Daily Health and Medicine News

Sleep Disorders News: Getting A Good Night’s Sleep

Getting A Good Night’s Sleep

A good night’s sleep is something we all value. Scientists tell us, and we know from experience, that it refreshes us, helps us perform better, and contributes significantly to health and happiness, especially in children. And yet, there are millions of us suffering from ongoing shortage of sleep.

According to the World Association of Sleep Medicine (WASM), sleep problems add up to a global epidemic that affects 45% of the world’s population.

“Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and sleep deprivation significantly impact physical, mental and emotional health, in addition to affecting work performance and personal relationships,” they said, on the fourth annual World Sleep Day on Friday 18th March 2011, when health professionals from WASM and other organizations worldwide came together to deliver the message that sleep is a “human privilege that is often compromised by the habits of modern life”.
The 24/7 Technological Society
When we think about it, these figures are hardly surprising. Over the last two or three decades, the choice of round the clock activity available to the average Westerner today has become overwhelming. We can shop at 2 am, either at the supermarket or online, we can do our banking online 24/7, we can watch any number of films and TV channels or catch up on programs around the clock, we can download games, books and software and start enjoying them without having to wait until the morning.

And then there’s the communications technology through which we make ourselves accessible to others, via mobile or cell phones, internet chats and and social networks like Facebook and Twitter. Over less than a generation our social “interfaces” have multiplied enormously, leading to an ever increasing volume of transactions with a growing number of people.
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And all this impacts not only our daytime activity, but damages our sleep environment: it’s much harder to wind down and prepare for sleep when the bedroom is more like a NASA control center than a haven of peace and tranquility.

This is especially evident in the younger generation. Research suggests that as a group, teenagers are experiencing sleep deprivation on an unprecedented scale. A contributing factor is the tide of technology flooding into the bedroom of the average teenager.

Home insurance surveys show that most British children have a games console, a TV, a CD player and a DVD player in their bedroom, which one in five parents now ranks as containing more expensive items than the kitchen or living room. The bedroom is also the room teenagers spend most of their time in, and where they tend to hang out with their friends when they call round.

Calling and texting on cell phones is an especially big stealer of sleep time among teenagers. Doctors in the US are becoming very concerned about the effect this has on their health and development.

Dr R Michael Seyffert of the New Jersey Neuroscience Institute at JFK Medical Center in Edison, sees two or three teenagers a month with severe night-time cell phone problems, which he defines as spending two or more hours of texting and phoning each night. He says he has seen more of this in the last five years than ever before, and predicts it is only going to get worse.

Few would disagree with him: as we drift on this tide of technology toward a total 24/7, globally connected society, with an increasing number of gadgets to inform, stimulate and entertain us, the traditional boundaries between activity and sleep are being eroded, and we are likely to see a rise in the number of people experiencing health problems from lack of sleep.
How Much Sleep Do We Need?
Expert opinion varies as to the exact number of hours of sleep we need for optimum health, and some suggest it also depends on individual needs and age. The American Academy of Sleep Medicine says most adults need about seven to eight hours of sleep a night to feel alert and well rested. The National Sleep Foundation also recommends between 7 and 9 hours.

One recent study suggests it could be as little as 6 hours, but more than 9 hours could be just as bad as not enough. Dr Charles Bae, a neurologist at the Cleveland Clinic Sleep Disorders Center in Ohio, and colleagues examined data on 10,654 patients who had competed questionnaires about quality of life, depression and average hours sleep per night.

They were surprised to find that sleeping more than 9 hours a night was linked to a similar reduction in quality of life and increase in symptoms of depression as sleeping less than 6, they said at the SLEEP 2011 conference in Minneapolis.

Children and teenagers need more sleep than adults. Teenagers need at least 9 hours, says the National Sleep Foundation in the US.

Many people do not realize that sleep is far from being a “passive” process where the brain just switches off at night. It is an “active” process involving the whole body and the brain.

Neurotransmitters, chemicals that brain cells use to signal to each other, control whether we are asleep or awake by action on different parts of the brain. In the brainstem, which joins the brain to the spinal cord, brain cells produce serotonin and norepinephrine that keep some parts of the brain active while we are awake, while other brain cells at the base of the brain control signals that lead to sleepiness and falling asleep by “switching off” the ones that keep us awake.

When we sleep we go through several stages of sleep from light to deep sleep, and then the cycle starts over. One of the stages is REM (rapid eye movement), which stimulates the brain regions used in learning. Infants spend much more time in REM sleep than adults. REM is also linked to increased production of proteins and learning of mental skills.

Research also suggests that a chemical called adenosine, which causes drowsiness, gradually accumulates in the bloodstream while we are awake and gradually breaks down during sleep.

Study: Sleep boosts athletic performance

Young basketball players wanting to improve their game should put in long hours — not only of practice time, but also of sleep, U.S. researchers say.

A researcher in the Stanford University Sleep Disorders Clinic and Research Laboratory said her study has shown that basketball players at the college level improved on-court performance by increasing their amount of total sleep time.

“Athletes may be able to optimize training and competition outcomes by identifying strategies to maximize the benefits of sleep,” the researchers wrote in the journal SLEEP.

While it’s long been known lack of sleep can have negative consequences, very few studies have looked at the effect that sleep extension can have on performance, particularly of athletes, a Stanford release said Friday.

Most athletes focus on nutrition and physical training as part of their regimen, Mah said, but competitive athletes at all levels typically do not consider optimizing their sleep and recovery.

“Intuitively many players and coaches know that rest and sleep are important, but it is often the first to be sacrificed,” she said.

Over the course of two basketball seasons, Mah and colleagues worked with 11 healthy players to measure the effects of sleep extension on specific measures of athletic performance. At the end of the study period, the players ran faster 282-foot sprints (16.2 seconds vs. 15.5 seconds) and their shooting accuracy during practice improved, with free throw percentages increasing by 9 percent and 3-point field goal percentage increasing by 9.2 percent.

Sleep is an “unrecognized, but likely critical factor in reaching peak performance,” Mah said.

Home Sleep Testing (HST) Surpasses User Expectations

Sleep Group Solutions (SGS) is pleased to announce the widespread launch of InterpStudies.com, a home sleep study interpretation portal. Home sleep testing has been among the fastest growing segments of the sleep and medical market as it is a viable and cost effective study, similar to the overnight PSG tests done in sleep labs.

Home sleep tests (HST), such as the Embletta is the same HST device used today in many hospitals, Sleep Disorders Centers, VA and Kaiser Systems. These home sleep tests are user friendly, and frequently administered by primary care physicians, internal medicine physicians, dentists and other specialties. Since Embletta supplies many sleep labs with sleep study technology-sleep doctors are familiar with the data and diagnosing is seamless when studies are uploaded to InterpStudies.com. “Interpstudies.com was built with a scalable infrastructure so that companies interested in getting started with home sleep testing do not need to invest in the technology and expensive servers or programs, nor networking with physicians to make a system like this work. With Sleep Group Solutions and the InterpStudies.com network distributors, DME companies, multi-state medical groups and others can work with home sleep testing and offer physician interpretation nationwide with no additional investment.” explains John Nadeau, Sleep Group Solutions, VP.

Being a part of Sleep Group Solutions ‘Complete Home Sleep Testing Solution’ includes:

*Embletta Units: The “gold standard” in home sleep testing, and most other HST devises
*Customized web portal access for you and your customers: Seamless and easy access
*Interpretations by InterpStudies.com

Create your business’s own ‘Complete Home Sleep Testing Solution’ today, with the most cost effective model, and comprehensive company around. Dr. Gregory Carnevale, a sleep doctor in New York, and part creator of InterpStudies.com says “InterpStudies, LLC was born out of this idea to provide home sleep study interpretations efficiently and accurately using the most modern technology, and competitive price.” Dr. Carnevale mentions in a recent interview with the Sleep Magazine, and that’s exactly what InterpStudies delivers.

About Interpstudies.com
InterpStudies is a completely web-based company that transfers (“uploads”) home sleep study data that you provide to our team of “Analyzers” who are board certified sleep physicians. Our Analyzers will send you a report within 5 business days providing you with the most current American Academy of Sleep Medicine guidelines regarding diagnosis and treatment options, including CPAP, oral appliances and other treatments. Interpstudies.com work most often with Remlogic software and Embletta home sleep study equipment. Additional devices can be used including: MediByte Jr, Easy Ambulatory PSG, Somte, Watch-PAT (Prices and acceptance of new clients will change from time to time). The InterpStudy team with help you with all phases of the process including set-up and uploading. Most of this assistance can be done remotely.

About Sleep Group Solution

Sleep Group Solutions is an airway diagnostic technology company serving the needs of physicians and dentists interested in screening, diagnosing and treating sleep apnea and other upper airway disorders. Sleep Group Solutions offers the latest screening and diagnostic equipment solutions for patients with allergy, sinus congestion, rhinitis, deviated septum, nasal polyps, snoring and sleep apnea. SGS offers the most comprehensive dental sleep medicine CE seminars in the industry focused on teaching dentists the protocols needed to make the treatment of snoring and sleep apnea part of their practice. SGS offers sleep study interpretation, oral appliances (Norad Boil & Bite, Respire), online directory 1800SleepLab.com and online marketing at Sleeptest.com. SGS is the manufacturer of the Eccovision Systems Rhinometer and Pharyngometer.

Healthy Nutrition: Menu labels don’t influence student food choices

Menu labels don’t influence student food choices

Who chooses high-vegetable food options over hamburgers? Not college students, if a study is any guide.

Menu labels on college cafeteria food that highlight the nutritional good and the bad of various meal options make no difference in students’ choices, according to the study in the American Journal of Clinical Nutrition.

The results add to evidence that despite laws in some cities mandating calorie counts on fast-food menus, nutritional information makes little difference to people when they are eating out.

