Daily Health and Medicine News

Cancer Prevention News: Cancer prevention

Cancer prevention

At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer.
Tobacco

Tobacco use is the single greatest avoidable risk factor for cancer mortality worldwide, causing an estimated 22% of cancer deaths per year. In 2004, 1.6 million of the 7.4 million cancer deaths were due to tobacco use.

Tobacco smoking causes many types of cancer, including cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix. About 70% of the lung cancer burden can be attributed to smoking alone. Second-hand smoke (SHS), also known as environmental tobacco smoke, has been proven to cause lung cancer in nonsmoking adults. Smokeless tobacco (also called oral tobacco, chewing tobacco or snuff) causes oral, esophageal and pancreatic cancer.

Physical inactivity, dietary factors, obesity and being overweight

Dietary modification is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease.

Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk. National policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.

Alcohol use

Alcohol use is a risk factor for many cancer types including cancer of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and breast. Risk of cancer increases with the amount of alcohol consumed. The risk from heavy drinking for several cancer types (e.g. oral cavity, pharynx, larynx and oesophagus) substantially increases if the person is also a heavy smoker. Attributable fractions vary between men and women for certain types of alcohol-related cancer, mainly because of differences in average levels of consumption. For example, 22% of mouth and oropharynx cancers in men are attributable to alcohol whereas in women the attributable burden drops to 9%. A similar sex difference exists for oesophageal and liver cancers (Rehm et al., 2004).

Infections

Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries. Viral hepatitis B and C cause cancer of the liver; human papilloma virus infection causes cervical cancer; the bacterium Helicobacter pylori increases the risk of stomach cancer. In some countries the parasitic infection schistosomiasis increases the risk of bladder cancer and in other countries the liver fluke increases the risk of cholangiocarcinoma of the bile ducts. Preventive measures include vaccination and prevention of infection and infestation.

Environmental pollution

Environmental pollution of air, water and soil with carcinogenic chemicals accounts for 1–4% of all cancers (IARC/WHO, 2003). Exposure to carcinogenic chemicals in the environment can occur through drinking water or pollution of indoor and ambient air. In Bangladesh, 5–10% of all cancer deaths in an arsenic-contaminated region were attributable to arsenic exposure (Smith, Lingas & Rahman, 2000). Exposure to carcinogens also occurs via the contamination of food by chemicals, such as afl atoxins or dioxins. Indoor air pollution from coal fires doubles the risk of lung cancer, particularly among non-smoking women (Smith, Mehta & Feuz, 2004). Worldwide, indoor air pollution from domestic coal fires is responsible for approximately 1.5% of all lung cancer deaths. Coal use in households is particularly widespread in Asia.
Occupational carcinogens

More than 40 agents, mixtures and exposure circumstances in the working environment are carcinogenic to humans and are classified as occupational carcinogens (Siemiatycki et al., 2004). That occupational carcinogens are causally related to cancer of the lung, bladder, larynx and skin, leukaemia and nasopharyngeal cancer is well documented. Mesothelioma (cancer of the outer lining of the lung or chest cavity) is to a large extent caused by work-related exposure to asbestos.

Occupational cancers are concentrated among specific groups of the working population, for whom the risk of developing a particular form of cancer may be much higher than for the general population. About 20–30% of the male and 5–20% of the female working-age population (people aged 15–64 years) may have been exposed to lung carcinogens during their working lives, accounting for about 10% of lung cancers worldwide. About 2% of leukaemia cases worldwide are attributable to occupational exposures.
Radiation

Ionizing radiation is carcinogenic to humans. Knowledge on radiation risk has been mainly acquired from epidemiological studies of the Japanese A-bomb survivors as well as from studies of medical and occupational radiation exposure cohorts. Ionizing radiation can induce leukaemia and a number of solid tumours, with higher risks at young age at exposure. Residential exposure to radon gas from soil and building materials is estimated to cause between 3% and 14% of all lung cancers, making it the second cause of lung cancer after tobacco smoke. Radon levels in homes can be reduced by improving the ventilation and sealing floors and walls. Ionizing radiation is an essential diagnostic and therapeutic tool. To guarantee that benefits exceed potential radiation risks radiological medical procedures should be appropriately prescribed and properly performed, to reduce unnecessary radiation doses, particularly in children.

Ultraviolet (UV) radiation, and in particular solar radiation, is carcinogenic to humans, causing all major types of skin cancer, such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Globally in 2000, over 200 000 cases of melanoma were diagnosed and there were 65 000 melanoma-associated deaths. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures. UV-emitting tanning devices are now also classified as carcinogenic to humans based on their association with skin and ocular melanoma cancers.

Breast Cancer Prevention: New Advice

Despite all of the attention we pay to trying to cure it, very little solid evidence exists on how to prevent breast cancer. Don’t smoke, don’t get fat, and exercise plenty—that’s about all the advice the experts have for us, and it’s frustratingly vague, because those are the same rules we’re supposed to follow for preventing every other health issue out there.

So it’s nice to hear from the American Institute for Cancer Research about new evidence that eating plenty of fiber can reduce breast cancer risk by a significant amount. Researchers that the AICR helped fund an analysis of 16 studies of almost one million women and found a 5% reduction in risk for each 10 grams of fiber per day the women consumed. Although we all know that fiber is good for you, and helps prevent colorectal cancer, previous research into breast cancer preventnion had been inconclusive.

Two really interesting things about this research: One, fiber intake reduced breast cancer risk regardless of women’s weight, so it’s not just that thin women were eating more fiber and getting less breast cancer because of their lower weights—fiber has some cancer-preventing power independent of its ability to help keep you slim. Second, soluble fiber prevented breast cancer, but insoluble fiber did not seem to. Soluble fiber is the kind that’s good for your heart (and is found in oatmeal and most fruits and vegetables), while insoluble is the one that keeps your digestion moving (and is sometimes known as “roughage”).

Although they don’t know exactly why insoluble fiber helps women ward off breast cancer, the lead researcher suspects that it’s related to fiber helping us remove excess estrogen from our bodies. As I’ve written before, too much estrogen (sometimes called “estrogen dominance”) seems to be bad for us.

But while it’s always nice to hear that there might be something we can do to prevent this disease, it’s also important to remember that we’re far from having big answers. I just learned that style guru Charla Krupp, author of the books How Not to Look Old and How Not to Look Fat died of breast cancer the other day at 58. Charla was lean and active (and, say those who knew her, smart and funny and a great friend) and I’m willing to bet she ate plenty of fiber.

Arthritis Treatment News: Why It’s Hard to Stick With Rheumatoid Arthritis Treatment

Why It’s Hard to Stick With Rheumatoid Arthritis Treatment

If dealing with rheumatoid arthritis is a full-time job, the treatment for RA is a task that requires painstaking attention to detail and a whole-hearted commitment to a long-term goal.

While the payoff can be huge — —preventing or at least slowing down potentially disabling joint destruction — —it’s still hard for patients to stick with the treatment, whether it’s pills, self-administered injections, or three-hour-long infusions given in a doctor’s office.

Consider also that RA medications can be pricey and have side effects and that there’s the psychological impact of having to undergo lifelong treatment, and you have a recipe for noncompliance — —the medical term for people who don’t take their medicine as directed.

“Compliance is a huge issue,” confirms Christopher Ritchlin, MD, MPH, a rheumatologist and professor of medicine at the University of Rochester Medical Center in New York. According to a 2007 study, some people with RA missed their meds between 10 percent and 36 percent of the time, depending on the drug taken. Other studies have reported noncompliance rates as high as 70 percent.

“I can deal with bouts of pain, but the fact that it’s chronic and never going away, that’s the hardest thing to deal with,” says Angela Lundberg, 32, who was diagnosed at 18.

It’s especially tempting to skip medication when the beneficial effects aren’t obvious unless you’re looking at an X-ray showing the condition’s progression (or even if they are obvious). Still, research suggests that without treatment joints will deteriorate more rapidly and the journey to disability will be quicker. Hence, it’s important to find ways to stay motivated.

How treatment helps

Even though there are many different kinds of RA medication, the mainstay of treatment is the disease-modifying antirheumatic drug, or DMARD. (Other important classes of drugs for RA are inflammation-fighting corticosteroids, like prednisone, and nonsteroidal anti-inflammatory meds, or NSAIDs.)

