Children May Outgrow Migraines

A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

However, adolescents whose parents or siblings have migraines may be less likely to outgrow their own.

That's especially true of adolescents initially diagnosed as having migraines without aura -- a form in which the migraines are not accompanied by sensory disturbances such as flashing lights, strange odors, or sounds, according to the research.

On balance, it is good news for children and teens who have migraines, says Rosolino Camarda, MD, of the University of Palermo in Italy, one of the study's researchers. It means most of them won't have to cope with disabling headaches as adults, Camarda says.

Researchers Studied Entire Town

In 1989, Camarda's team screened all primary school students aged 11-14 in the town of Monreale, Italy. They identified 80 adolescents as having probable migraine.

Because some studies have suggested the International Headache Society's criteria are too restrictive for patients under age 15, the researchers not only included adolescents diagnosed with migraine without aura, but also those said to have migrainous disorder or non-classifiable headache.

In 1999, they re-evaluated 55 cases -- 30 women and 25 men who were then aged 21-24. Of these, 28 had initially been diagnosed as having migraine without aura, 14 with migrainous disorder, and 13 with non-classifiable headache.

"Our study shows that over a 10-year period, migraine headaches starting in adolescence have a favorable long-term prognosis," Camarda tells WebMD. "About 40% of our subjects experienced remission, and 20% of them transformed to tension-type headache, which is a less distressing headache."

Remission Depends of the Patient

Remission Depends of the Patient

Although most patients improved, about 40% still had persistent headaches.

This included 15 subjects diagnosed with migraine without aura, two with aura, five with migrainous disorder, and one with non-classifiable headache.

The study showed migraine was most likely to persist in adolescents initially diagnosed with migraine without aura and least likely to persist in those initially diagnosed with migrainous disorder or non-classifiable headache.

It also showed a family history of migraine was a strong risk factor for migraine persistence. Adolescents who had parents or siblings with migraine were seven times as likely to still have migraine 10 years later as those whose first-degree relatives were migraine-free.

"Our data suggest that migraine without aura is probably genetically determined," Camarda says.

Public Health Implications

Because migraine without aura is far more common in young adults than migraine with aura, it is an "enormous public health problem," Camarda says.

"Our data have important implications for prevention," Camarda says.

The researcher suggests that aggressive medical treatment of children and teens who have migraine without aura, especially those with a family history of migraine, might lead to eventual remission or to transformation into a less-severe tension-type headache.

Unlike some previous studies, the new one did not confirm that migraine is more likely to persist in girls than boys, although it did show a trend in that direction.

Because the study included only 55 subjects, the association between gender and migraine persistence was probably underestimated, Camarda says.

Larger studies are needed to answer lingering questions about the natural history of migraine, say Camarda and colleagues.

Long Term Prognosis Unclear

"Even if migraine remits, it can reoccur later in life," says Stephen Silberstein, MD, of Thomas Jefferson University in Philadelphia, who was not connected with the new study.

Silberstein says the Italian study "partly replicates" a 1997 Swedish study of 73 children with migraine followed for 40 years.

That study showed that 23% of the children -- boys more often than girls -- were migraine-free by age 25, he says. But it also showed more than half still had migraine attacks at 50.

Contradicting the Italian researchers, Silberstein says he doubts migraine transforms into tension-type headache. "I believe they are just milder attacks of migraine," he tells WebMD.

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Drug-Slang Quiz Helps Parents Help Kids

Use of terms like 'fry stick' or 'schwagg' are clues youngsters are in trouble, experts say

If you're a parent, you might want to brush up on your drug slang to stay alert to possible drug use by your children, suggest addiction experts at the Menninger Clinic in Houston.

Slang terms for drugs constantly change and evolve, the researchers said. For example, while marijuana is still called weed or pot by some, it's also referred to by newer terms such as chronic or schwagg. Heroin is still be called smack but, depending on the type of heroin, it may also be called black tar or brown sugar.

Then there are terms such as Special K and biscuits. Special K refers to ketamine, a powerful hallucinogenic drug similar to LSD and PCP. A biscuit (or tab) is a hit of the "club drug" Ecstasy.

In order to test your knowledge of drug slang, here's a quiz created by the Menninger Clinic experts:

1. K-Hole is slang for: a) a type of ketamine; b) periods of ketamine-induced confusion.

2. The painkiller Oxycontin is also called: a) oxies; b) cotton.

3. Rophies is the nickname for: a) Rohypnol, the date rape drug; b) the rush you feel after using cocaine.

4. Fry sticks are: a) the act of injecting yourself with speed; b) marijuana cigarettes dipped in formaldehyde and sometimes laced with PCP.

5. Inhaling a small amount of cocaine is called a: a) bump; b) blip.

6. Combining the prescription drug Viagra with Ecstasy is called: a) 24-7 heaven; b) sextasy.

7. "Amped out" is: a) fatigue after using amphetamine; b)using the maximum amount of steroids your body can take.