“Although it is important to inform consumers about the nutritional characteristics of the food offered, providing nutrition information in less healthy food environments such as fast-food restaurants is unlikely to alter consumers’ food choices,” wrote Christine Hoefkens and Wim Verbeke, two of the study’s authors, in an email to Reuters health.

The research team, based at Ghent University in Belgium, asked 224 people who regularly ate at two of the university’s cafeterias to log their diets for several days.

Then the researchers put up posters in the cafeterias that rated meals on how healthy they were — zero stars for the least healthy to three stars for the most healthy. Study participants and other diners didn’t know the posters were part of a study.

Labels next to menu items also highlighted whether a meal was high in salt, calories, saturated fats or vegetables.

Six months later, the participants, who were mostly female undergraduates, again logged what they ate for a few days.

Though the researchers predicted the diners would have responded to the posters and made healthier food choices, they found no difference in the number of meals eaten from each star category.

The results were not surprising, said Lisa Harnack, a professor at the University of Minnesota in Minneapolis, who was not involved in the study.

“In studies, when you ask people how important nutrition is to them when they’re ordering food from a restaurant menu, it’s far less important than a food price or taste. It’s just not a consideration,” she told Reuters Health.

U.S. cities such as New York and Philadelphia require fast-food chain restaurants to include calorie information on menus, while the health care reform bill passed in 2010 will also require that fast-food restaurants and vending machines include nutritional information.

What was concerning about the college student population was that the cafeteria meals were often their main source of food, Hoefkens and Verbeke said.

But others, such as Gail Kaye, the nutrition program director at Ohio State University, said that menu labels might still work to encourage healthier eating if they were paired with a healthier-leaning menu.

In the Ghent study, for instance, 70 percent of the meals earned zero or one stars, both before and after the labels, with the students’ meal choices mirroring the proportion of offerings in each star category.

McCain Foods Backs Healthy Eating Programme for Children

McCain Foods has announced that it will be working with PhunkyFoods, the award-winning schools healthy lifestyles programme, which helps teachers to give curriculum linked lessons in healthy eating and physical activity to primary age schoolchildren.

The company, which employs around 2,000 people in Britain, joins a consortium of Nestlé and Northern Foods in supporting the Harrogate-based programme which was created seven years ago by nutritional consultancy Purely Nutrition.

Bill Bartlett, Corporate Affairs Director for McCain Foods, said: “We are delighted to provide unbranded support for PhunkyFoods’ mission to help children across the country gain a greater understanding of the importance of healthy eating and active lifestyles.

“Many children have very little understanding of where their food even comes from, let alone its nutritional content and, as a responsible food company, we strongly believe we have an important role to play in changing that.”

Mr Bartlett added: “McCain Foods is fully committed to promoting good nutrition, learning and skills and physical activity. We already support a number of initiatives at a local and national level and we welcome the opportunity to strengthen our support in this area still further.”

There are now more than 1,000 schools in England, including seventy-five near McCain’s main UK sites, using the PhunkyFoods programme which subscribes to the National Curriculum.

The programme teaches children up to 11, which is seen as the critical age, healthy lifestyle messages through art, drama, music, play and hands-on food experience.

PhunkyFoods managing director Sorrell Fearnall said she was delighted that PhunkyFoods now had the support of a company as influential as McCain which clearly believed in the values of the programme.

“PhunkyFoods is now supported by a powerful food industry consortium and this will enable the programme to be developed and delivered cost effectively,” she said. “This innovative partnership approach to our work and to delivering public health messages is closely aligned with the Prime Minister’s Big Society values. It is also in tune with Health Secretary Andrew Lansley’s Responsibility Deal between government and industry to make food sold to the public healthier.”

Ms Fearnall added: “Given the severity of the obesity epidemic the PhunkyFoods programme offers an effective solution and could be rolled out to all primary schools in England. Our vision is for all 16,970 primary schools to be running the programme by 2013.”

EU researchers revolted as EFSA clears health claims vault

The European Food Safety Authority last week delivered the fifth batch of article 13, general function health claims bringing the total assessed to 2723. There are just 35 to go – to be published next month in a final mini-batch that will conclude the task begun in August 2008.

The Parma-based agency is no doubt slapping itself on the back for completing an exhaustive and gargantuan task but industry and academia would prefer slapping the face of EFSA’s health claim panelists that have for the best part of three years relentlessly rejected so much nutrition science.

As the negative opinions piled up, along with the more specific claims in article 13.5 (emerging and proprietary science) and article 14 (children’s development and disease risk factor reduction) these same academics, NGOs and industry stakeholders politely disagreed with EFSA’s conclusions among each other, at conferences, in the press and via official channels established by the nutrition and health claims regulation (NHCR).

When these gained no traction with EFSA’s Panel on Dietetic Products, Nutrition and Allergies (NDA), the tone became more antagonistic, letters were fired off to MEPs and European Commission figures, the annoyance and frustration palpable when the NDA hosted rare public meetings.

Academics formed groups like the gut health scientists that have banded together (www.gut-health.eu ) to protest the treatment of pre- and probiotic submissions, and are learning that lobbying is not something scientists can afford to ignore in the European nutrition science environment.

A first class organisation (not)

But in the face of a scientific agency that has made it made blatantly clear that its pharma-style approach to nutrition science is not going to change one iota, battered academics and business folk are throwing their hands in the air and the gallows-humour is emerging.

Take this highly ironic missive from prominent probiotic researcher, Glenn Gibson, PhD, from Reading University in the UK.

“I am sure that EFSA are a first class organisation who know exactly what they are doing by putting the science first. I have to admire their stance in protecting consumers by trying to ensure that all valid pro and prebiotic products will disappear from Europe within a few years.”

Or this from Gregor Reid, PhD, the Canada-based researcher who has spent more than 20 years researching the ability of probiotics to benefit vaginal health, who was stunned last week when EFSA concluded vaginal health was not a nutrition matter.

“I have sent the EFSA committee a picture of the female anatomy. It seems they are unaware of the vagina’s location. Next, they will receive a large sack of mail, actually close to one billion letters. They will believe it’s fan mail and get excited for the first time in five years, but it will be from women who suffer from vaginal and bladder infections, letting them appreciate the failings of drugs, diagnostics and management practices approved by EFSA’s drug colleagues.”

Ouch.

Professor Reid, like a lot of researchers in the area has reached his tether, and no amount of consoling from the NDA about how the experts on the panel are bound by the regulation, and that research is one thing, but panel opinions are another is going to change that.

In the meantime, as the conspiracy theories grow about hidden agendas especially in the absence of a single minority opinion among all those 1000s of opinions, the NHCR’s effect among European healthy foods, ingredients and supplements purveyors comes into view.

“We’re off to Asia,” the owner of a promising French fruit extract firm told NutraIngredients at a recent conference, as he left the hall where an NDA panellist was telling attendees about the NDA’s approach to guarantee only strong claims made it to market.

“We give up on Europe.”

Back Pain Treatment News: Sit Up Straight. Your Back Will Thank You.

Sit Up Straight. Your Back Will Thank You.

EVERYONE wants to avoid back trouble, but surprisingly few of us manage to escape it. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain.

But back pain is notoriously difficult, and expensive, to remedy.

“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”

Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.

Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.

“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.

Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.

“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”

Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.

THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.

There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.

If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.

“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).

The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.

Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.

If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

Oswalt’s Back A Pain For Phillies

It is officially time to be very concerned about Roy Oswalt. The back issue lingers. His fastball slows. One wonders if his head and heart are in the game.

Last night’s loss dropped Oswalt to 4-6 with a 3.79 ERA. He has won only once since April 21. Do you realize that Kyle Kendrick has better stats than Roy? Kendrick is 4-4 with a 3.23.

As Richie Ashburn used to say, hard to believe, Harry.

Lower back tightness forced Oswalt out of last night’s game in St. Louis after two innings. He was trailing 4-0. It was his shortest outing in two seasons. “I was more heaving the ball than throwing it,” Oswalt told reporters. He expects to have an MRI on Monday.

The Phillies right-hander has had these back issues before. He left a game against Florida with back spasms on April 15, tried to pitch through it in his next two starts, only to land on the disabled list a couple of weeks later. Now the back is acting up again. Not a good sign.

It may not have helped that he was driving back-hoes and bulldozers, aiding in the tornado clean-up back home in Weir, Mississippi for more than a week. His stint on the 15-day DL began shortly after he returned. Whether that aggravated his condition is anyone’s guess, but it probably didn’t help. While he tended to the problems on the home front with the Phillies’ blessing, it is a bit curious that Oswalt would leave the team for that length of time. His family members were safe and unharmed, and his property suffered minimal damage.

It was the second time the Oswalts had suffered through the horrors of a tornado. The family home, the one Roy grew up in, was completely destroyed the first time around. This storm wasn’t nearly as bad, at least not in their area. Roy seemed to return with a renewed perspective on life in general. He talked about how baseball was “fourth on the list,” of his priorities. It made one question whether Oswalt’s passion for the game still burns. And if it doesn’t, that is a bigger problem than a recurring injury.

It appears that his back has not been right all year and that it is a factor in his struggles. It could be the chief reason for the two-time 20-game winner’s diminished velocity. Oswalt’s WHIP of 1.298 is his highest since 2007. But Phillies fans must hope the MRI is clean, and that he’s not headed for another stay on the DL; that this isn’t a chronic injury that derails his season. With such an impotent offense, the Phils cannot afford to be down to just three aces. They have the best record in baseball thanks mainly to their outstanding pitching. They need all four aces, and each on top of his game. Because a rotation of Halladay, Lee, Hamels, Worley and Kendrick somehow seems far too mortal, doesn’t it? The Phillies aren’t quite as formidable without Oswalt, or for that matter, with a scuffling Oswalt.

The way this team struggles to score runs, they need him to be the Roy Oswalt of a year ago, the one who went 7-1 as a Phillie. They need him. With a healthy back, and his head in the game.