DMARDs are the only RA drugs—whether they are newer biologics, such as Enbrel, Humira, Orencia, Remicade, and Rituxan, or older drugs, such as methotrexate and Plaquenil — —that have been shown to slow down joint destruction. After years of research, experts think a “hit it early, hit it hard” approach is best, meaning it’s better to take strong medication that delays joint destruction as soon as a diagnosis of RA is confirmed, rather than wait until the disease progresses.

Many of the DMARDs work by suppressing the hyperactive immune system to keep it from attacking the joints. These drugs are typically very helpful so the benefits outweigh the risk of side effects—and side effects are one of the main reasons people may skip meds.

“Each one of the drugs used to treat rheumatoid arthritis has its own unique set of side effects, some of them mild. But most of the drugs that are the most effective have potentially serious side effects,” says Bruce Baethge, MD, a professor of internal medicine at Texas A&M Health Science Center College of Medicine in College Station and a rheumatologist with Scott & White in Temple. “Fortunately, they only occur in a small percentage of people, but that doesn’t mean it can’t happen.”

The more serious adverse effects can include a heightened risk for infection, including upper-respiratory infections and even tuberculosis. Methotrexate, a drug that is the “anchor therapy” for the condition, can cause nausea and mouth sores, says Eric Matteson, MD, a rheumatologist with the Mayo Clinic in Rochester, Minn.

The fear of side effects can be as big a problem as the side effects themselves.

Dr. Ritchlin tells the story of one patient who had severe psoriatic arthritis, a cousin of rheumatoid arthritis. “His arthritis was flaring like crazy. He could barely walk,” he recalls. But when asked how often he was taking Enbrel, the man told Dr. Ritchlin that it was only once every four months, rather than twice a week as recommended, because he was afraid of getting lymphoma.

RA in general can increase lymphoma risk, and although the Food and Drug Administration has investigated a link between some biologics and lymphoma, there isn’t evidence to support the link.

Some people can be hesitant to take methotrexate, Dr. Ritchlin adds, due to the fact that it is also given to cancer patients in chemotherapy regimens—even though the dosage for RA is only a fraction of that used in cancer treatment.

Dr. Matteson says education is key. “The more the patients understand about the drugs, the more likely they are to be compliant, even if they see they are problematic. We point out that they also have a very difficult and often devastating disease, so we try to put that in perspective.”

Another way to keep things in perspective is to stay on top of monitoring the disease. Dr. Matteson says that his patients receive regular tests, such as X-rays, to assess their joint health. If patients see that joint destruction has halted since they started a DMARD, for example, they may feel more compelled to stick to their drug regime.

However, if the medicines do turn out to be too difficult to take, Dr. Matteson recommends that patients bring up these issues with their doctor and ask about alternatives. “If the problems are prohibitive, we have effective alternatives available. We try to individualize the therapies,” he says.

For example, if methotrexate makes a patient nauseated, Dr. Matteson would seek another option or another way of taking methotrexate, or recommend an antinausea medication to counter this side effect.

Cost and other issues

DMARDs and other RA medications aren’t necessarily easy to take, cheap, or fast acting. Some have to be taken two or three times a day (Plaquenil is one example); others are taken once a day; and some other drugs, like Enbrel, require a self-injection once a week.

Lundberg, who lives in the Minneapolis area, had been visiting a clinic every two months for a Remicade infusion. But when she moved to Ireland for a short time, she had to switch to Enbrel, which is self-injected, because it was difficult to get to the doctor’s office for regular appointments. “It’s not hard to learn the injection, but I never got comfortable doing it,” she says. “I always got really nervous and hated it.”

Dr. Matteson advises patients to speak with their doctor about switching to a different delivery method. “I seek to offer these where available,” he says. “This is a common point of discussion.”

Cost is also a factor. The cheapest DMARD is probably methotrexate, which can run from $500 to $1,000 a year, depending on factors like dosing, how it is delivered, and insurance coverage, says Dr. Matteson. Biologics “are easily up to $20,000 or $30,000 a year and insurance is extremely variable,” he adds.

If cost is a factor, contact the drug manufacturer. Almost all will provide reduced-cost medication if you meet their income requirement. The Chronic Disease Fund, Patient Advocate Foundation Co-Pay Relief, and The HealthWell Foundation are nonprofit organizations that help people with RA cover their co-payments and other medical expenses.

When you start a new medication, it can also help to have realistic expectations. It can take months for some of the DMARDs, such as Remicade, Enbrel and Humira, to work, says Dr. Baethge.

Overall, one of the best ways to stick with treatment or cope with side effects is to talk to other people with RA. Social support is invaluable for any chronic condition, and about 1.3 million people in the U.S. have RA. “RA affects 1 percent of the population so it’s not hard to find someone,” Dr. Baethge says.

Lundberg has volunteered with the Arthritis Foundation, where she has met other young people with RA, and even started a blog.

“It makes me feel like I’m not totally alone,” she says.

Cornerstone Physical Therapy on arthritis treatment

Arthritis is a word that many of us have heard of, and might even experience, but what does it really mean? According to the Arthritis Foundation, 46 million adults in the U.S. have some form of arthritis. Common symptoms of osteoarthirits include joint pain, swelling, stiffness and tenderness, resulting in pain with functional activities such as standing, walking, or even holding a coffee mug. Osteoarthritis, the most common form of arthritis, typically affects the weight-bearing joints, such as the knees, hips, and ankles, due to the compressive forces placed on these joints. These compressive forces break down cartilage, which is at the ends of joints, causing the ends of bone to rub together. More specifically, arthritis is an acute or chronic inflammation of the joints of the body, which is a wearing away of the smooth cartilaginous surfaces on the ends of bone. As a result of the wearing away of the cartilage, one might experience popping or grinding of a joint, known as crepetous, which can be painful, resulting in decreased function.

When pain develops, the inflammatory response takes over, shutting down certain muscles in order to protect the body, resulting in a further decrease in function and greater levels of pain. Osteoarthritis can be diagnosed by your physician through physical examination and diagnostic imaging, such as x-rays. In osteoarthritis, improving joint mobility, flexibility, range of motions and strength will decrease pain and loss of function.

Proper education is extremely important when treating this patient population to prevent further wearing away of these joint surfaces. Arthritis is a term heard very often, and sometimes overused in the medical field, and frequently overlooked. With the advancements in medicine and with physical therapy intervention, there is no reason one should not live in pain, nor discomfort because of arthritis.

Come and see your local physical therapist, at Cornerstone Physical Therapy Health and Wellness Center, conveniently located on 77 Brant Ave. in Clark. If you have any questions in regards to choosing the proper course of treatment and specific exercises you might benefit from, or any other orthopedic condition, give us a call at 732-499-4540. We specialize in many facets of physical therapy, focusing on complete patient satisfaction and patient results. We also guarantee that each individual will be seen within 48 hours, and we are now accepting all insurances. Let us help you enjoy your life, without worrying about uneasy pain.

Flu Treatment News: Which treatments should I take for flu symptoms?

Which treatments should I take for flu symptoms?

The flu treatment you should take depends on your symptoms. For example, if you have nasal or sinus congestion, then a decongestant can be helpful.

Decongestants come oral or nasal spray forms. Decongestants are used to reduce swelling in the nasal passageways. However, nasal spray decongestants should not be used for more than a few days because, if they are used too long and then stopped, they can cause rebound symptoms.

If you have a runny nose, postnasal drip, or itchy, watery eyes — then an antihistamine may be helpful for your flu symptoms. Antihistamines block the effect of “histamine,” and help relieve such annoying symptoms as sneezing, itching, and nasal discharge.

Over-the-counter antihistamines often make people drowsy, whereas decongestants can make people hyper or keep them awake. Keep in mind that both decongestants and antihistamines can interact with other drugs you may be taking, and they may aggravate some conditions. Talk to your doctor or pharmacist about which flu symptom treatment is best for you.
Which treatment should I use for nasal congestion?

If you need immediate relief for swollen, congested nasal passages, you may get relief with an over-the-counter decongestant nasal spray. It is important to stop using decongestant nasal sprays after three to five days to avoid the development of rebound congestion.

Some doctors suggest using a saline spray instead of a medicated spray. Saline sprays loosen thick mucus in the nasal passageways but have no rebound effect. It may be used for extended periods of time without significant side effects.
Is it safe to take a decongestant if I have high blood pressure?

Decongestants can increase blood pressure and heart rate. Pseudoephedrine and phenylephrine are oral decongestants commonly available in over-the-counter products. In general, if your blood pressure is well controlled with medications, then a decongestant shouldn’t be a problem as long as you monitor your blood pressure. This may not be true, however, with certain types of blood pressure medications. Check with your doctor or pharmacist about safety.
Which flu treatment works best for my cough?