8. Working Man's Cocaine is: a) crack cocaine; b) methamphetamine.

9. A marijuana cigarette rolled with cocaine is called a: a) primo; b) speedy.

10. "Juice" is the slang term for: a) steroids; b) PCP.

Here are the answers: 1 (b), 2 (b), 3 (a), 4 (b), 5 (a), 6 (b), 7 (a), 8 (b), 9 (a), 10 (both a or b).

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High Blood Pressure, the Insidious Killer

Jay B Stockman

Next time you are with a group of 3 friends, take a good look around; one of you will have high blood pressure. The sad part is, since there are no symptoms, you may not even be aware of it. Untreated high blood pressure can lead to heart attack, congestive heart failure, stroke, or kidney failure. Various risk factors contribute to this disease that are both under our control, and out of our control. The only way to determine if you have high blood pressure is to have your blood pressure checked. The insidious nature of this disease makes it a true Silent Killer.

The brain requires unobstructed blood flow to nourish its many functions. Very high, sustained blood pressure will eventually cause blood vessels to weaken. Over time these weaken vessels can break, and blood will leak into the brain. The area of the brain that is being fed by these broken vessels start to die, and this will cause a stroke. Additionally, if a blot clot blocks a narrowed artery, blood ceases to flow and a stroke will occur. Symptoms of a stroke include sudden numbness or weakness of the face, arm or leg, especially on one side of the body, confusion, trouble speaking, or seeing, sudden severe headache. If you or someone with you has one or more of these signs, don't delay, call 911.

Like the brain, the heart requires blood to bring oxygen, and nutrients to its muscle tissue. The narrowing of the arteries due to blockage can cause high blood pressure. If this blockage occurs in the arteries of the heart, coronary arteries, heart muscle damage can occur, resulting in a heart attack. Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.

Adopting a healthy lifestyle including healthy eating habits, reducing salt in the diet, maintaining a healthy weight, limiting alcohol consumption, being physically active, and quitting smoking is an effective step in preventing and controlling high blood pressure.
The kidneys act as filters to rid the body of all waste products. Eventually, high blood pressure can thicken, then narrow the blood vessels of the kidneys. The kidneys becomes less efficient, filtering less fluid, and waste builds up in the blood. Over time, the kidneys may fail altogether. When this happens, medical treatment such as dialysis, or a kidney transplant may be needed.

The best way to find out if you have high blood pressure is by having your blood pressure checked regularly. Generally speaking, doctors will diagnose a person with high blood pressure on the basis of two or more readings, taken on different occasions. A consistent blood pressure reading of 140/90 mmHg or higher is considered high blood pressure, or hypertensive. It is vital to take steps to keep your blood pressure under control. The treatment goal is blood pressure below 140/90 and lower for people with other conditions, such as diabetes and kidney disease.

Adopting a healthy lifestyle including healthy eating habits, reducing salt in the diet, maintaining a healthy weight, limiting alcohol consumption, being physically active, and quitting smoking is an effective step in preventing and controlling high blood pressure. If lifestyle improvements alone are not sufficient in keeping pressure controlled, it may be necessary to add blood pressure medications. There are several options that physicians have at their disposal, and each option should be discussed, as to their side effects and efficacy.

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Weather and joint pain: Any connection?

Is there any truth to the common belief that cold, damp weather worsens arthritis pain?

Answer:

Many studies have explored the relationship between joint pain and weather changes, such as barometric pressure, temperature and humidity. Although both anecdotal and scientific evidence suggest that a connection exists, it has not been proven.

Your joints are lined with a membrane (synovium) that secretes a lubricating fluid (synovial fluid). In arthritis, particularly inflammatory types such as rheumatoid arthritis, the amount of fluid increases. Theoretically, changes in barometric pressure could affect the fluid in joints if, for example, a chemical in the joint increased — causing inflammation — when pressure rose and fell. But there's no conclusive evidence that supports this theory.

One recent study suggests that changes in barometric pressure and cooler temperatures are associated with joint pain. Still, other studies have found no connection or contradictory results — some people have increased pain with low barometric pressure and others have increased pain with high pressure. The reason for these discrepancies isn't clear.

Researchers have also studied the effect of weather changes, such as temperature and humidity, on pain in people with rheumatoid arthritis, osteoarthritis and lower back pain. But results so far are inconclusive.

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Testosterone Tumbling in American Males

The testosterone-fueled American male may be losing his punch.

Over the past two decades, levels of the sex hormone in U.S. men have been falling steadily, a new study finds.

For example, average total testosterone levels in men aged 65 to 69 fell from 503 nanograms/decileter (ng/dL) in 1988 to 423 ng/dL in 2003.