System to cut surgery wait times

A new provincewide system aims to dramatically reduce wait times for patients with lower back pain.

When initial treatments don’t work, back pain patients are often added to a long lineup of people waiting to see a spine surgeon. The average wait time is about six months, and after all that waiting, more than 80 per cent of those patients don’t end up in the operating room, says Dr. Daryl Fourney, associate professor of neurosurgery at the University of Saskatchewan.

Education sessions for front-line health workers, plus two new spine clinics in Saskatoon and Regina, will attempt to steer patients away from long waits for specialists and get them into treatment more quickly. The goal: to whittle the family doctor-to-surgeon wait time down from six months to six weeks for the minority of patients who do need to go under the knife.

“Patients often wait an agonizingly long time to see a spine surgeon in Canada, only to find out – after they’ve had expensive tests like an MRI – that they don’t need surgery,” Fourney said at the opening of Saskatoon’s spine clinic in City Hospital. “The system, the way it is, is just not working very well.”

The strategy, called a “spine pathway,” began last year with education sessions for family doctors, chiropractors, nurse practitioners and physiotherapists, bringing them up to speed with the best evidence-based treatments for back pain.

About 450 health professionals have taken the course so far.

If trying best practices doesn’t work, health professionals can refer patients to the new spine clinics, which opened last month.

The clinics will determine who should see a surgeon, and who could benefit from other therapies – ideally cutting down surgeons’ queues.

The provincial strategy is a Canadian first, and possibly the first of its kind in the developed world, says Fourney .

“I don’t think throwing more money at the existing system is going to fix it,” he said. “What’s going make improvements and changes is really looking at what we’re doing, and trying to change the system around using those resources more effectively.”

Jackie Mann, vice-president of acute care for the Saskatoon Health Region, says the new approach should also help cut down on unnecessary MRI scans, and hopefully reduce wait times for the high-tech images.

More than a third of the MRIs done in the province are done on lower backs, and the new tack aims to reduce their numbers by five per cent within a year.

Treating back pain quicker

After waiting in agony for more than a year to get a diagnosis, Bryce McAuley is relieved the province has a prescription to assess and treat low back pain more quickly.

“I can’t get around – I drag one leg most of the time,” the 76-year-old Manor resident said on Thursday.

McAuley is one of 55 patients who have been referred to Regina’s spine pathway clinic since it opened in early May.

A spine pathway clinic on Broad Street in Regina and one at Saskatoon’s City Hospital have been set up to speed up the treatment and assessment of people suffering from low back pain.

The Ministry of Health worked with a team of national and international experts to classify all spine conditions into four patterns of pain. Family physicians, chiropractors and physiotherapists can take an online course (www. spine pathway.sk.ca) to learn how to use a standardized system to identify whether a patient’s back pain can be resolved with exercises and rest, or if an MRI or surgical referral is required.

“This is the only comprehensive spine care pathway,” said Regina neurosurgeon Dr. Joseph Buwembo. “It is a first for Saskatchewan and it’s a first for Canada. And, as far as we know, there is no other pathway of this nature in the world.”

McAuley is impressed by the treatment he’s received at the Broad Street clinic. After a thorough assessment by a physiotherapist, the senior was finally diagnosed.

“Three vertebraes are completely deteriorated and the sciatic nerve is causing pain down my right hip and leg … I’ve had constant pain for quite a few years,” he said.

On June 30, he’ll learn more about the surgery he requires.

At the Regina clinic’s official opening on Thursday, Health Minister Don McMorris said the spine pathway is part of the government’s overall plan to ensure that by 2014 no residents wait longer than three months for surgery.

“It’s difficult for family physicians to diagnose a patient with one of the 900 possible spine conditions,” McMorris said.

“The volume of referrals means wait times for MRIs and specialist consultations are just way too long. Saskatchewan’s spine pathway is addressing those challenges.”

Each year, about 10,000 Saskatchewan residents see a health-care professional because of back pain. About 5,000 are referred to a spine specialist, but only 20 per cent require surgery.

With a streamlined process, Buwembo expects patients will have shorter waits to see a specialist after their family doctor, chiropractor or physiotherapist refers them.

“We’re looking at 12 weeks as the patient journey to the final decision to treat, which will be a reduction from 42 weeks,” he said.

Dr. Brian Laursen, a busy family practitioner, said the spine pathway “is exactly what I need for my patients with low back pain.”

The pathway allows family doctors to identify patterns of pain based on the patient’s history and a simple examination.

“If I can go directly to managing the symptoms instead of finding out what the causes are, it makes my life a lot easier and it certainly makes it a lot easier for my patients,” Laursen said.

He said the pathway identifies a number of red flags that suggest potentially more serious underlying causes.

“We actually have a failsafe mechanism built into the pathway,” Laursen said.

If a serious problem is identified, the patient will get an urgent referral to a surgeon for assessment.

About 36 per cent of all MRIs performed in the province are for low back pain and injuries.

This year, the pathway’s goal is a five-per-cent reduction in the number of spine patients referred for an MRI.

For every 100 people removed from the wait list for an MRI of the spine, the wait time for an elective MRI is reduced by a week.

The ministry will spend about $675,000 to operate the provincial spine clinics in 2011-12.

“It’s a small number compared to what we’re going to see in savings on the back end,” McMorris said.

Arthritis Treatment News: Abbott, Biotest To Team Up On Treatment For Arthritis, Psoriasis

Abbott, Biotest To Team Up On Treatment For Arthritis, Psoriasis

Abbott Laboratories (ABT) reached an agreement with Biotest AG (BBTAY, BIO.XE) to develop and commercialize the Germany-based company’s treatment for rheumatoid arthritis and psoriasis.

Under the agreement, Abbott will pay an upfront fee of $85 million to Biotest, which specializes in haematology and immunology products. The agreement also includes potential milestone payments of up to $395 million.

The companies will co-promote the treatment in Germany, France, the U.K., Italy and Spain. Abbott will have exclusive rights outside those five markets.

Abbott’s diversified business lineup has cushioned it from some problems facing other large drug makers, such as patent expirations and generic competition. It has made a series of acquisitions in recent years to help reduce its dependence for sales growth on the anti-inflammatory drug Humira, which may face heightened competition in coming years.

Biotest’s treatment, which aims to improve the body’s immune system response to the diseases, is in phase II clinical trials. Preclinical studies are under way to assess potential use in other immune-system related diseases.

“This novel compound will strengthen Abbott’s immunology pipeline and we look forward to continuing to build on our expertise in exploring multiple mechanisms and approaches to treat inflammatory diseases,” said John Leonard, senior vice president of global research and development at Abbott.
Mexican pharmacy online
Abbott in April reported a 14% decline in first-quarter earnings on costs associated with acquisitions and employee layoffs, while newly acquired drugs in foreign markets contributed to a 17% increase in revenue.

Abbott shares were up 8 cents at $52.10 in early trading. Biotest’s American depositary shares rose 8 cents to $30.56.

FDA Committee Votes Against Green-Lighting Novartis’ Gouty Arthritis sBLA

An FDA advisory committee has voted against recommending the sBLA for Novartis’ ACZ885 (canakinumab) in the treatment of gouty arthritis in patients who don’t obtain adequate relief using NSAID drugs or colchicine. Although the advisory committee was happy with the efficacy of the drug, its concerns lay with overall safety. The committee has, as a result, suggested ACZ885 may be more suitable for a narrower population of patients. Novartis says it now aims to work with FDA to identify the right patient population.

The recommendation, which FDA is not bound by in terms of making a final regulatory decision, was based on the committee’s review of data from two pivotal Phase III studies in over 450 gouty arthritis patients. Reported by Novartis last month, the study results showed that in comparison with steroid therapy, treatment with ACZ885 led to better pain relief at 72 hours, and a 56% reduction in the risk of new attacks over six months. 28% of patients receiving ACZ885 experienced new attacks over 24 weeks, compared with 49% of patients treated using the injectable steroid triamcinolone acetonide.

ACZ885 is a fully human monoclonal antibody designed to selectively inhibit interleukin-1 beta. The drug is already approved under the brand name Ilaris® in over 45 countries, including the EU and U.S., for the treatment of adults and children with cryopyrin-associated periodic syndromes. Approval applications for canakinumab as a treatment for gouty arthritis in patients for whom other treatment are inadequate were submitted in the EU in 2010 and in the U.S., Canada, and Switzerland in the first quarter of 2011. A final FDA decision is expected during Q3 2011.

Arthritis treatment undergoes Rapidfact testing

Quotient Clinical has announced an agreement with Medigene to undertake a Rapidfact formulation development and clinical testing programme on Rhudex.

This is subject to ethical and Medicines and Healthcare Products Regulatory Agency approval.

Rhudex is a potential first-in-class treatment for rheumatoid arthritis and other inflammatory disorders.

Quotient Clinical’s Rapidfact service makes use of its tightly integrated GMP manufacturing and clinical testing processes and facilities to enable the rapid clinical evaluation of new drug formulations.

Rapidfact is said to enable shortening of project timelines and a reduction of ~90 per cent in API consumption.

Dental Care News: Free dental care gives uninsured a reason to smile

Eastman Dental Celebrates Completion of $5.9 Million Renovations

Eastman Dental today celebrated the completion of a two-year, $5.9 million renovation and re-engineering project that allows a major increase in access to care in both downtown Rochester and at its main clinic site on the University of Rochester Medical Center campus.

Rochester Mayor Tom Richards, and representatives from the offices of Senator Kirsten Gillibrand, Representative Tom Reed, Representative Ann Marie Buerkle, Assemblyman Sean Hanna, and Assemblyman Mark Johns, and County Executive Maggie Brooks were present to help celebrate this new chapter for Eastman Dental, which for nearly 100 years, has been Rochester’s largest oral health care provider to the underserved.