An occasional cough may clear the lung of pollutants and excess phlegm. A persistent cough should be diagnosed and treated specifically. On the pharmacy shelf, you’ll find numerous cough medicines with various combinations of decongestants, antihistamines, analgesics/antipyretics, cough suppressants, and expectorants. Ask your pharmacist which combination, if any, would be appropriate for your cough.

Popular anti-flu drug may be no better than aspirin

The most widely used drug in the world prescribed to fight the flu may prove ineffective for many this year, researchers say.
Tamiflu, the mainstay of flu treatment in the US, now may not work to prevent the flu if you’ve been exposed to someone who already has the flu (such as a sick coworker) or if there is a flu outbreak in your community or in reducing secondary complications such as pneumonia, according to a report published online January 18 in the British Medical Journal (BMJ).
“The Cochrane researchers set out to test Roche’s claim that Tamiflu prevented complications and reduced the number of people needing hospital treatment,”read a BMJ press release. “But their investigation was hampered by Roche’s refusal to provide all of its trial data for analysis.”
Every year, about 25 to 50 million Americans suffer from the flu, WebMD News reports. Symptoms come on rapidly which often result in absences from work and school.
If these symptoms are caught early, usually within first 24-48 hours, doctors can prescribe Tamiflu to treat the stuffy nose, cough, sore throat, fever/chills, aches, tiredness; making them less severe and shortens the recovery time so that people feel better faster.
But the flu can have serious complications ranging from ear and sinus infections to life-threatening pneumonia that may require hospitalization.
ABC news reports that the flu virus usually causes about 36,000 deaths in the United States each year. Pneumonia resulting from flu is usually the fatal complication.
Rome-based physician and epidemiologist Tom Jefferson, MD, along with colleagues at the Cochrane Collaboration pored over nearly 30,000 pages of clinical studies to examine the company’s claims only to be stonewalled.
Tara Iannuccillo, a Roche spokesperson denies Cochrane’s allegations, saying that Roche stands behind the “robustness and integrity of our data supporting the efficacy and safety of Tamiflu.
“Roche provided the Cochrane group with access to 3,200 pages of very detailed information, enabling their questions to be answered.”
But their questions weren’t answered. They were just beginning. Indeed, Roche did send them 3,195 pages of information covering 10 treatment trials of Tamiflu, but the table of contents suggested that there was more to the story.
“What we’re seeing is largely Chapter One and Chapter Two of reports that usually have four or five chapters,” Peter Doshi from Johns Hopkins University and the BMJ article’s lead author told Medpage Today.
Added Dr. Doshi: “We are no longer sure that oseltamivir (Tamiflu) offers a therapeutic and public health policy advantage over cheap, over the counter drugs such as aspirin.”
“The authors have been unable to obtain the full set of clinical study reports or obtain verification of data from the manufacturer of oseltamivir (Roche) despite five requests between June 2010 and February 2011,” Cochrane Collaboration researchers report.
Roche, based in Switzerland, added some $3.4 billion to the company’s bottom line in 2009 alone, according to Deborah Cohen, investigations editor of BMJ; much of it spurred by retail sales and the stockpiling of the drug by governments and corporations.
Since 2005, federal and state governments in the United States have spent more than $1.5 billion to stockpile Tamiflu and another antiflu drug, Relenza which has to be inhaled,the New York Time reports.
Fiona Godlee, MD, Editor-in-Chief of BMJ writes that the decisions to stockpile the drug and made it widely available have been based on the flawed evidence.
Scientists at the Cochrane Collaboration recommend that until more is known about the Tamiflu from clinical studies in preventing complications of the flu ” health professionals, patients and other decision makers need to reflect on the findings of this review before making any decision about the use of the drug.”

Review renews questions about oseltamivir benefits

A lengthy new analysis of unpublished clinical trial data is renewing questions about the effectiveness of the influenza drug oseltamivir (Tamiflu), saying that although the drug shortens flu symptoms by about a day, there is no evidence that it reduces hospital admissions.

The report by Tom Jefferson and colleagues, members of the Cochrane Collaboration, also says that, despite sifting thousands of pages of documents, the team couldn’t gather enough data to determine whether oseltamivir reduces flu complications and transmission. The 200-page report was published yesterday by The Cochrane Library.

The report also raises some questions about the safety of oseltamivir, saying some reports of adverse events possibly related to the drug were not included in published reports of clinical trials.

Roche, manufacturer of Tamiflu, said numerous clinical trials and medical experience have shown that oseltamivir is effective and usually well-tolerated. The company said it supplied 3,200 pages of data to Jefferson’s team, though the researchers say in the report that the company withheld some data they requested.

European and US health officials said they had not had time to study the report, but they noted that it ignores a significant body of observational data supporting the effectiveness of oseltamivir against both seasonal flu and the 2009 pandemic virus.

The analysis was sponsored by the UK National Institute for Health Research Health Technology Assessment program. The Cochrane Collaboration is an international network of researchers who study the quality of evidence for healthcare interventions. Jefferson is an independent epidemiologist based in Rome.

Targeting publication bias
The report is the latest of several reviews of the neuraminidase inhibitors (NIs, including oseltamivir and zanamivir [Relenza]) from Cochrane researchers. The authors say their aim was to eliminate publication bias—the fact that studies with positive findings about an intervention are more likely to be published than those with negative or inconclusive findings.

During the 2009 pandemic, the Australian and British governments asked for an update of the previous Cochrane review of NIs, according to the report. That update ended up being inconclusive, because the researchers could not verify the data behind manufacturer and government claims about oseltamivir. The authors point in particular to a meta-analysis of 10 clinical trials, eight of which have never been published.

“We identified that a large number of studies, including data from 60% of the people who have been involved in randomised, placebo-controlled phase III treatment trials of oseltamivir have never been published,” Jefferson said in a press release from Wiley-Blackwell, publisher of the Cochrane Library. “We are concerned that these data remain unavailable for scrutiny by the scientific community.”

Accordingly, the researchers decided to try “to get to the bottom of the issue of the effects of NIs by appraising evidence from unpublished clinical study reports . . . and regulatory documents containing comments and reviews,” the report says. The authors eventually collected 16,000 pages of data from the drug manufacturers and US, European, and Japanese regulatory agencies, according to the press release.

The team identified 67 clinical trials of oseltamivir and zanamivir, most of them in adults, but 42 of these were unusable because of insufficient information or unresolved discrepancies in the data. Of the 25 trials included in the analysis, 15 were of oseltamivir and 10 of zanamivir, and all were sponsored by the drug manufacturers.

The analysis focused mainly on oseltamivir because it is much more widely used and stockpiled and is on the World Health Organization list of essential drugs. In the end, the researchers decided to postpone its analysis of zanamivir, awaiting receipt of individual patient data promised by GlaxoSmithKline, its manufacturer.

After sifting all the oseltamivir data, the researchers concluded that the drug shortens the time to alleviation of symptoms by an average of about 21 hours, from the average of 160 hours of symptoms in placebo-group patients. But from seven studies that examined the question, they found no effect on the rate of hospitalizations.

The report adds, “Due to limitations in the design, conduct and reporting of the trial programme, the data available to us lacked sufficient detail to credibly assess a possible effect of oseltamivir on complications and viral transmission.”

The researchers say they found some inconsistencies between published trial reports and the unpublished trial records. The press release says some of these had to do with oseltamivir safety. The unpublished reports mentioned “serious adverse events,” some of them possibly related to the drug, but one of the two most cited publications does not mention those events, while the other says there were “no drug-related serious adverse events,” according to the release.

Another finding is that subjects randomly assigned to receive oseltamivir were less likely to be diagnosed as having flu than were control subjects (odds ratio based on eight studies, 0.83; 95% confidence interval, 0.73 to 0.94). The authors assert that oseltamivir probably interfered with the antibody response and that therefore the placebo and treatment arms of the flu-infected subgroup in trials—defined in part by a rise in antibody titers—are not comparable.

They further suggest that this raises doubts about the proposed effects of oseltamivir. One possibility, they say, is that by interfering with antibody production, oseltamivir “has the effect of selecting the strongest antibody responders,” who are probably the healthiest people and those least likely to experience flu complications.

Jefferson and colleagues conclude with a prediction that the full clinical study reports from the trials could clarify the outstanding questions about oseltamivir. “These full clinical study reports are at present unavailable to us,” they write.

