies published in European journals showed no increased risk of brain tumors in adults from regular cell phone use.

A 2006 Danish study published in the Journal of the National Cancer Institute showed no link between brain tumors and cell phone use among people who had had cell phones for up to 21 years.

Not all cell phone research has been related to cancer.

In May 2008, a study published online in Epidemiology showed a statistical association between cell phone use during pregnancy and increased risk of children's behavior problems. That study did not prove that cell phones were to blame.

And in September 2007, researchers in India reported that longtime cell phone users who talk more than an hour a day may be more likely to have high-frequency hearing loss.

There is one safety risk that is established -- you shouldn't talk on your cell phone while driving, says the National Highway Traffic Safety Administration.

What additional research is needed?

A report issued by the National Research Council in January 2008 called for further research on topics including studies of children and pregnant women. The council drafted that report after the FDA asked for a wish list of research topics related to wireless communication safety.

Does the FDA test cell phone safety?

No. The FDA doesn't review the safety of radiation-emitting consumer products, such as wireless phones, before they can be sold. But the FDA has the authority to take action if wireless phones are shown to emit radiofrequency at levels that are dangerous to users.

Kids and Violent Movies: A Scary Trend

8/13/2008 2:14:00 AM

More Young Children Are Watching Violent Movies; Researchers Fear the Negative Effects of Violent Media on Kids

By Caroline Wilbert
WebMD Health News

Reviewed by Louise Chang, MD

Aug. 5, 2008 -- More than 12% of children aged 10 to 14 are watching R-rated violent movies, prompting researchers to call for an overhaul of the movie rating system and for more involvement from pediatricians.

A study by Dartmouth researchers, published in the journal Pediatrics, focuses on 40 movies rated R for violence and shows that these movies have been seen by about 12.5% of American children between the ages of 10 and 14. The study was conducted in 2003 among 6,522 adolescents aged 10-14 and included top box-office movies from 1998 to 2003 that were rated R for violence. Some movies scored higher. The R-rated Scary Movie, starring Carmen Electra, had been seen by 48% of children aged 10 to 14.

"We know so much about the harmful effects of exposure to violent media content, but how much exposure children actually get has largely been ignored," says Keilah Worth, PhD, the lead author on the study and a post-doctoral fellow at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center's Norris Cotton Cancer Center.

Researchers point to an existing body of research that documents the negative effects of violent media on children. "A clear picture has emerged that exposure to violent media increases the likelihood of aggressive thoughts, emotions, and behavior," the authors write.

The movie rating system, designed 40 years ago when the only way to see a movie was in a theater, no longer is adequate, according to researchers. These days, with DVDs, pay-per-view, and movies that are downloadable off the Internet, children have more access than ever to adult media. Many parents likely are not aware of what their kids are watching.

Researchers call for pediatricians to play a more active role by educating parents about how many children are actually watching violent movies and the harmful effects of that exposure. Doctors could also assist parents with technology, such as the V-chip, to restrict access to media.

"Ratings need to be more prominent on all movies, whether they are seen in theaters or purchased in the store, and we need clearer messages to parents," James Sargent, MD, professor of pediatrics at Dartmouth Medical School, says in a news release.

Before you head out to the beach or indoors to tan, test your tanning savvy.

7/29/2008 4:03:00 AM

Beach season is here, and the great summertime tanning debate is heating up once again.

Is tanning really so bad for us? What's wrong with wanting to get a little color? And if we're too busy to sunbathe outdoors, what harm could a few sessions in a tanning salon do?

This year, there's a new wrinkle in the tanning debate. Even before spring break, the Indoor Tanning Association launched an aggressive campaign with full-page advertisements in major newspapers. Among other claims, the campaign contends that the link between tanning and melanoma, the most deadly form of skin cancer, is hype. In response, two melanoma research organizations have issued a strong warning about the harmful effects of tanning.

With these two giants battling it out, the consumer may be left confused. What's true and what's spin?

Here, test your savvy on tanning myths:

True or False? Indoor Tanning Doesn't Cause Melanoma

False.

The indoor tanning industry contends otherwise, saying in some ads that the link is "hype" and not proven.

"There are a lot of studies out there and a lot of conflicting evidence about what causes melanoma," says John Overstreet, the executive director of the Indoor Tanning Association in Washington, D.C., an industry trade group. "There are many factors involved with melanoma skin cancer," he says, adding that heredity is a major factor. For those with a family history of melanoma, he says, " We would certainly advise you not to tan indoors."

"You constantly hear indoor tanning causes melanoma," he says. "'Causes' means, if you do it, you have [melanoma]. Many millions of people do this [indoor tanning] and don't get skin cancer."

But researchers say that the link between ultraviolet exposure from the sun or tanning beds and melanoma is indisputable, counters David E. Fisher, MD, PhD, chairman of dermatology and director of the melanoma program at Massachusetts General Hospital at Harvard Medical School, Boston.

"There is no question that ultraviolet exposure is associated with an increased risk of melanoma," says Fisher, who is also the president of the Society for Melanoma Research. That group, along with the Melanoma Research Foundation, issued the strong anti-tanning statement.

Fisher points to a study published in the International Journal of Cancer in March 2007 that reviewed 19 published studies on the association of tanning beds and skin cancers. They found use of the tanning beds before age 35 boosted the risk of melanoma by 75%.

As for Overstreet's contention that most melanoma is associated with a family history, not so, says Fisher. "The vast majority are what we call sporadic melanomas."

"Most of the remaining risk factors [besides hereditary] are related to UV exposure," he says, such as being fair-skinned, not tanning easily, being a redhead who freckles easily, and having a history of blistering childhood sunburns.