Since the late 1990’s, patient demand each year increasingly exceeded capacity at both locations. The number of patients who came in for dental emergencies increased 100 percent over five years, placing significant strain on Eastman’s facilities and its ability to provide comprehensive care to all patients. In late 2008, Eastman Dental was awarded a $3.9 million New York State HEAL (Health Care Efficiency and Affordability Law) grant to enhance emergency services for the underserved, while creating a gateway to regular oral health and medical care, and to increase access and capacity for the underserved.
Diflucan Canada pharmacy
With those funds, Eastman Dental built at its main site on Elmwood Ave. a first-of-its-kind urgent care dental clinic, added six new treatment rooms in its General Dentistry and Orthodontic clinics, expanded and reconfigured its check-in and check-out process to provide better quality care, and more efficient service for all patients. Eastman Dental Downtown added four new treatment rooms, allowing twice as many patient visits as before in this high poverty area of Rochester, as well as a much needed makeover to the waiting room and clinic areas. In both locations, aging equipment was replaced, new technology was incorporated to increase scheduling and treatment efficiency, and ongoing training for staff and streamlining operations was put in place.

Cyril Meyerowitz, D.D.S., M.S., director, Eastman Institute for Oral Health, announced that U of R and Eastman Dental alumnus and Midland Management President Jack W. Howitt, AB, DDS, made one of the largest individual gifts in Eastman Dental’s history, and dedicated the newly named Howitt Urgent Dental Care clinic during the ceremony.

“I’ve always had a firm connection to dentistry and watching Eastman Dental morph into the Eastman Institute for Oral Health has been exciting,” Howitt said. “For me, the new urgent care portion of Eastman Institute was a logical place to direct my commitment. This gift marks my 55th reunion year from the U of R, and honors my two late uncles, Dr. Nathan G. Howitt and Dr. S. Michael Howitt, who were both in the dental profession.”

In addition, major functional and cosmetic renovations to the atrium and all the waiting rooms improve patient flow and customer service.

On display are beautiful glassware, Inuit and African sculptures, and other artwork donated by Stanley Handelman, D.D.S., former chair of the Advanced Education in General Dentistry Division and highly regarded professor, researcher and mentor for 40 years. Together, the artwork and new furniture provide a tranquil, comfortable, and inviting space in the newly designed atrium, where coffee and refreshments are available for purchase, and a patient ambassador is always available to answer any questions.

“We are extremely grateful for Jack Howitt’s generosity and commitment to our patients,” Meyerowitz said. “The new urgent care clinic and the renovations and updates are allowing us to provide substantially better quality, patient-centered care more cost effectively.”

Free dental care gives uninsured a reason to smile

Felecia Haywood bounded out of the dental chair, still numb but giddy after getting three fillings and having her chipped front tooth repaired.

“I’ve got my smile back!” said Haywood, 50, who had not been to a dentist since the fifth grade. She chipped her tooth about 10 years ago while eating.

Haywood and dozens of homeless and very-low-income patients of the nonprofit Glide Health Services in San Francisco received two weeks of free dental cleaning and treatments at Tooth Travelers, a mobile dental program stationed in the parking lot of Glide Memorial Church’s parking lot at 330 Ellis St. through today.

A dentist and assistants extracted more than 45 teeth and filled at least 50 cavities during 140 appointments in the 40-foot dental van since setting up at Glide on June 6. Many of the patients had been waiting for months for the chance to see a dentist.

“As health care reform is happening, there’s really nothing for people 18 and over when it comes to dental services,” said Karen Hill, clinic manager of Glide Health Services, a nurse-run health program at the church’s foundation for the needy and homeless.

Because of budget constraints, the state eliminated virtually all adult Medi-Cal dental services, known as Denti-Cal, in July 2009. The decision has left indigent and uninsured people with few options, so they often show up at emergency rooms in pain to have their teeth pulled and abscesses treated.

Services in the van are limited to dental screening, teeth cleaning, fillings, simple extractions, fluoride treatments and X-rays. Patients with more serious dental problems are referred to UCSF and University of the Pacific dental schools and community clinics for low-cost care.

The last time James Jones needed dental treatment, he had to go to San Francisco General Hospital for an abscess and a broken tooth. But the 60-year-old retired AC Transit worker, who has been without dental coverage since 1996, said through a mouth of cotton that his experience at the mobile clinic was more comfortable and completely painless.

“I hate dentists, but they were very pleasant,” said Jones, referring to the dental assistant and Dr. Monte Cooper, who removed five of Jones’ teeth during two visits to the trailer.

Tooth Travelers, based in Placerville (El Dorado County), was founded by Julie Day in 2009 after she was laid off from her job after 23 years in the dental insurance industry.

The mobile unit typically visits affordable housing developments and is funded by those property owners. The van’s visit to Glide was funded through a $25,000 donation from Wells Fargo.

“These people have challenges most of us will never experience or even comprehend,” Day said of the patients at Glide. “They are truly gracious and grateful.”

James Inglis, 47, had 18 teeth pulled about 12 years ago when he quit using drugs. Inglis, who has an upper and lower dental partial, was grateful to receive free dental services at the mobile unit because he has been laid off from his job and is homeless.

“Of course, I only have six teeth left, but that’s OK,” he said “They’re healthy.”

Asthma Treatment News: UK doctors begin pioneering asthma treatment

UK doctors begin pioneering asthma treatment

Doctors in Manchester and Glasgow have begun treating NHS asthma patients with a pioneering treatment described as “melting away” muscle in the airways.

Instead of using drugs such as steroids, a wire probe is inserted into the lungs and then heats the tissue.

Currently, the procedure – called bronchial thermoplasty – is not being used anywhere else in Europe.

The technique uses 10-second bursts of radio waves which heat the lining of the lungs to 65 degrees Celsius.

That destroys some of the muscle tissue which constricts during an asthma attack, making breathing difficult.

Dr Rob Niven, senior lecturer in Respiratory Medicine at the University Hospital of South Manchester, who led the team carrying out the procedure at Wythenshawe Hospital, said “bronchial thermoplasty is the first non-drug treatment for asthma and it may be a new option for patients with severe asthma who have symptoms despite use of drug therapies.”

“The operation went according to plan and our patient has responded well. It will be a little while before we are able to say it’s been a complete success, but I am cautiously optimistic,” he said.

Normal airway
Airway of asthma patient has thickened muscle walls restricting the opening
Bronchoscope containing small wire probe passed into lungs
Probe is expanded so it touches walls of airways
Probe is then heated, reducing thickness of muscle tissue. Process is repeated along the airway to increase capacity
‘Encouraging’

The procedure follows six years of trials in the UK, Canada and South America. Patients in the United States have been receiving the treatment for some months already.

Bronchial thermoplasty will not be used on children, says Dr Niven, and its effectiveness decreases as patients age.

Tens of thousands of patients across the UK with the most severe forms of asthma stand to benefit most from the treatment.
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Symptoms can worsen to begin with, as the heat also causes damage to the sensitive lung lining. But once this is repaired doctors say asthmatics can be helped for up to five years.

However, cost is a potential problem – it costs around £10,000 per patient, although savings could be made in the longer term through fewer hospital admissions and reductions in the costs of medicines.

It will be up to the local NHS bodies, which buy care for patients, to decide on whether to fund it, possibly on a case-by-case basis.

According to the campaign group Asthma UK, 5.4 million people in the UK have asthma and around 250,000 of these have severe asthma.

The group’s Chief Medical Adviser, Professor Ian Pavord, said of bronchial thermoplasty: “In some people with severe asthma, the symptoms of their asthma have been improved and the risk of them having an asthma attack has been reduced, so it is encouraging to see that the technique has now been carried out outside of clinical trials.”

“However, this kind of procedure will not work for everyone so we would encourage people with asthma to discuss various treatment options with their GP to find the best way for them to keep their asthma managed and under control.”

Anthropology of Asthma

Citing a study he conducted in India — in which he showed doctors video footage of people with typical asthma symptoms — Van Sickle notes that in some cultures, physicians are hesitant to diagnose patients with asthma because of social stigma.

“A diagnosis of chronic disease can impair a woman’s marital chances, and a physician is unlikely to make an unpopular diagnosis because a patient can always go down the street and get a different physician,” Van Sickle says of the study performed in India. After performing the same experiment in Wisconsin, he found that doctors were considerably more likely to associate the symptoms with asthma.

Van Sickle suggests that the additional study of lifestyle factors should reveal a better understanding of potential causes of the disease and help physicians treat and eventually prevent asthma.

Indians Eat Live Sardines to Cure Asthma

Indians Eat Live Sardines to Cure Asthma– In an effort to cure asthma, hundreds of Indians gather for an annual ‘fish medicine festival’ where live sardines are consumed. Despite efforts to battle the respiratory affliction, this somewhat bizarre tradition has garnered negative attention from human right campaigners around the world.

The festival takes place every June on a day determined by astrological means. The ‘treatment’ of eating live sardines is administered by members of the Goud family in southern India. According to the Goud family, they have been administering this treatment to those afflicted with asthma for 166 years.
Indians Eat Live Sardines to Cure Asthma

Millions of people suffer from asthma and other respiratory diseases in India. The treatment the Goud family administers is taking a live sardine and smearing it with ‘secret’ spices. According to legend, this recipe of ‘secret’ spices was given to them by a Hindu Saint who said they could never profit from it. For that reason the hundreds of thousands of people over the years who have come to the Goud family have received their sardines for free.

There is no evidence that this is effective in any way. Human rights organizations are protesting about children’s participation in the event. They think that their lack of consent and the questionable hygienic practices are in violation of basic human rights.