ECDC expert weighs in
Dr Angus Nicoll, head of the influenza program at the European Centre for Disease Prevention and Control (ECDC) and honorary professor at the London School of Hygiene and Tropical Medicine, said it was difficult to comment definitively on a 200-page document that has only just gone public, but it did not seem to be saying much that the Jefferson group had not said before.

“What is important now is that independent scientists comment on the document and ask questions through the ‘Submit Comments’ field at the manuscript,” he said (see link below). “As I understand it, these comments will be responded to—and that is the Cochrane process for reviews like this so they now undergo open peer review.”

However, Nicoll felt that a fundamental design problem of the review is that it excludes all observational data, commenting, “Jefferson has a very pure approach not considering observational data.” He said the disadvantage of this approach is that it lacks power to detect uncommon but important effects—either good results like the prevention of severe flu complications or rare adverse effects of drugs.

“Our reading of the observational data, like that published in the BMJ by China CDC recently from the pandemic [see link below], is that early oseltamivir use is associated with less severe complications,” he said. “The observational data are weak, but they are mostly pointing towards a protective effect. That particularly came out in the pandemic, but is also the case with seasonal flu. Just relying on trial data can lead to the old trap of thinking that absence of evidence of effectiveness (protection against complications) equals evidence of no effect.”

Nicoll also said that there are two or three evidence-based reviews of observational data coming and they should be awaited so that the trial and observational data can both be considered.

He also took issue with the Cochrane team’s conclusion that there is no clinical trial evidence that NIs reduce severe outcomes in flu patients. He said they discounted analyses by Miguel Hernan and Marc Lipsitch of Harvard University.

In an earlier report, according to Nicoll, the Jefferson group examined a meta-analysis of clinical trials of oseltamivir by Kaiser and others. (The new report says the meta-analysis included 10 manufacturer-funded trials, eight of which have never been published.) When Jefferson and colleagues tried to reanalyze the data in the Kaiser paper they couldn’t reproduce the findings, Nicoll said.

But subsequently Hernan and Lipsitch asked for more primary data from the 10 trials and reanalyzed them along with additional data, producing results consistent with oseltamivir reducing flu complications. Their report was published in Clinical Infectious Diseases last year (see link below).

“Lipsitch and Hernan are a very well respected independent group, so when we saw their findings we realized there was evidence of reduced complications from trials in seasonal flu,” Nicoll said.

Finally, Nicoll commented that the bottom line of the Jefferson reviews is always that there should be more large, randomized trials, independent of industry and now, even independent of governments. Clearly those could not include people at higher risk from flu, such as older people, young children, and those with other conditions, he said, noting that the sample sizes needed for such trials would be impossibly large.

“There are some questions that you have to answer without relying on trials alone,” he concluded.

CDC official notes observational data
Tim Uyeki, MD, MPH, a flu expert at the US Centers for Disease Control and Prevention (CDC), said he had not read the report, but, like Nicoll, he commented that the Cochrane review did not consider the observational data supporting oseltamivir. Uyeki is deputy chief for science in the Epidemiology and Prevention Branch of the CDC’s Influenza Division.

“There is a substantial amount of data from observational studies of oseltamivir treatment of seasonal flu and pandemic flu to suggest clinical benefit when treatment is initiated early,” and even some benefit when treatment is begun more than 2 days (but less than 5 day) after illness onset,” Uyeki said. “There are some limited studies that have also suggested a reduction in risk of admission to ICU or death.”

He added that the observational studies all point in the direction of clinical benefits. “When the ACIP [Advisory Committee on Immunization Practices] and CDC and other groups are making clinical recommendations and recommendations for public health, it’s important to look at all of the evidence that’s available, including evidence from randomized placebo-controlled trials as well as observational data,” he added.

Roche’s response
In a statement released yesterday, Roche officials defended oseltamivir’s track record and the company’s openness in supplying data to Jefferson’s team.

“Numerous clinical trials and real-life medical experience show Tamiflu is effective in reducing the severity and duration of influenza symptoms as well as specified secondary complications,” the company said. “Analyses by health authorities and independent research groups show that, during the 2009 H1N1 pandemic, Tamiflu saved lives and reduced hospitalization. Similar benefits have also been reported for seasonal influenza.”

The company said the drug has been used to treat and prevent influenza in 90 million people, including nearly 20 million children, in 80 countries. In addition, “clinical studies show that Tamiflu is well tolerated in the overwhelming majority of cases. Like all medicines, Tamiflu can have side effects and these are listed in the Summary of Product Characteristics.”

Roche also said it provided the Cochrane group “3,200 pages of very detailed information, enabling their questions to be answered.”

“All completed Roche sponsored clinical studies on the safety and efficacy of Tamiflu are available as peer-reviewed publications or in summary form on www.roche-trials.com,” the statement said. “More detailed clinical trial reports are available for use by investigators on a password-protected site, enabling researchers to verify the findings of these studies and publications relating to them.”

Health News Online: Bellco Health staying put, expanding in Amityville

Joint Juice Announces the State of America’s Joint Health

Today Joint Juice, Inc., a leading San Francisco-based nutrition company, announces the latest results from its online joint health assessment[1], revealing the U.S. states with the best – and worst – joint health. As people across America recently made New Year’s resolutions to improve their fitness, Joint Juice encourages them to remember take care of their joints as they get in shape. According to findings, Hawaii came out on top as the state with the best joint health, tied with Washington D.C. and Arkansas. Maine was at the bottom of the list, earning the distinction of the state with the worst joint health.

“Joints are the foundation of an active and healthy lifestyle, yet are often overlooked,” said David Ritterbush, Chief Executive Officer of Joint Juice, Inc. “We are on a mission to educate Americans about the importance of joint care by continuing to provide educational tools such as our joint health assessment, and offering innovative products to help people continue to do their favorite activities.”

Since the launch of the joint health assessment in 2010 on the Joint Juice website nearly 10,000 people have taken the test to evaluate their personal joint health. The results incorporated data from participants in all 50 states. The illustrative joint health assessment created by Kevin R. Stone, M.D., renowned orthopaedic surgeon and Joint Juice, Inc. founder evaluates the condition of an individual’s joints based on a series of 15 questions regarding diet, exercise, lifestyle, Body Mass Index (BMI), and joint health history. Interspersed throughout the assessment are tips from legendary quarterback Joe Montana, who shares his story about how Joint Juice combined with a healthy lifestyle has helped him stay active. Results were collected from June 2010 through December 2011, and summarized in five categories: Excellent, Good, Average, Below Average, and Poor.

In 2012, Joint Juice, Inc. will continue their partnership with Joe Montana for the second consecutive year to encourage Americans to focus on their joint health so they can get back to doing the activities that they love to do. The nationwide campaign will offer tips, tricks, and exercises to help people get on a path to healthier joints.

To learn more about joint health or to take the Joint Juice® joint health assessment, please visit jointjuice.com.

Supermarkets accused of exploiting loopholes to undermine alcohol pricing laws

MSPs have accused supermarkets of “undermining the spirit” of alcohol discounting laws by slashing their prices and encouraging online purchasing.

Legislation came into force in October last year banning volume sales of alcohol, with the aim of stopping “irresponsible promotions” such as two for one deals and group discounts on wine.

However loopholes in the law mean retailers are still able to offer such discounts on internet sales made in England, and have been able to sell the same bottles of alcohol for whatever the combined discount price was to begin with.

Members of Holyrood’s Health Committee raised the issue with representatives from Asda and Tesco today during a session on the Scottish Government’s proposals for minimum alcohol pricing.

SNP MSP Jim Eadie asked: “Do you accept that there are many people who feel that you are not abiding by the spirit of the legislation that was introduced by the Parliament?

“The one thing that you did almost immediately when certain promotions were banned was to introduce bottles of wine for £3.33.”

Mr Eadie said the supermarkets had been accused of “undermining the spirit of the legislation” by “slashing prices and encouraging online purchasing”.

He continued: “It does leave the impression with the wider health community in Scotland who are widely focused on what is the biggest public health challenge facing this country, that your companies are putting their profits before the health of the people of Scotland.”

David Paterson, head of regional affairs at Asda, replied: “The clear intention of the quantity discount ban was to reduce any incentive for a customer to buy a larger amount of alcohol than they had intended to.

“That was the clear and unequivocal objective.