True or False? Outdoor Tanning Causes Skin Cancer

True. The tanning industry's focus on melanoma only is misleading, says Fisher, noting that the link between non-melanoma skin cancer and UV exposure is solid.

Multiple studies have demonstrated a relationship between UV exposure and an increased risk of developing skin cancer, according to a report published in the May 2008 Journal of the American Academy of Dermatology, although the specifics of the association are different for melanoma and the non-melanoma skin cancers, squamous cell and basal cell.

True or False? You Need Sunlight to Get Enough Vitamin D

False. No one's disputing that exposure to sunlight produces vitamin D, "the sunshine vitamin," or that vitamin D isn't important. A spate of recent studies has found that adequate levels of vitamin D may lead to improved heart health and protect from breast cancer, among other long-known benefits such as bone health.

"I have no argument on the potential benefit of vitamin D," Fisher says.

Limited exposure to natural sun -- exposing skin to about 2 to 10 minutes a day without sunscreen -- is recommended by some experts as a way to produce enough vitamin D, but Fisher and others don't agree that's best. "There is no need to get your vitamin D from UV radiation," Fisher says. "You can get it from a pill." Many foods are also fortified with vitamin D such as milk.

Brandith Irwin, MD, a Seattle dermatologist and spokeswoman for the American Academy of Dermatology, agrees. "It's easy to supplement without tanning," Irwin says. Even with sunscreen on, she says, you may produce some vitamin D. "No sunscreen blocks all UV rays."

But depending on where you live, limited sun exposure won't always produce enough vitamin D, she says. "In many parts of the country, you could lay out without sunscreen for an hour and not get enough vitamin D production," Irwin says.

Irwin says vitamin D replacement can be easily obtained via an inexpensive supplement -- without risk to your skin.

Dietary sources include milk, cereal, yogurt, and orange juice fortified with vitamin D as well as salmon, mackerel, and tuna.

The Food and Nutrition Board of the Institute of Medicine recommends as an adequate vitamin D intake 200 IU for adults 19 to 50, 400 IU for adults 51 to 70, and 600 IU for those 71 and older.

But in 2007, a team of researchers published an editorial in the American Journal of Clinical Nutrition suggesting that daily intakes of about 1,700 IU would be better to ensure an adequate blood level of vitamin D.

True or False? Tanning Causes Premature Aging of the Skin

True. Whether the exposure is indoors or outdoors, ultraviolet exposure over time causes what doctors call "photo aging," or wrinkles and a leathery look.

German researchers evaluated 59 people who voluntarily started to use sun beds over a three-month period. Use of the sun bed induced a DNA mutation in the skin known to be linked with photo aging, they report in the Journal of Investigative Dermatology.

In another study, published in Aging Cell, ultraviolet radiation exposure from the sun was found to speed the accumulation of DNA mutations in human skin associated with premature aging.

To help prevent cancer and premature aging, experts recommend that you:

Wear a broad spectrum sunscreen year-round of at least SPF 15 that protects against both UVA and UVB rays.
Avoid sun exposure between the peak hours of 10 a.m. and 3 p.m.
Wear protective clothing, such as a broad-brimmed hat and long sleeves.
Apply sunscreen 30 minutes before going out in the sun and every two hours after while you are exposed.

10 Challenges, 10 Solutions

7/29/2008 1:02:00 AM

Experts' best advice for working pregnant women and new moms.

1) Negotiating maternity leave

"I have three cardinal rules: Take the most time your employer will grant, ask for more than you're offered, and take time off before the baby arrives, if you can. Once you have your baby, you can return to work early, in the unlikely event that you want to. But it's hard to extend your maternity leave once it’s written in stone." — Betty Holcomb, author of The Best Friend’s Guide to Maternity Leave (Perseus, 2001)

2) Dealing with your supervisor

"Most bosses act like babies. They expect you to take care of them and of what they define as a 'problem' — your maternity leave. You have to be the parent who says, 'Calm down; the work is going to get done, and here’s how.' Present your boss with a detailed plan: Split up your work among co-workers, hire a temp or whatever."

3) Avoiding workplace hazards

"Anesthetics, radiation, carbon monoxide, solvents, toxic metals, biological hazards and extreme heat and humidity should be avoided at all costs." — Ann Douglas, author of The Mother of All Pregnancy Books (John Wiley & Sons, 2002)

4) Deciding when to quit working

"Take some time off before the baby arrives. You need time to collect yourself, to prepare for your transition and to rest."

5) Deciding whether to move

"So many expecting couples move out to the suburbs. Then, after their baby is born, they feel isolated and lonely. Don't move away from a community where you have lots of support. Don't buy that dream house yet—keep your expenses low and stay where your support structure is for now." — Linda Mason, co-founder of Bright Horizons child care and author of The Working Mother’s Guide to Life (Three Rivers Press, 2002)

6) Coping with exhaustion

"Take advantage of any opportunity to squeeze in a nap, and pare your to-do list down to the bare essentials. Either ask your partner to pitch in with the housework and cooking or splurge and treat yourself to a cleaning service or takeout."

7) Dealing with resentful co-workers

"There are many things in people's lives that interfere with work besides having a baby. Be sensitive to what's going on in your co-workers' lives so there’s a give-and-take and not just a take on your part. If someone covers for you while your baby is sick, offer to help him out when he's training for a marathon, taking care of a sick parent, preparing for a night-school exam or moving to a new apartment."

8) Keeping dad involved

"Encourage your partner's involvement early and in his own way. I strongly advise dads to take a few weeks off work after the birth. And remember that your way isn't the only right way—dads do things differently than moms, and this dual-parent approach actually benefits the child's development."