Quit Smoking News: EU launches new quit smoking campaign

EU launches new quit smoking campaign

Ex-smokers have more money, more freedom, better health and less stress than smokers, argues the European Commission in its new campaign, ‘Ex-smokers are unstoppable’. Launched on 16 June, it emphasises the advantages of quitting, whereas the previous two campaigns – ‘Feel free to say no’ (2002-2004) and ‘HELP’ (2005-2010) – stressed the dangers of smoking. This new action focuses on the benefits to smokers of kicking the habit and provides practical aid through the free iCoach platform, which also aims to help those not planning to quit and those in danger of taking up smoking again.

“As a former smoker myself, I know how hard it is to quit, but most importantly how gratifying it is. We need motivation and practical help, two things provided by this new campaign,” commented Health Commissioner John Dalli at the kick-off of the campaign in a park near the European Commission.

The campaign will run from 2011 to 2014 and specifically targets smokers between 25 and 34-years-old, which represents nearly 28 million people in the EU. Smoking is the leading cause of avoidable illness in the EU and the cause of death of more than 650,000 people in the Union every year. To date, 15 member states have passed laws that protect citizens on the whole from exposure to tobacco smoke.

Up in smoke: Tobacco issues

This year, more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment, or other disease. That does not include the more than 600,000 people who will die from exposure to second hand smoke.(1) Countries throughout the world are instituting tobacco control measures, such as the WHO Framework Convention on Tobacco Control, to help reduce the harm caused by smoking. World No Tobacco Day was May 31. Ashtrays with fresh flowers are a common symbol of World No Tobacco Day. Is an International Tobacco Control Project: Evaluating the impact of the WHO treaty across the globe, the answer?

Do you consider it your responsibility to help your patients quit smoking? If so, then you are in good company. The American Dental Hygienists’ Association (ADHA) thinks so as well. Also, a recent study that surveyed 231 periodontists found that 92% believe that tobacco-cessation interventions are a responsibility of the dental profession.(2) While the topics surrounding these issues are many, this issue will highlight how to reach younger smokers with a quit message, second hand smoke and risk for periodontitis, a message from the Smoking Cessation Leadership Center, and the hookah and its effects on oral health.
The Mexican pharmacy
In addition to systemic health issues, tobacco use and dependence causes oral health problems and has a great impact on the development and progression of periodontal disease. There is a clear causal relationship between smoking and periodontal disease and the negative effects of smoking on wound healing.(3) Smokers present tougher bacterial challenge to periodontal treatment than non-smokers.

Periodontal disease is difficult to successfully treat in any dental patient. One patient type that can be especially challenging is smokers. Smokers are up to 6X more likely to experience periodontal destruction compared to non-smokers.(4) A new study has found that smoking may pose other problems.(5) In patients with moderate-to-severe chronic periodontitis, researchers in this study found that smokers consistently demonstrated lower levels of health-protective bacteria, and significantly higher levels of disease-related bacteria subgingivally. These included higher levels of the red complex Treponema and Tannerella species, which have been linked to more severe and refractory periodontitis.(6,7)

This may help to explain why smokers are less responsive to scaling and root planing (SRP) alone, exhibiting smaller pocket depth reductions and fewer clinical gains resulting in deeper periodontal pockets.(4,8,9,10,11,12) In addition to other types of treatment, minocycline microspheres improve healing in patients who smoke. A study demonstrated that at 9 months, patients experienced 32% greater reduction in pocket depths with Arestin+ SRP vs. SRP alone.(9) Another study demonstrated that Arestin+ SRP was nearly 4X more likely to reduce pockets to <5 mm than SRP alone.(13) **

Tobacco-dependence treatment and tobacco cessation programs are vital components of clinical practice, and tobacco cessation programs should be incorporated into practice protocols. The use of tobacco cessation interventions by dental hygienists, general dentists, and oral maxillofacial surgeons has been reported in the literature. There is an ADA code for tobacco counseling in dental practice, D1320, and this can be used when cessation programs are implemented.

The primary barriers to providing tobacco-cessation interventions were low patient acceptance of treatment, lack of time, and lack of training. The following were other barriers cited: lack of reimbursement; believing that there was little chance of success in providing tobacco-cessation intervention; believing that patient acceptance of treatment is low; possibility of offending and losing patients; and lack of personal interest by the provider.

The basic steps of a tobacco-dependence treatment protocol can be implemented in three minutes or less. If the dental hygienist is familiar with community or state resources for tobacco-dependence treatment, like 1-800-QUIT NOW quit hot line, patients can be given information on these resources and referred for further assessment and assistance in quitting.

Ask, advise, refer is a shortened form of the 5 A’s (ask, advise, assess, assist, and arrange) — a series of steps to be used in a healthcare setting to treat tobacco use and dependence — and for promoting tobacco cessation. For more information, go to ADHA’s www.askadviserefer.org. When it comes to lack of reimbursement, while many insurance plans do not provide coverage for cessation counseling, this seems to be changing.

In a newly updated Cochrane Review, Cahill and Perera summarize the effectiveness of incentives for smoking cessation.(14,15) Their disappointing conclusion is that, while there is some evidence that incentives work in the short term, the effects generally dissipate, and there is still insufficient evidence to recommend their adoption into routine practice. Much therefore remains to be discovered, but what are the particular questions that this review highlights?

Behavior change has been divided into “simple” or single actions at a point in time, and “complex” behavior change are those requiring effort over a sustained period.(16) Adherence to medication is an example of a simple behavior change. A systematic review in the British Medical Journal (BMJ), which assessed financial incentives to motivate adherence to medical instructions, identified 11 randomized controlled trials.(17) The incentives ranged from USD 5 to about USD 1,000. Of the 11 studies included in the review, 10 demonstrated a positive effect. The studies incentivized several types of interventions, such as immunization, engaging with antihypertensive treatment, attending postpartum appointments, completing cocaine dependency treatment, and dental care for children.

Complex behavior change requires both sustained effort and typically the adoption of multiple strategies to achieve change. Tobacco and smoking cessation, and weight loss to reduce obesity, require complex behavior change. A systematic review of trials of incentives for weight loss found that larger incentives seemed more effective but that the effectiveness of interventions seemed to decline when the incentive was withdrawn, paralleling the data in the Cahill and Perera review.(18)

Should we conclude that incentives are effective for simple but not complex behavior change? This conclusion does not take into effect the strong evidence for the efficacy of incentives for the management of drug misuse.(19) There is also evidence for improved abstinence from problem drug use, clearly a complex behavioral change. Although ceasing to use illicit drugs does require complex change, some actions are simple. Deciding to engage in a treatment program and partaking in programs for supervised dispensing of methadone are simple behaviors. These are part of the set of behaviors that have been effectively rewarded in previous trials of incentives in drug misuse.

The shining exception to the rather negative findings in the Cochrane Review of incentives for smoking cessation is the trial by Volpp and colleagues.(20)

In the Volpp study, participants obtained rewards for attending a smoking cessation clinic and for validated abstinence. As a result, nearly three times as many in the intervention group attended as in the control group. The intervention also increased the rate at which participants achieved abstinence at short-term follow-up. Though a somewhat lower proportion of people who achieved early abstinence returned to smoking in the intervention group than the control group, it seems the main effect was inducing two simple behavior changes. One prompted individuals to decide to quit smoking, and the other prompted individuals to use evidence-based treatment.

Smoking in pregnancy is a difficult public health problem. A Cochrane Review of smoking cessation in pregnancy found that many of the interventions that are known to be effective in adult smokers are not known to be effective in pregnant women.(21) Financial incentives seemed the most effective intervention, increasing abstinence over three-fold. However, the outcomes of these trials were abstinence for the previous seven days, so the data are preliminary. According to the authors, many women who smoke in pregnancy are among the most disadvantaged in society. If incentives have a place in smoking cessation, it is perhaps this group who might be seen as the most deserving.

Both this review and the Cahill and Perera review show us the potential value of incentives. They appear to work sometimes for some smokers. Understanding how they work, whether the benefits are sustained, and that their effects are not due to gaming the system, is a public health priority.

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to second hand smoke, and another 8.6 million live with a serious illness caused by smoking. The CDC issued a brief entitled “Tobacco Use: Targeting the Nation’s Leading Killer, At A Glance 2011”.(22)

The tobacco use epidemic can be stopped. The Institute of Medicine (IOM) report, “Ending the Tobacco Problem: A Blueprint for the Nation”, presents a plan to “reduce smoking so substantially that it is no longer a public health problem for our nation.(23) Foremost among the IOM recommendations is that each state should fund a comprehensive tobacco control program at the level recommended by CDC in Best Practices for Comprehensive Tobacco Control Programs–2007.(24) This publication is a guide to help states plan and establish effective tobacco control programs to prevent and reduce tobacco use.

Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking. A comprehensive program is a coordinated effort to establish smoke-free policies, reduce the social acceptability of tobacco use, promote cessation, help tobacco users quit, and prevent initiation of tobacco use. This approach combines educational, clinical, regulatory, economic, and social strategies. Research has documented the effectiveness of laws and policies to protect the public from second hand smoke exposure, promote cessation, and prevent initiation by young people.

CDC also promotes MPOWER, a package of six proven strategies identified by the World Health Organization (WHO) that can help reduce tobacco use and tobacco-related illness and death.(26) Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; and Raise taxes on tobacco.

CDC, in partnership with the National Cancer Institute, the North American Quitline Consortium, and state tobacco control programs, has developed the National Network of Tobacco Cessation Quitlines. By calling 1-800-QUIT NOW, callers from across the nation have free and easy access to tobacco cessation services in their state.(27)

So what are you waiting for? With all these resources, there is no excuse not to assist your patients with tobacco cessation. If not you, who? If not now, when?

Will Quitting Smoking Make You Fat?

Many smokers who want to quit are afraid they will gain weight, so they rather not kick the habit. The fear of getting fat after quitting is not altogether unwarranted. Many ex-smokers do put on some extra weight, about five pounds on average.

Now, scientists think they know why. Recent studies have shown that nicotine helps suppress appetite by activating certain receptors in the brain, especially those in the so-called “reward regions,” where we sense pleasure and from where many of us also develop addictions.