“We made it very clear particularly in the last Alcohol Bill that when you intervene in a market which is part of a wider UK single market, there are a number of unintended consequences and they cannot be wished away.

“So in the same sense that I have seen attacks on other retailers about the use of online, it seems a bizarre situation to me that there are companies based solely in England that can continue to sell alcohol at whatever price they want but that in some sense companies that are in Scotland and invest here shouldn’t also be able to do that. There has to be a level playing field.”

He added: “I think it’s worth saying that we didn’t slash our prices and we haven’t driven customers online. We don’t have an online alcohol offering.”

Labour MSP Dr Richard Simpson continued to press the supermarkets on the issue.

He said: “We may not have written the legislation correctly and I am not saying you are incorrect in terms of the law. I think we failed to understand fully when we passed that Bill that it would not end volume discounting.

“The spirit of the law was quite clear, that we wanted to ban discounting for volume, and yet the supermarkets particularly – and also the small stores – are still selling on a volume discounting basis.”

Dr Simpson asked the supermarkets how they would respond to minimum pricing.

Emma Reynolds, government affairs director for Tesco, said: “In a competitive market, if you do want action on price, it needs to be government-led and through legislation because we are in the business of competing for the best possible offers for customers.

“That is why we have said we’ll be constructive in government-led discussions on price.”

Mr Paterson said there were already rules about when and where retailers can sell alcohol, alongside the ban on quantity discounts.

He added: “When you get to a point where the price is set, we will have one of the most restrictive alcohol retailing regimes in the world, and it will be quite clear how you deal with that.”

Mr Paterson said Asda would abide by any laws passed by Holyrood.

The session also took evidence from a number of other representatives from the drinks industry including the Scotch Whisky Association, Diageo, Tennent Caledonian Breweries (UK) Limited, the National Association of Cider Makers, the Scottish Beer and Pub Association and the Scottish Licensed Trade Association.

Diabetes Treatment News: Integrated Diabetes-Depression Treatment Improves Outcome

Integrated Diabetes-Depression Treatment Improves Outcome

Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

MONDAY, Jan. 16 (HealthDay News) — Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

Hillary R. Bogner, M.D., of the University of Pennsylvania in Philadelphia, and colleagues conducted a randomized controlled trial — involving 180 primary care patients receiving pharmacotherapy for type 2 diabetes and depression — to determine whether an integrated treatment approach could improve glycemic control, adherence to medications, and depression symptoms. Patients received either integrated care, which involved additional education and guideline-based treatment recommendations and frequent monitoring of adherence and clinical status, or usual care. Depression was measured using the nine-item Patient Health Questionnaire (PHQ-9); medication adherence was assessed using the Medication Event Monitoring System; and glycated hemoglobin (HbA1c) was used to quantify the patient’s level of glycemic control.

The investigators found that, at 12 weeks, 60.9 percent of patients receiving integrated care achieved an HbA1c level of less than 7 percent, compared with 35.7 percent of those who received usual care. Patients in the integrated care group were also more likely to achieve remission of depression, with 58.7 percent scoring less than five on the PHQ-9 questionnaire compared with only 30.7 percent of patients receiving usual care.

“Our results show the usefulness of a simple, brief, integrated care management intervention for primary care patients with type 2 diabetes and depression,” the authors write.

NM hospital hires its first endocrinologist

The hospital recently hired a doctor with six years of experience treating American Indian patients to assist physicians who treat the most complex diabetic patients in the county.

Dr. George Ang, born in the Philippines, started work in Farmington in December as a physician at San Juan Health Partners. He’s the first endocrinologist at the health partnership or San Juan Regional Medical Center, hospital officials said.

Ang previously worked six years in Gallup at Rehoboth McKinley Christian Hospital and moved to Farmington in search of more patients. He expects to stay busy because of this area’s high rates of diabetes, especially among American Indians.

Endocrinologists are internal medicine physicians with additional training with the body’s glands that produce hormones.

While some endocrinologists specialize in treating health issues such as infertility or excessive or limited growth, Ang is content to work primarily with diabetic patients.

“I just happened to really love diabetes,” he said. “So this was a good fit for me because there is a huge need (for an endocrinologist) among the Native Americans.”

Local diabetes rates have long concerned health officials. Statewide, New Mexico has a diabetes rate of 10 percent. Among American Indians, more than 16 percent of the population has diabetes, said Sandra Grunwaldt, the diabetic education coordinator at the hospital.

Ang said an unhealthy lifestyle coupled with a wariness to medication contribute to the discrepancy in diabetes rates among ethnicities.

Ang said personable care can improve the chance of success when treating a patient for diabetes. Especially when treating American Indian patients, he said.

“They don’t like another specialist telling them they have to do this and this. That doesn’t really work, scaring them into shaping up,” Ang said. “What I’ve found is key to being successful is building trust, especially among the Native Americans.”

Building trust comes from congratulating patients for shedding a few pounds. Or by memorizing the generic equivalents to big-name medications that are available at Walmart at a lower cost, he said.

Accepting bad health problems as a way of life is also a problem when it comes to treating Navajo diabetes patients, Ang said.

“Some think (kidney disease) is a part of diabetes. Grandma and great grandma were on dialysis, mom is on dialysis and I’ll get kidney disease. That’s a big misconception,” Ang said. “We know we can prevent that but it’s difficult. … It’s a daily battle.”

The hospital is trying to improve treatment for all diabetic patients, Grunwaldt said. Ang’s hire is at one end of the spectrum, as he will treat the most complex and difficult cases.

Because of Ang “we can see people affected by the more severe, long-term effects of diabetes and reduce their risk of getting to the point,” Grunwaldt said.

The hospital is also trying to improve treatment and awareness for people who do not yet have the disease.

In addition to offering free six-week-long diabetes education courses to diabetic patients, the hospital will start at the end of January offering a Lifestyle Balance Program. It’s a similar education program for people who are at risk of getting diabetes, Grunwaldt said.

For treating diabetes, “lifestyle is key,” Ang said. “It’s more effective than any drug.”

Type 2 diabetes patients with hypertension do not need to rush to drug treatment

People with type 2 diabetes have to keep a close eye on their blood pressure. But that does not mean they have to start taking blood pressure drugs the minute they are diagnosed.

Middle-aged diabetes patients with high blood pressure have time to learn how to manage their blood pressure without the use of medications.

Waiting up to a year before starting drug treatment for high blood pressure leads to only a small reduction in life expectancy.
Learn to control your blood pressure without drugs.

High blood pressure – or hypertension – is harmful for anyone with or without diabetes. Having said that, diabetes patients with high blood pressure have an especially high risk for stroke, heart disease, kidney failure, loss of vision, and amputations.

Even though controlling high blood pressure can prevent these health problems, doctors and patients alike often fail to take the steps needed to lower blood pressure.

Many patients do not make the proper lifestyle changes, while their doctors can be hesitant to put them on additional drugs.

Until recently, the consequences of these treatment delays had not been measured. Neda Laiteerapong, M.D., of the University of Chicago, and colleagues used computer software to find out how much harm is caused by different delays in managing blood pressure in recently diagnosed diabetes patients.

The researchers found that a one-year delay causes only small damage. However, waiting 10 years or more can cause as much damage as smoking does in patients with heart disease.

According to both the American Diabetes Association and the National Institutes of Health, diabetes patients should aim for a blood pressure below 130/80 mmHg, a target that is lower than that recommended for the general public.

Yet, about two-thirds of adults with diabetes do not reach that goal, either because they lack access to proper health care or due to what can be called “clinical inertia” – when patients do not make lifestyle changes or when doctors are hesitant to push additional medications.

Most experts recommend that diabetes patients with moderately high blood pressure starting taking blood pressure medications within three months. For those with dangerously high blood pressure, they recommend starting drug treatment immediately.

The problem with beginning drug treatment so early is that patients do not have enough time to learn good habits and make the necessary lifestyle changes. Starting drug treatment early also means that patients have to start paying for those drugs sooner.

“We ask patients with diabetes to do a billion things,” says Dr. Laiteerapong. Patients have to juggle a variety of tasks, including testing their blood sugar, counting carbohydrates, and exercising for half an hour each day.

“Most, if not all, of this is new to them,” Dr. Laiteerapong explains. “They need time to adapt. It’s important to do this right, but our results say it’s not that important to do it so fast.”

The study’s findings suggest that doctors should work with patients to help them learn the necessary skills instead of racing into drug treatment.

According to the authors, diabetes patients with high blood pressure have “at least up to one year to focus on diabetes self-management and lifestyle modification.” That is, they have more time.

For their study, Dr. Laiteerapong and colleagues ran published data through computer software to determine the extent to which delaying hypertension treatment caused harm to recently diagnosed type 2 diabetes patients between 50 and 59 years of age.

“Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small,” the researchers conclude.

“Health care providers may wish to focus on diabetes management alone in the first year after diagnosis to help patients establish effective self-management and lifestyle modification.

However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits.”

In other words, blood pressure drugs can wait. But after one year, it is clear that drug treatment is extremely valuable to the health of patients.

The study – which received financial support from the National Institutes of Health – is published in the Journal of General Internal Medicine.
Diabetes

Nearly 26 million individuals are affected by diabetes in the United States each year, with about seven million people going undiagnosed. Diabetes is a chronic metabolic disease with no cure in which a person has high blood sugar because the body does not produce enough insulin (Type 1) or because cells do not respond to the insulin that is produced (Type 2).

There are three main types of diabetes: Type 1, Type 2 and Gestational. Several groups of oral drugs, are effective for Type 2, such as Glucophage, Glucotrol, and Prandin, among many others. The therapeutic combination in Type 2 may eventually include injected insulin as symptoms worsen.

ADHD treatment news: Demystifying the Myths and Misconceptions behind ADHD

Demystifying the Myths and Misconceptions behind ADHD

The disease Attention Deficit Hyperactivity Disorder (ADHD) may be familiar to most people, but only a few are knowledgeable about its causes. It is necessary to secure oneself with knowledge about irregular behaviors and their medical explanations to prevent them and administer proper cures. Regrettably, most people’s notions about ADHD are enmeshed with various myths and misconceptions that consequently develop a stigma against patients with this psychological deficit.

For that reason, children with this attention and hyperactivity problem continue to be branded as troublemakers and spoiled brats, while adult patients are considered lazy and dumb. Most people believe that ADHD is not even a medically accepted condition or that it does not exist at all. Because of this, individuals with ADHD tend to be indifferent or isolated instead of having a concrete support system from their respective communities.

That situation is not effective at all because feeling ostracized and misjudged can aggravate their condition. Hence, the best way to tackle the issue is to first fix some of the incorrect impressions that people have against this behavioral disorder. For example, some believe that ADHD is just a way to increase the profits of drug companies and therapists.

However, the truth is that Attention Deficit Hyperactivity Disorder or ADHD exists and has been tormenting thousands of children across the globe. If not addressed immediately, this can be a lifetime problem that individuals and their families have to endure. Thankfully, there are several residential treatment centers today that can help heal not only the ADHD per se, but also the emotional wounds that other members of society have induced on the patients themselves.

Apart from serving as a shelter, these establishments also have a well-equipped residential treatment facility that can give the treatment needs of teens with ADHD. This demystifies yet another belief which claims that children who have ADHD are over-diagnosed and over-medicated. Certain people believe that the condition has grown to be an excuse for all misbehaving youths; however, professional psychologists can confirm that they have valid methods of diagnosing and treating ADHD.

Another myth is that the signs and symptoms of ADHD like loss of motivation, alcohol dependency, lazy learning habits, and sensitivity to food are all done on purpose and controllable. This misguided notion usually results in harsh parenting. To prevent such from occurring, parents should seek professional help from youth treatment centers that can provide all the necessary medical and emotional help their children need.

ADHD Program in Long Island, New York Finds Success with Executive Skills Training Curriculum

The Child and Adult Diagnostic and Treatment Program for ADHD, a division of East End Psychological Services ( http://www.eepservices.org ), is successfully treating ADHD in children, adolescents and adults by teaching strategies that enhance executive skills.

“Many people with ADHD struggle with executive skill deficits which are based in the biology of their brain. Thus, effective ADHD intervention involves strengthening the individual’s executive functions, which directly impact academic, career and social success. Executive skills permit individuals to manage or self-regulate themselves and guide behavior across time,” explains Dr. Joseph Volpe, Clinical Psychologist and Coordinator of the Program. “The ADHD Program at East End Psychological Services provides comprehensive executive skills training as a way to improve academic functioning, enhance career success and nurture personal relationships. Our methods for evaluating and teaching executive strategies have become especially valuable to our clientele at this time as many popular ADHD medications have been in short supply, especially less expensive generic medications.”

Before the training protocol is implemented, staff psychologists collect detailed background history about the individual. Next, clients are evaluated for baseline executive functions including attention span, behavioral inhibition, working memory, planning skills, and organizational abilities. Psychoeducational testing is provided when there is evidence for learning or other cognitive problems. Social-emotional and personality variables are tested as well. Direct consultation with school staff is part of the assessment process for school-aged children. Interviews with significant others are utilized when evaluating adults.

Through various interventions which include behavior modification techniques, cognitive therapy and behavioral counseling, clients learn how to improve impulse control, planning and organizational abilities, time management, emotional regulation, and working memory. These are skills that are necessary for success in the home, school, and/or employment settings. When assisting children, staff collaborate with parents and teachers so that these skills can be generalized between the home and school environments. With adults, the individual is trained to use these skills at college, at work and within their personal and social relationships.

Sachs Center Offers Parent Coaching To Help Children With ADHD

The Sachs Center in New York City now offers Coaching for parents struggling with their children, especially those diagnosed with ADHD. This specialized treatment is an affordable way for parents to learn about their child’s ADHD and how best to manage their behavior.

Parents with children diagnosed with ADHD often face additional parenting challenges. Children with ADHD require unique parenting skills to manage their outbursts, inability to focus and complete tasks, generally undesirable behavior, and most commonly, their tantrums.

The most important aspect to remember about tantrums is that the child is just trying to get their needs met. The Sachs Center parent coaching encourages caregivers to see that their child is looking for attention, or for something tangible such as food or a toy. Regardless, the parent’s best course of action is inaction; ignoring the behavior completely and maintaining their composure. The parent is encouraged to say, “When you calm down, then I can talk with you,” thereby removing the chance of emotional escalation. Otherwise, the parent’s return of an angry outburst will only add fuel to the tantrum’s fire. Once the anger passes, the child can then access their sadness for not getting their needs met, and that is when they reach to the parent for comfort and the tantrum ends.

Anxiety Treatment News: Genes behind anxiety in patients with too much protein identified

Genes behind anxiety in patients with too much protein identified

London, Jan 9 (ANI): Overexpression of two genes is responsible for the anxiety and behavioural issues associated with excess MeCP2 protein, say scientists.

The genes (Crh [corticotropin-releasing hormone] and Oprm 1 [mu-opioid receptor MOR 1]) may point the way to treating these problems in patients with too much of the protein, said scientists at the Baylor College of Medicine.

MeCP2 is a “Goldilocks” in the protein world. When the protein is lacking or defective, girls develop the neurological disorder Rett syndrome early in life.

Too much protein results in the more recently identified MeCP2 duplication syndrome, which usually affects boys, who may inherit the gene duplications either from their mothers or, in rare cases, develop it sporadically.

In both cases, anxiety and social behavioural deficits are typical of those with the disease, along with other motor problems and cognitive defects.

“This is a nice example of a translational story,” said Dr. Rodney Samaco, assistant professor of molecular and human genetics at BCM and first author of the study.

“We first identified the mouse model for MeCP2 duplication syndrome and then found people with the disorder in the clinic. We went back to the lab and found out that MeCP2 was indeed the major contributor to this phenotype in patients.

“We have now identified two genes involved in two major symptoms of the syndrome. Eventually, we may take the information back to the clinic to develop a treatment for patients,” Samaco stated.

Patients with MeCP2 duplication disorder have a duplication in chromosomes that span both the MECP2 gene and another called IRAK1. But with this new study, it is now clear that excess MeCP2 accounts for the neuropsychiatric symptoms.

This finding is important because it shows that tweaking the expression of genes that the protein affects, rather than trying to adjust the levels of the finicky MeCP2 protein itself, can modify symptoms of MeCP2 disorders.

The finding appeared online in the journal Nature Genetics. (ANI)

Supplement Can Bolster Pets’ Anxiety Treatment

When it comes to pets, fears, anxieties and phobias are more common than most people realize. In people—at least some of them—logic and reasoning can be used to help that person understand that an object, noise or event is not as scary as it may seem. But for pets, their perception is their reality. No amount of discussion or psychotherapy can change their minds about a situation that seems threatening or dangerous to them.