A team of researchers at Yale University School of Medicine now found that nicotine can also bind regulator neurons to these receptors, which send out satiety messages, much like the signals our brain receives when our stomach is full to make us stop eating.

This mechanism may explain why smokers are usually not as hungry when they smoke and why they tend to eat more after quitting.

Considering the implications of their study results, some scientist now hope to develop a drug that can simulate the effects of nicotine on the brain, thereby eliminating the health hazards commonly attributed to tobacco use. Appetite-controlling drugs, like cytisine, to help quitters avoid unwanted weight gain are already available in Eastern Europe but not in the U.S.

Developing drugs that target specific receptors in the brain is a difficult challenge. Some scientists involved in this kind of research have warned that even if drug treatments were to prove effective, they may also trigger some unwanted side effects. The reason is that the receptors in charge of regulating appetite are also closely connected to the body’s stress responses, which normally are only mobilized in times of acute danger. Activating these receptors on an ongoing basis through medication could lead to symptoms similar to chronic stress and, over time, to diseases like high blood pressure and heart disease.

Of course, everyone agrees that fear of gaining weight should not ever prevent smokers from quitting. Instead of waiting for a wonder drug that might help people stay slim, there are many better ways to regulate one’s appetite and manage one’s weight more naturally.

A good way to start is to be more conscious of the metabolism. Smoking raises the metabolic rate and also increases the heart rate up to 20 times of normal. This is one reason why many smokers suffer from high blood pressure and heart disease.

When smokers quit, their metabolism slows down considerably. It can take weeks or even months before metabolic levels stabilize at normal levels. Meanwhile, calories are being burned at a much lesser rate. At the same time, many recovering smokers eat more food to cope with withdrawal symptoms or boredom. Senses of taste and smell come back to life after quitting, which may increase appetite as well.

Alcohol is often used to “take the edge off” when the cravings become more intense. Alcoholic beverages, of course, have lots of calories, and all too often these are not taken into account.

Another reason for increase of food intake is what smokers call “oral gratification.” Many ex-smokers miss the feeling of “having something to do with their mouths and hands.” Frequent snacking often serves as a substitute to fill the void.

Many people reach for food for similar reasons smokers reach for cigarettes, namely to handle stress, to reward or comfort themselves, to pass time, deal with boredom or to be social. For smokers trying to quit, the choice of means may change but not necessarily their behavioral tendencies.

So, is there a special regimen for ex-smokers to avoid falling into the weight gain trap? Not really. Ultimately, they have to act just like the rest of us who try our best to stay in shape: Healthy eating, limiting portion sizes, no snacking, regular exercise, stress reduction and enough sleep. Following all these measures combined should render any wonder drug of the future obsolete right now.

Obesity Treatment News: Benefits of obesity treatment depend on individual

Benefits of obesity treatment depend on individual

Recent research has suggested that different groups of people stand to gain in different ways from obesity treatment.

Published in the JAMA journal, the study looked at 850 veterans who underwent obesity treatment between 2000 and 2006.

A control group were also monitored, who had an average age of 54.7 and an average Body Mass Index (BMI) or 42.

The veterans, meanwhile, had an average age of 49.5 years and a BMI of 47.4.

A total of 1.29 per cent of the surgical cases died within 30 days of surgery, but once six years had passed, a mortality rate of 6.8 per cent was recorded in this group.

Meanwhile, the control group had a mortality rate of 15.2 per cent after this time.

However, further analysis concluded that the surgery was not significantly associated with reduced mortality when propensity-match patients were looked at.

The study’s authors noted: “Our results highlight the importance of statistical adjustment and careful selection of surgical and nonsurgical cohorts, particularly during evaluation of bariatric surgery according to administrative data.”

Obesity Groups See Evidence FDA Decisions Will Discourage Obesity Research

The Obesity Care Continuum (OCC), represented by The Obesity Society (TOS), the Obesity Action Coalition (OAC), the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American Dietetic Association (ADA), expresses a deep concern for the recent decision by the FDA, Division of Metabolic and Endocrinologic Products (DMEP), to require Orexigen to conduct a pre-approval cardiovascular outcomes trial for Contrave, even after the FDA Advisory Panel voted for approval of Contrave with a post-approval cardiovascular trial. Furthermore, the OCC believes that the requested pre-approval outcomes trial is unprecedented for any disease and would generate more information than is necessary or feasible.

This verdict has far broader consequences than simply impacting one company and one drug. The decision falls on the heels of two other decisions to disallow additional drugs for obesity treatment made over the last 12 months by the FDA, Center for Drug Evaluation and Research (CDER). The FDA/CDER’s charge is “to perform an essential public health task by making sure that safe and effective drugs are available to improve the health of people in the United States.” The agency has not approved an obesity drug since 1999, and, last year, also removed from the market a drug it approved in 1997. The OCC feels this track record shows a trend of the FDA being “benefit-blind” causing an overly risk averse position. “We believe that in order to comprehensively treat the disease of obesity, healthcare professionals must have access to a variety of treatment options. We are extremely disappointed in the short-sightedness of the FDA to objectively and fairly evaluate benefits as well as risks of potential obesity medications,” said Jennifer Lovejoy, TOS President.

If the Agency’s approach to this class of drugs continues, it will likely further discourage any research and development in the area of obesity ever again. We have already witnessed the withdrawal of the major pharmaceutical companies from this market given the lack of clear predictability surrounding FDA’s approval process. We are now seeing the same result in the small biotech market and truly wonder who will fill this void in the absence of any firm drug approval guidance from the FDA.

The greatest consequence however is the impact that lack of treatment options has on the American people. More than a third of US adults are obese, and vulnerable to obesity’s damaging consequences and a growing number are severely affected and left without treatment options. Obesity is responsible for the deaths of more than 100,000 Americans each year. Costs attributable to obesity and overweight have been estimated at $270 billion annually, including direct medical costs and indirect costs, such as absenteeism and productivity losses. “The result of limiting treatment options for healthcare professionals will be catastrophic to the health of millions of Americans and our healthcare system,” said Joe Nadglowski, OAC President and CEO.

With the obesity epidemic driving risk for type 2 diabetes, sleep apnea, fatty liver disease and many other co-morbidities, we cannot afford to wait any longer to fairly weigh the risks against the benefits and the benefits lost to find a way toward drug approval.

About OCC

All of our organizations work together representing patients, registered dietitians, scientists, clinicians, and surgeons to elevate the recognition of both the prevention and treatment of obesity.

About TOS

The Obesity Society is the leading scientific society dedicated to the study of obesity. Since 1982, The Obesity Society has been committed to encouraging research on the causes and treatment of obesity, and to keeping the medical community and public informed of new advances. Visit TOS at obesity.org.

About OAC

The OAC is a national nonprofit charity dedicated to helping individuals affected by obesity. The OAC was formed to bring together individuals struggling with weight issues and provide educational resources and advocacy tools. In 2011, the OAC launched a national Membership Drive to recruit 50,000 members to strengthen its advocacy efforts and raise awareness of the disease of obesity. For more information on OAC Membership, please visit www.obesityaction.org.

About the ASMBS

The mission of the ASMBS is to advance the art and science of bariatric surgery by continued encouragement of its members to: improve the care and treatment of people with obesity and related diseases; advance the science and understanding of metabolic surgery; foster communication between health professionals on obesity and related conditions; and advocate for health care policy that ensures patient access to high-quality prevention and treatment of obesity. Visit ASMBS at asmbs.org.

About ADA

The American Dietetic Association is the world’s largest organization of food and nutrition professionals. ADA is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy. Visit ADA at eatright.org.

Genetic factor controls obesity-induced inflammation

ISLAMABAD: Scientists have discovered a genetic factor that can regulate obesity-induced inflammation that contributes to chronic health problems.

Researchers at Case Western Reserve University School of Medicine feel if they learn to control levels of the factor in defense cells called macrophages, they would find a new treatment for health-harming obesity.

“We have a shot at a novel treatment for obesity and its complications, such as diabetes, heart disease and cancer,” Mukesh K. Jain, MD, Ellery Sedgwick Jr. Chair, director of the Case Cardiovascular Research Institute, and senior author of the new study, said.

Macrophages contain low levels of KLF4 and are more easily irritated by cytokines, which are cell-signalling proteins, and fatty acids released by fat cells, and they respond by producing a low level of inflammation, Jain explained.

“A low level of inflammation over time is deleterious,” he said.

In people, long-lasting inflammation is connected to diabetes, increased risk of cardiovascular disease, cancer and other chronic illnesses.

In experiments using mouse models, Jain’s team found that when KLF4 was removed from macrophages, they all assumed the inflammatory state.

Furthermore, when the KLF4-deficient mice were fed a high-fat diet for 10 weeks, they gained 15 percent more weight than control animals fed the same diet, and developed severe diabetes as evidenced by glucose tolerance tests.

The researchers are now designing experiments to determine if they can prevent or reverse the shift from anti-inflammatory to inflammatory by increasing KLF4 levels in macrophages as cytokines or fats bombard them.

The findings have been published online in the Journal of Clinical Investigation

New Study Identifies Key Risk Factors for Bariatric Surgery

Newswise — ORLANDO, FL – June 15, 2011 – University of California at Irvine (UC Irvine) researchers reviewed data from more than 100,000 bariatric surgery patients and discovered the top six risk factors that could help doctors and patients predict, evaluate, reduce or avoid in-hospital mortality after weight loss surgery. The findings* were presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

The risk factors include the type of weight loss operation (gastric bypass or gastric band), surgical technique (open or laparoscopic), patient gender, type of insurance (private or Medicare), age and the presence of Type 2 diabetes. Researchers say one or more of these risk factors may increase the risk of death before discharge from the hospital.