In a national online survey about anxiety in pets, nearly 40 percent of pet owners who responded say they have at least one pet that experiences anxiety.1 Possible contributing factors to anxious behavior may be a lack of proper socialization, some traumatic event, genetic predisposition, and even cognitive decline.

As an animal ages, hearing and sight may be compromised, and with confusion or even discomfort from arthritis, that can result in a more stressed or anxious pet.

Nearly a third of the owners who responded to the online survey say their pets’ fears and anxieties are “extremely or very” problematic, while 44 percent say it is “somewhat” problematic. And 70 percent say the anxiety their pet experiences occurs “fairly often” or “frequently.”

It has been reported that a major reason owners relinquish pets or have them euthanized is for behavior-related issues,2,3 some of which can be related to anxiety and fear.

Occasional fear is normal as a response to unknown or threatening people, sounds or events, and to avoid risky situations. But if the anxiety is chronic and worsening, or exaggerated during episodic instances, the pet can be suffering.

Changes in the pet’s life, from a move to a new pet or baby, can contribute to insecurity and anxiety about the animal’s everyday existence. A dog may show excessive attention-seeking behavior, be constantly vigilant and show repetitive behavior (licking), and cats may start urine marking or spraying.

Chronic stress and anxiety can potentially increase the risk of illness, including skin and digestive problems or heart disease, and can lead to behavior problems or aggression.

Episodic anxiety can result in intense reactions to things such as thunderstorms, fireworks, houseguests and traveling.

Sometimes owners hesitate to bring the issue to their veterinarian’s attention, but ignoring the problem seldom helps it go away.

Early Detection
Veterinarians should rule out any physical problems and take a complete and detailed history (medical, nutritional and behavioral) to help define the issue better. While the possibility of preventing anxious behavior is debatable, early detection of tell-tale signs can stimulate measures to try to keep it from getting worse.

Veterinarians and veterinary staff can discuss appropriate early socialization, teach pet owners to avoid punishment and use positive reinforcement, and try to avoid stressful stimuli, if reasonable. Proper behavior modification can go a long way to helping a pet cope with exposure to fearful situations, and the veterinary team can be a great resource in providing guidance.

Methods such as counter-conditioning and desensitization can be very effective in certain cases. Some pets, however, may benefit from the addition of medications or supplements, particularly during the period of behavior modification, to reduce the perceived level of anxiety and allow the training to be more effective.

While certain prescription medications can help (SSRIs, tricyclic antidepressants and benzodiazapines), some owners are reluctant to go straight to the pharmaceutical solution as a first line of treatment. Concerns about sedative effects and having a change in their family interaction lead some pet owners to look for alternatives.

In fact, a combined 51 percent of pet owners in the previously mentioned survey “try to avoid pharmaceuticals for my pet” and “prefer natural products.” Only 31 percent say they have no issues with pharmaceuticals.

A Supplemental Option
The amino acid L-theanine is found naturally in green tea and is known for its calming properties. At therapeutic levels, L-theanine is shown to increase concentrations of GABA, an inhibitory neurotransmitter, and increase brain serotonin and dopamine levels.4 Suntheanine is a patented, pure active form of L-theanine, free of D-theanine, which can exhibit a competitive effect with respect to intestinal absorption.

In humans, L-theanine has been shown to generate alpha brain waves, indicative of relaxed, effortless alertness, or in other words, calming effects without drowsiness.

Anxitane (L-Theanine) Chewable Tablets, available through Virbac Animal Health, contain Suntheanine in a chewable form proven to reduce clinical signs related to fear and anxiety.

In an open-field trial designed and performed by veterinary behaviorists Drs. Valerie Dramard and Laurent Kern,5 two of three dogs showed significant improvement when treated with Anxitane Tablets. In clinical signs associated with fear, such as trembling, mydriasis, hypervigilance, inhibition, flight and avoidance, there was a significant reduction (P < 0.0001), with similar data in cats resulting in owner satisfaction.5

While some pets may show a rapid response, for chronic conditions, progressive improvement in behavior is expected over three to six weeks. For the best evaluation in a pet, regular administration for a period of two months may be needed to assess its full potential, and it can be used long-term.

For episodic stressful situations such as car rides, fireworks or visitors, doses should be administered 12 hours and two hours before the event. For a prolonged situation, the administration can be repeated every six hours.

While thunderstorms may be considered episodic events, they are often difficult to predict, so regular administration during thunderstorm season with supplementation during the storm could be the best regimen for the pet, paired with behavior modification.

In summary, while anxiety and stress may be common in pets and each one’s experience is individualized, veterinarians can play an important role in helping the owner recognize the early signs, and to be proactive in recommending behavior modification and potential supplements or medication to help decrease the impact these behavior problems can have on pets.

Healthy Nutrition News: Nutrition offers key to healthy weight loss

Nutrition offers key to healthy weight loss

Over the years, Craig’s weight had become so high he stopped weighing himself because he couldn’t bear to look at the number. A friend of his, concerned about his laboured breath and evident fatigue, had convinced Craig to buy a treadmill for his home.

Tired of being the fat guy, Craig began the very difficult task of working up a sweat on the treadmill almost every day. Several months into his new exercise regime and having lost virtually no weight, he wondered why the scale refused to budge.

If you are overweight or obese and have a New Year’s resolution to lose weight, adding more exercise can improve your overall health and cardiovascular fitness, but it may do little to drop the number on the scale.

A 2011 article published in the American Journal of Medicine reviewed 14 trials and 1,847 patients, and found that moderately intense exercise programs of six months only resulted in a 1.6-kg weight loss and 2.12-cm decrease in waist circumference. Similar programs of a year didn’t offer much difference (1.7-kg and 1.95-cm decrease).

If you have a substantial amount of weight to lose, these small losses may feel like plenty of hard work without getting a paycheque. This may be one of the reasons fitness facilities are so busy in the New Year and then see a large drop-off in the months to come. No results, no motivation to continue.

Research over the years consistently shows that while you can lose small amounts of weight by initiating an exercise program, much bigger weight loss results come from nutrition changes. Even better, using a combination of reducing your calorie intake and adding exercise can offer a slightly better weight loss than just nutrition alone.

So if exercise alone isn’t the best strategy to lose weight, you might wonder how someone you know has lost plenty of weight simply by exercising more. One theory is that this has more to do with the influence exercise has on reducing your intake (calories in) than the calories burned during exercise (calories out).

A 2011 article in the Journal of Obesity suggested that metabolic, hormonal and psychological changes are involved. Exercise can help improve your overall mood and stress response, which can help you tackle emotional eating and regulate how much you eat. Physical activity also helps combat depression and sleep issues, which in recent years have been linked to higher risk of obesity.

Also important to note is while exercise alone may do little to help you lose extra pounds, research shows that exercise is one of the best ways to prevent weight gain and also to maintain weight loss over the long run.

Sidebar

Where to start

If you have a large amount of weight to lose, you could begin a new eating plan as well as a new fitness regime at the same time — but I would encourage you to start with one or the other.

It’s very challenging to successfully start and maintain both areas of change, especially when you are living a real life with big family and work commitments. Go easy on yourself and commit to one major lifestyle change at a time.

Start with your nutrition first, since the above research shows you can begin seeing faster changes on the scale, which can be more motivating to continue on your journey to better health.

Once you see the changes in your body from improved nutrition, it can be psychologically as well as physically easier to get going on a healthy exercise plan for life.

Chick-fil-A Debuts One of America’s Most Nutritious Kid’s Meals

According to the Let’s Move initiative, one in three American children is considered overweight or obese. Children also consume 31 percent more calories and 56 percent more fat than their peers did 40 years ago. Starting today, Chick-fil-A® is taking another step in continuing to address the issue of childhood obesity by debuting one of the nation’s most nutritious kid’s meals.

In recent months, many fast food chains have updated their side options in an attempt to offer healthier children’s menu items. Chick-fil-A instead is concentrating on making the entree healthier by adding Grilled Chicken Nuggets as an alternative for children. The move marks the first time a national fast food chain has offered a grilled entree as part of a children’s menu.

The chain also is enhancing its side choices, adding Buddy Fruits® Pure Blended Fruit To Go applesauce as a complement to the Fruit Cup option Chick-fil-A added to its menu in 2004. And, the chain is changing its children’s beverage line to only feature one percent milk, 100 percent apple juice, its signature freshly squeezed lemonade, and water as drink choices.