“Bariatric surgery is safer than it has ever been, but there may be more we can do to make it even safer and improve the odds of survival for high risk patients,” said Ninh T. Nguyen, MD, the study’s primary author and Chief of the Division of Gastrointestinal Surgery at UC Irvine Medical Center. “Doctors can use these risk factors to help in pre-operative planning and to help patients better understand his or her individual risk.”

Researchers analyzed hospital discharge data from the University HealthSystem Consortium (UHC) database where they identified 105,287 patients who underwent bariatric surgery between 2002 and 2009 at academic medical centers in the United States. More than 80 percent of the patients were female and nearly three-quarters were Caucasian. The type of operations included laparoscopic gastric bypass (45%), open gastric bypass (41%) and laparoscopic adjustable gastric banding (14%). The overall in-hospital mortality rate was 0.17 percent, which was the primary outcome examined in the study.

For each top risk factor an adjusted odds ratio (AOR) was calculated using statistical analyses to determine its individual and relative impact on in-patient mortality. The higher the AOR, the greater the odds of it having an impact on patients.

The study showed a person who had an open, rather than a laparoscopic, weight loss operation faced nearly five times (AOR 4.8) the risk of in-hospital mortality. The AOR was 5.8 if the patient had a gastric bypass versus non-bypass patients, 3.2 if the patient was male, 3.0 if the patient had Medicare coverage rather than private insurance, 1.9 if the patient was age 60 or over and 1.6 if Type 2 diabetes was present.

“It’s important to remember that despite these risk factors, we are still talking about highly effective and safe operations that result in significant weight loss and improvement or resolution of obesity-related diseases. Morbid obesity itself is a major risk factor for premature death, and in fact may be riskier without intervention than the surgery itself,” added Dr. Nguyen. “The data shows laparoscopic bariatric surgery has become no riskier than gallbladder or hip replacement surgery.”

Previous studies have shown that the risks of living with morbid obesity outweigh the risks of bariatric surgery ,(1) and that patients may improve life expectancy by 89 percent(2) and reduce their risk of premature death by 30 to 40 percent ,(3,4) after bariatric surgery.

Dr. Nguyen and his colleagues also identified a simple risk classification system that aims to enable clinicians to predict individual patient risk of mortality that they can use to strategize a preoperative plan that may reduce surgical risk. In this bariatric mortality risk classification, patients can be grouped according to a score that is calculated based on the number of points assigned to their individual risk factors (I, II, III, or IV). The lowest risk group (class I) has an in-hospital mortality of 0.10 percent while the highest risk group (class IV) has a mortality of 0.70 percent.

Bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions.(5) People with morbid obesity have BMI of 40 or more, or BMI of 35 or more with an obesity-related disease such as Type 2 diabetes, heart disease or sleep apnea. Recently the FDA approved the use of an adjustable gastric band for BMI 30 and above, recognizing that there is an increase in mortality and medical complications of obesity at even this level of obesity.

According to the ASMBS, more than 15 million Americans have morbid obesity. Studies have shown patients may lose 30 to 50 percent of their excess weight 6 months after surgery and 77 percent of their excess weight as early as one year after surgery.(6)

The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB). Bariatric surgery limits the amount of food the stomach can hold, and/or limits the amount of calories absorbed, by surgically reducing the stomach’s capacity to a few ounces.

The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion,(7) double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018.(8) The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of bariatric surgery due in large part to improved laparoscopic techniques and the advent of bariatric surgical centers of excellence. The overall risk of death from bariatric surgery is about 0.1 percent(9) and the risk of major complications is about 4 percent.(10)

In addition to Dr. Nguyen, study authors include Brian Nguyen BS, Brian Smith MD, Xuan-Mai T. Nguyen PhD, Christian Elliott BS, Kevin Reavis MD, and Samuel Hohmann PhD.

About the ASMBS

The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients.

Cancer Prevention News: Explaining New High Risk Breast Cancer Prevention Treatment

Explaining New High Risk Breast Cancer Prevention Treatment

“A new study, using estrogen-fighting drugs, helps prevent breast cancer in high risk patients—with fewer side effects,” said Dr. Robyn Young, a specialist focusing entirely on breast cancer treatment (http://www.thecentertx.com/physicians_young.html).

Young explained, “Estrogen is a hormone that causes some types of breast cancer cells to grow. These drugs, also called aromatase inhibitors, remove estrogen. Compared to the existing prevention therapy, Tamoxifen, which slightly increases the chance of blood clots or endometrial cancer, these drugs look like a much better option for patients with a high risk of getting breast cancer.”

The new study, announced this week at the annual meeting of the American Society of Clinical Oncology, showed that aromatase inhibitors cut the relative risk of getting breast cancer by 65%, for women who had at least one risk factor—without the traditional side effects. The study was led by Dr. Paul Goss of Massachusetts General Hospital and involved 4,560 women.

This therapy is not intended to prevent the disease in those with an average risk.

High risk factors include, but are not limited to:
Family history of breast cancer
Breast biopsy results showing abnormal cells called hyperplasia
Genetic testing results showing possible future breast cancer

Irvine boy donates presents to cancer patients

When most 7-year-olds think about their birthday, they don’t focus on giving their presents away to cancer patients.

But this year, Jet Charter, 7, of Irvine and several friends brought more than 100 gifts and toys to pediatric cancer patients undergoing radiation treatment at St. Joseph Hospital in Orange.

The Todos Conference Room in The Center for Cancer Prevention and Treatment was decorated with balloons and kids were served birthday treats.

Jet and friends lined up to put birthday gifts and donated toys in the hospital’s ‘treasure chest.’ After radiation treatment, patients get to select a gift from the treasure chest before going home.

The room filled with hospital employees, and parents and kids sang “Happy Birthday” to Jet. At the end of the song, Jet was presented with a thank you certificate from the hospital.

Jet’s father, Ron Charter, worked closely with the hospital and received support from friends and family.

Gift cards from Jet’s birthday party were used to purchase toys for girls’ and unisex toys for all of the children undergoing radiation treatment at the cancer center.

The family hopes to return next year for Jet’s 8th birthday in hopes to always keep the treasure chest full of toys for the patients.

Massive trial trying to pinpoint cause of cancer

David Greenway’s death from brain cancer on Nov. 17, 1991, came four months after he began getting excruciating headaches.

They turned out to be the first symptoms of the disease.

Greenway died two days before his 23rd birthday. At the time, Suzanne Mensch, Greenway’s older sister by 14 months, couldn’t help but wonder if cancer would strike her next.

“Any headache for the longest time has really scared me,” said Mensch, 43, of Elkton, Md. “It really has freaked me out where I wonder whether this is the beginning of a cancer diagnosis.”

Mensch still wonders why she has been spared from cancer and her brother was killed by it. She hopes researchers will be able to unlock that mystery through her participation in a cancer trial that has recruited people in New Castle County and Cecil County, Md.

The Cancer Prevention Study-3 — called CPS-3 for short — is the American Cancer Society’s fourth large-scale follow-up study on cancer. It is following as many as 500,000 Americans — including nearly 200 local people — over 20 to 30 years.

Some participants will develop cancer and others won’t. The study’s goal is to pinpoint the personal habits, genetic traits and environmental triggers that cause or prevent cancer.

A previous Cancer Society study exposed the strong link between smoking and lung cancer. The link between obesity and the increased odds of dying from cancer was established in another study. More than 300 scientific articles have been published on the results of such studies.

“One of the most unique facets of this study is that we’ll be looking at any cancer,” said Alpa V. Patel, the principal investigator of CPS-3. “This study doesn’t have a focus on any specific type of cancer.”
Getting specific

To participate, enrollees need to be between 30 and 65 and have no history of cancer.

Nearly 100,000 people have enrolled so far, with the recruitment period ending in December 2013. Researchers are aiming for a sample size in which 25 percent of the subjects are minorities.

Cassandra Cogan was motivated to sign up because her family has a cancer history.

Her father survived colon cancer and her grandmother survived breast cancer. But Cogan’s aunt, Eileen Paulus, died in April from pancreatic cancer after surviving cancer in her uterus and breast.

“It does make me wonder why Eileen got all the cancer and I’m hoping that with the studies … the researchers will find a link, whether it’s with lifestyles or medications,” said Cogan, 32 of Elkton. “It makes me feel good knowing that I live in an area that they picked for the study.”

Patel said the Elkton area was selected this year as one of the 100 enrollment sites because of its robust volunteer team.

Because the latest study involves the collection of blood samples from participants, it could significantly advance cancer research, said Dr. Diana Dickson-Witmer, a surgeon and associate medical director of the Christiana Care Breast Center at the Helen F. Graham Cancer Center in Stanton.

“They can look at the specific chromosomes of the people who developed cancers to see if there were patterns that formed,” Dickson-Witmer said.
‘Unique opportunity’

Bob Gravell, 58, of Odessa, is aware of how pervasive cancer is in Delaware, where 507 of every 100,000 people are diagnosed with cancer and 194 of every 100,000 people here die of cancer. Both rates — collected by Delaware’s Division of Public Health — are higher than the national rates.

But the breadth of CPS-3 was the reason he enrolled recently in the study at Elkton High School, during the annual Relay for Life, an overnight walking-and-running fundraiser run by the Cancer Society.

“It’s kind of a unique opportunity to be part of a statistically significant study,” he said.

By joining the study, Mensch said, she feels like she’s contributing to the efforts to find a cure for the disease.

“It’s like donating blood,” she said. “You don’t know for sure if your blood is going to help someone in an accident or whether it’s going to expire on a shelf. But you give it because it has that potential to help. This study has that kind of potential.”

Anxiety Treatment: Extreme perfectionism toying with minds

Extreme perfectionism toying with minds

Psychologists think they may have found a catch-all treatment for anxiety, depression and eating disorders.

They say breaking down the habits of Australia’s many ‘clinical perfectionists’ – those who strive for perfection to the point of self sabotage – actually reduces the prevalence of accompanying, destructive disorders.

Twenty-five-year-old ‘Sarah’, as she wishes to be called, knows all too well what happens when perfectionism is taken to the extreme.

She hit rock bottom at the age of 11. Now a professional runner, she is in a much happier place, but says it took a lot of hard work to get there.

“Even as a young child my room was immaculate and I used to line up my stuffed toys in perfect order,” she said.

“My room had to be not touched and I remember I used to get quite upset when my sisters would come in and mess it up.

“Then at school I used to be the first person to want to finish my assignments and get good marks, just going that one step further with my projects.

“I was a high achiever and I wanted to do well. I wanted to push the boundaries. I enjoyed doing it, if you know what I mean, it was just me.”

But Sarah says being perfect wasn’t an easy quest, and by Year Six it began to take its toll.

“I started to withdraw a lot from my family and from school life and I used to get quite worked up so I had, almost like depression, at such a young age,” she said.

“I was striving to succeed in everything and it all became too much.”

I wanted to push the boundaries. I enjoyed doing it, if you know what I mean, it was just me.
Sarah

Sarah now considers herself a “refined perfectionist”, but admits she is in a constant struggle with her old self.

When congratulated on a recent run she did, her response was: “I was actually disappointed with it… I did meet my goal, but my real goal was not that.”

Healthy versus unhealthy

Professor Tracey Wade from Flinders University, in South Australia, is presenting at an Australian Psychological Society conference in Coolum, on Queensland’s Sunshine Coast, this week.

She says clinical perfectionists have a habit of setting goals which, when met, they put down to being too easy.

“Healthy perfectionism is aiming for high standards, a lot of people do that, but it becomes unhealthy depending on how you manage that process,” she said.

“When you don’t achieve your standards all the time and you criticise yourself, then that tends to become associated with depression and anxiety and possibly eating disorders.

“So unhealthy perfectionists, even when they attain their goal, they think it couldn’t have been hard enough, so they raise the bar a bit higher.

“Healthy perfectionists can take pleasure in their achievements, they’re disappointed when they don’t achieve but they don’t judge themselves as not being worthwhile whereas an unhealthy perfectionist, if they attain their goal they don’t take much pleasure in it and if they don’t attain their goal they criticise themselves as a person and basically see themselves as being worthless.”

Kimberley Hoiles from Curtin University, in Western Australia, is doing her PhD on clinical perfectionism.

She is trialling an eight-week treatment program on a group of 40 self-confessed perfectionists.

Ms Hoiles says the aim is to reduce perfectionism while also reducing anxiety and depression, without specifically targeting those symptoms.

She says she is amazed at how widespread clinical perfectionism is.

“We’re all perfectionist and we all have certain things we do that are a bit funny here and there, but when it starts to interfere in our lives and we start to get anxious or depressed, then that’s when it starts to become more clinical perfectionism,” she said.

“I had this one woman who would spend hours cleaning this room she knew people would be sitting in.

“We did an experiment with her where we asked her to leave a dirty spoon in the sink, and she just couldn’t do it because she was too anxious about it.

“This other man I know was a handy man, in the process of renovating his bathroom.

“He was so anxious about painting the wall and putting the tiles up that he couldn’t actually do it, so he was avoiding doing it, avoiding that fear of failure, so he actually now showers outside.

“Usually perfectionists also have quite dichotomise standards in terms of dieting, so if they eat that one piece of chocolate then they’ve ruined their diet and they become very depressed.”

Unhealthy perfectionists, even when they attain their goal, they think it couldn’t have been hard enough, so they raise the bar a bit higher.
Professor Tracey Wade

Compassion over criticism

Professor Wade says clinical perfectionism is becoming more and more widespread in Australia. She suspects up to 30 per cent of the population may be vulnerable to the disorder.

“I think we have become more of an achievement-oriented society,” she said.

“Particularly schools are focussing on getting students to be competitive and to do well, sports can be quite competitive, so there’s a message out there that you have to be better than the next person.

“Certainly we want people to achieve and to do well but there are different ways of doing it… whether it’s through criticism, or though encouragement and self compassion.”

She too is working on a study of clinical perfectionism, attempting to develop resilience in a group of 1,000 13 to 15-year-olds.

“We have noticed that when we help people to overcome unhealthy perfectionism, it often helps to alleviate other disorders, such as anxiety and depression,” she said.

“It may be that helping to break the unhealthy perfectionism habit is a helpful catch-all treatment.”

Professor Wade says the key to overcoming unhealthy perfectionism is to see failures in context.

“Focus on your whole life and avoid the temptation to define yourself by a list of achievements,” she said.

“Self-compassion and kindness is also important, because criticism and abuse is not the way to get the best out of anyone, including yourself.”

Sarah has her own advice.

“I think a lot of it is to do with managing it,” she said.

“Sometimes when things get really hard in your life you may fall back on those traits initially, but when things settle down you know that that’s not the way to go anymore.

“Sometimes I just need to take a deep breath, and then I’m OK.”

What’s at the root of our tooth anxiety?

From those “teeth falling out” dreams to fear of the dentist, we do a lot of worrying about our pearly (or not-so-pearly) whites. So why all the anxiety about teeth? We’ll drill into it this week.

Read on to find out what’s on the show. You can also listen to the podcast by clicking the player below (or download it here, or from iTunes). (Originally aired Oct. 16, 2010)

If a stranger came up to you on the street and asked you to look into your mouth, would you say yes? What if that stranger was Sook-Yin Lee, and she had a microphone? Tune in to see who opens wide, and who doesn’t. (Also heard on Your DNTO)

A perfect set of pearly whites… that’s the image we’re sold in commercials. Everyone’s supposed to want that. But what if you don’t? Lisa Rundle tells us her story of orthodontic rebellion. (Also heard on Your DNTO)

Former Maple Leaf Todd Warriner tells us what it’s like for a hockey player to lose his teeth… and sports writer James Mirtle chats with Sook-Yin about the culture of “spittin’ Chicklets” in hockey. (Also heard on Your DNTO)

Raina Telgemeier has a lot of experience saying “ahhh.” When she was eleven years old,
she had an accident that led to four-and-a-half painful years of extreme dental treatment.
And she turned her traumatic tooth experiences into a graphic novel called Smile. She’ll tell us why the experience was so life-altering, and how it inspired her art.

Lots of people dislike going to the dentist because of concerns about physical pain. For Erik White, it was more about hurt feelings than hurt gums. He’ll tell us about his falling out with his childhood dentist.

So what’s fear of the dentist like from the other side? Sook-Yin sits down in the reclining chair to ask her dentist, Dr. Goldberg.

It’s the kind of thing that sounds like an urban legend: two teenagers with braces share an innocent (okay, relatively innocent) kiss, and wind up locked together by wires. But Jean Freeman lived that particular story… and she’ll tell us how she got out of it. (Also heard on Your DNTO)

The Tooth Fairy may seem harmless enough… and hey, who doesn’t love finding money under their pillow? But there’s a lot of anxiety around the good ol’ TF – mostly from the parents. Diane Flacks finds out why.

And what is it like for the kids when those chompers drop out? Sook-Yin talks with nine-year-old Max, who really just wants his two front teeth. (Also heard on Your DNTO)

The one-man band known as Bahamas (a.k.a. Afie Juryanen) probably isn’t the first Canadian musician to write an ode to hockey teeth. But he might be the first to write a song about hockey teeth that isn’t actually about missing chiclets. Bahamas will drop by the studio to tell us what the song is really about, and play it for us.

As an adult Jennifer Gee was always a bit anxious about her smile, so she went to see an orthodontist about getting braces. He tried his best to prepare her for all the potential pit-falls
but he forget to mention one pretty important thing… something her high school students took note of. She’ll reveal the one thing you really need to know when you’re getting braces.

Whiter! Brighter! Straighter! Is our quest for “perfect” teeth really healthy? Kirsten Bell has a unique perspective on that, since she’s an Australian ex-pat… and a cultural anthropologist. She’ll tell us what she’s observed about Canadian teeth, and why she thinks a dentist’s office is like a church. (Also heard on Your DNTO)

Most people who have bad teeth try to hide them by keeping their mouth shut, even refusing to smile. But not Jason Jones. He’ll tell us the story of his painfully bad teeth, and what happened when they appeared on the front page of the biggest newspaper in Canada. (And you can check out his before and after pics.) (Also heard on Your DNTO)

Anxiety reduction chemical identified

Researchers have pinpointed the action of a particular brain chemical in a specific area of the brain as key in regulating anxiety.

“We hope our finding will help pave the way for developing more selective treatments for anxiety disorders,” says Janet Menard, an associate professor in the Department of Psychology.

Dr. Menard’s team found that increasing levels of the brain chemical Neuropeptide-Y (NPY) in an area of the brain known as the lateral septum reduces the normal anxiety responses that occur in stressful situations. This discovery suggests that drugs selectively targeting NPY receptors in the brain could be more effective in treating anxiety than current treatment options and be less prone to abuse.

Dr. Menard’s new anxiety regulation findings were published in a recent issue of Pharmacology, Biochemistry and Behaviour.

Other groundbreaking research by researchers in the Behavioural Neuroscience group at Queen’s Department of Psychology includes:

• Richard Beninger, Head of Psychology – the role played by particular brain chemicals in the control of normal behaviour and in disorders such as schizophrenia and drug addiction.

• Cella Olmstead – recently pinpointed the area of the brain that controls impulsive behavior and identified mechanisms that affect how impulsive behavior is learned.

• Hans Dringenberg – how our brains develop during early life and how they continue to adapt and store new information.

• Niko Troje – the function behind the head-bobbing behavior frequently observed in pigeons and other birds.

These brain, behavior and cognition researchers are supported by funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), and have recently benefited from laboratory renovations and infrastructure enhancements facilitated by an equipment grant from the federal funding agency.