Chick-fil-A’s Grilled Nuggets, paired with the Fruit Cup and one-percent milk, is one of the most nutritious children’s meal combinations offered among any major fast food chain. The meal has only 210 calories and 3 grams of fat – reflecting an 86 percent cut in fat grams and a 56 percent calorie reduction compared with its previous offerings.

“According to reports from the Centers for Disease Control, Americans frequently choose convenience over nutrition. This has created a greater likelihood of our children becoming overweight or obese. The reality is that we live in an on-the-go world where parents have limited healthy meal options for their kids on the way to and from recreational activities, school or other events,” said Woody Faulk, Chick-fil-A’s vice president of brand strategy and design, who oversees Chick-fil-A’s menu. “Our new Kid’s Meal reflects our commitment to helping parents strike a balance between nutrition, convenience and price. We want parents to know that they do have a choice at Chick-fil-A.”

Following is more information on Chick-fil-A’s new Kid’s Meal offerings:

Introduction of Grilled Nuggets: These gluten-free Grilled Nuggets are made from a boneless, skinless breast of chicken tumbled in a salt and pepper spice blend and then grilled to perfection. The four count is only 80 calories and 1 gram of fat, while the six count contains 110 calories and 1.5 grams of fat.
Addition of Buddy Fruits ® Pure Blended Fruit To Go: Apple Cinnamon: Each squeezable fruit pouch is gluten-free, all natural and contains 100 percent pure fruit. It is 60 calories, 0 grams of fat and equals one serving of fruit.
Improved beverage options: Kid’s Meal beverage offerings will be changed to only feature one percent milk, 100 percent apple juice, Chick-fil-A’s freshly squeezed lemonade (30 percent DV vitamin C), and water as drink options.

According to Chick-fil-A’s full-time dietitian Jodie Worrell, these new menu additions come as part of Chick-fil-A’s broader initiative to offer healthier menu options to customers. Initiative highlights include the addition of the Fruit Cup in 2004 and moving to a complete menu (including all condiments) with zero trans fats in 2008. Chick-fil-A also is actively working to reduce sodium across its menu, including a 40 percent sodium reduction in its Chargrilled Chicken filet, 25 percent less sodium in breads and removing 10 percent of sodium in dressings and sauces.

“While we are excited about the moves we have made on the Kid’s Meal menu, we also are extremely proud of the progress we have made with our overall menu,” Worrell added. “Removing trans fats, adding more nutritious salads and reducing sodium are examples of some of the steps we have taken in recent years to further our commitment to customers of offering a well-balanced menu of choices. Our work is not complete though. We are constantly looking for a better way to offer our customers healthier choices.”

Kid’s Meal Commitment Extends Beyond the FoodChick-fil-A’s commitment to families extends beyond offing more nutritious menu options. The chain also uses its “Growing Kid’s Inside and Out®” Kid’s Meal program as an opportunity to nourish young minds through the premiums included as part of the meal. Rather than offering a toy promoting the latest movie or television series, Chick-fil-A complements its quality children’s menu offerings with meaningful and fun tools that encourage interaction between children and their families. Examples include Little Gold Books, VeggieTales CDs, Discovery Kid’s activities and books adapted from the Martha Speaks PBS series.

Acne Treatment News: New Website Launches for Seattle Cosmetic Dermatologist

New Website Launches for Seattle Cosmetic Dermatologist

At her center for cosmetic dermatology in Seattle, Dr. Jodie Reinertson has announced the release of a new website to highlight her services in skin care and facial rejuvenation. Through an assortment of enhanced features and in-depth procedure information, Dr. Reinertson says she hopes to boost patient interaction and education so as to promote the highest level of care possible.

Seattle, WA (PRWEB) January 05, 2012

Seattle cosmetic dermatologist Dr. Jodie Reinertson recently announced the launch of the new website for her practice focusing on skin care treatments and products. Her practice provides facial rejuvenation procedures and skin care such as BOTOX® Cosmetic, chemical peels, acne treatment, and laser-guided liposuction. Dr. Reinertson says she is excited about the new website and the opportunity to enhance patient education by offering thorough information through an interactive and aesthetically-driven interface. By releasing the updated website, she says she hopes to augment doctor-patient communication in order to continue providing quality care to her patients.

Notable features of the new website include drop-down tabs for a more facilitated user experience, in-depth information concerning procedure expectations and frequently asked questions, and an electronic store for cosmetic products. Dr. Reinertson says social media optimization with links to the practice’s Facebook page will allow for improved communication and interaction with patients about procedures such as medical weight loss and BOTOX in Seattle. The site also features an expansive photo gallery of before-and-after results to showcase Dr. Reinertson’s work.

Dr. Reinertson developed the new website in collaboration with Rosemont Media, a San Diego-based medical website design firm. Utilizing the latest in website design and cosmetic dermatology content, Dr. Reinertson hopes to enhance the patient education experience by providing an easy-to-use resource for procedure information and skin care products. She says the new website provides her the chance to continue striving for the highest quality patient care.

About Jodie Reinertson, MD

Dr. Jodie Reinertson graduated cum laude from Boston University and went on to earn her Doctor of Medicine with Honors from St. George’s University School of Medicine. She ocmpleted a Fellow program in Ultrasound at Albany Medical College as well as an Internship in Family Medicine and a residency in Radiology. Dr. Reinertson is a member of the International Academy of Cosmetic Dermatology, the International Society of Aesthetic Medicine, the American Society of Bariatric Physicians, and several other professional organizations. She is also active in the donation of skin care, beauty, and hygiene products to the Seattle chapter of Dress for Success, a program for disadvantaged women preparing to transition into the workforce.

Iridex to sell skin treatment unit to Cutera for $5 million

This unit of Mountain View-based Iridex (NASDAQ: IRIX) makes lasers to treat age spots and veins in people’s skin, and also to treat acne and remove hair. Iridex has a separate ophthalmology business not included in this sale — that unit makes laser treatments for serious eye diseases like age-related macular degeneration, glaucoma and diabetic retinopathy.

Brisbane’s Cutera (NASDAQ: CUTR) makes lasers and other light-based devices for cosmetic treatments — its machines also treat blemishes on the skin, to remove hair, and to treat visible veins in the skin. Cutera also sells devices to treat toenail fungus.

Dominik Beck is CEO and president of Iridex. He said the sale will let Iridex focus on its eye treatments. Iridex had accumulated a deficit of $19.4 million in October, when it filed its latest quarterly report. It earned $349,000 in that quarter.

Kevin Connors is president and CEO of Cutera. His company lost $2.9 million in the quarter ended September.

New acne treatment shows promise for patients

Anyone who’s dealt with severe acne knows that getting rid of it can be exhausting and expensive.

But a Boca Raton dermatologist says a new treatment could save you money while offering quicker results.

It’s been a long six years for Marco Aletto.

“It’s been a constant part of my life for a long time. I never really thought of it as something that could go away, it’s not a healthy thing to let something so superficial constrict your social life, but unfortunately it does. You meet somebody and the first think that they see is your acne,” said Aletto.

Aletto said he tried dozens of medications over the years, both over the counter and prescription.

Oral antibiotics worked, but he says he began to look for an alternative that would eliminate having to put medicine in his body.

He found Isolaz, a procedure that uses a laser combined with a vacuum.

Dr. Debra Sheldy said “the target is getting these patients off oral antibiotics and getting the inflammation down as quickly as possible and thus reducing the chances of scarring.”

The Isolaz vacuum suctions out the dirt, blackheads and excess oil in your pores. The laser then kills the bacteria.

Dermatologists say the procedure is quick, pain free, and leaves minimal reddening so there’s no downtime.

“I’ve taken every Isolaz treatment I’ve ever done on my lunch break from work which is maybe half an hour and the moment I leave I look better,” Aletto said.

Doctors at Clearyderm in Boca Raton say the quickness and ease of the treatment has been drawing more people into their doors.

That and an increase in adult cases of acne thanks to our stressful lives.

“We see cases from teenagers all the way up to the perimenopausal women who are going though hormone changes,” said Dr. Shelby.

Although they say Isolaz does eventually eliminate the need for oral medicine, a medicated wash and topical antibiotic are still used.

Dermatologists say most people see their acne cleared up within four to six treatments.

As for Aletto, “I’m already stunned by the results that I’ve gotten so quickly. I feel like I wasted all my time and energy.”

Isolaz costs about one hundred and fifty to three hundred dollars a treatment depending on where you get it done. Four to six are usually needed. More treatments may be required for severe cases and maintenance according to doctors.