The reasons for this trend are unclear, said researchers at the New England Research Institutes in Waterdown, Mass. They noted that neither aging nor certain other health factors, such as smoking or obesity, can fully explain the decline.

"Male serum testosterone levels appear to vary by generation, even after age is taken into account," study lead author Thomas G. Travison said in a prepared statement.

Testosterone is the primary male sex hormone and plays an important role in maintaining bone and muscle mass. Low testosterone levels have been linked to health problems, including lowered libido and diabetes.

It's normal for men's testosterone levels to peak in their late 20s and then start to gradually decline, experts say. But this study found that overall testosterone levels are lower than they were 20 years ago.

"In 1988, men who were 50 years and older had higher serum testosterone concentrations than did comparable 50-year-old men in 1996. This suggests that some factor other than age may be contributing to the observed declines in testosterone over time," Travison said.

He and his colleagues analyzed blood samples -- along with health and other information -- from about 1,500 men in the greater Boston area who took part in the Massachusetts Male Aging Study. That study collected data in 1987-89, 1995-97, and 2002-04.

"This analysis deals with men who were born between 1915 and 1945, but our baseline data were not obtained until the late 1980s, when the elder subjects were about 70 years old, and the youngest about 45," Travison said.

"Events occurring in earlier decades could certainly help explain our results, if their effects persisted into recent years," he noted.

The findings were published in the Journal of Clinical Endocrinology and Metabolism.

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Cancer Drug Studied in Children with Rare Form of Leukemia

Martin Champagne, MD, FRCP(C)

STI-571, also known as Gleevec, was approved for the treatment of chronic myeloid leukemia, or CML, one of the four main types of leukemia. It has also achieved remarkable clinical trial results in the treatment of a rare intestinal tumor called gastrointestinal stromal tumor, or GIST.

Researchers are also beginning to look at the effects of this new drug on children with CML, and in phase I clinical trials, the drug is showing promising results. Dr. Martin Champagne, a medical oncologist at St. Justine Hospital in Montreal, Canada, is the principal researcher of the current study investigating the use of Gleevec in children with CML. Below, he discusses these promising results and the special considerations involved in testing new drug treatments on children.

Q: Could you summarize the results of the trial?
The trial is a phase I trial, which means that we're looking at the dose-limiting toxicities and the maximum tolerated dose in children with the Philadelphia chromosome-positive leukemia, which is the defining characteristic of this particular type of rare leukemia. We were also looking at the way that their bodies were handling the drug. We have found that the drug is fairly well tolerated in the children tested.

The levels that we achieved in the patients were at levels where we would expect to see anti-leukemic activity based on preclinical models.

Q: So is it common for drugs to be tested separately for children and adults?
Yes. Children are not young adults. You can't figure out how the body will handle the drug just by making a sample rule of three and dividing by body weight. So we have to do specific studies to find out how they will handle and tolerate the drug - which is different in most studies than in adults.

Q: What kind of side effects have you seen in the study?
The most common toxicities that we found were minor nausea and vomiting. We also had some toxicity related to what we call the hematological parameters, which is a little bit of anemia, and decrease of white blood cells, which is no surprise in patients with leukemia at the start.

Q: How safe is this drug in children?
Although we did escalate the drug by different levels, and we increased the drug at a fairly high amount of total dose, we did not encounter significant toxicity of one organ or one function of the body that will prevent using the drug in children at the set dose. So, actually the drug was well tolerated for most of the kids.

Q: And when will the trial be completed?
The trial is still underway. We're looking for more patients so that we can test the drug at two levels, to find out if the preliminary information we got is consistent.

Q: This drug has been tested for safety in children, but what about efficacy?
We have no data yet that I can comment on. But we hope at least from our preclinical model that it will work, because the Philadelphia chromosome, which is the defining feature in these types of leukemia, is not different in the pediatric patients than it is in the adults. But we have to figure that out. We just don't know yet.

Q: Do you foresee any future implications for the use of Gleevec in children with leukemia?
There will be many challenges, because these particular types of leukemia are different in children than they are in adults. We'll ask medical oncologists to figure out what the best timing and schedule would be for giving the drug to children. We'll have to look at how we can incorporate the drug with chemotherapy trials, to see if we can build better results by using combination therapies.

Q: Do you believe that this drug could be a cure for leukemia in children as well as adults?
I hope for some kids it will be the solution. But you have to keep in mind that these types of leukemia are rare in children. They represent only about 2 to 3 percent of the most common type of leukemia, which is the acute lymphoblastic leukemia. So the major proportion of patients will have to rely still on other therapeutics to achieve a cure.

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Colon Cancer and IBD: Understanding the Link

Colon cancer, the third most common type of cancer in the United States, is a serious health threat for men and women over 50. However, if you are of the one million Americans living with an inflammatory bowel disease (IBD), you face a higher risk for colon cancer than the average person.

IBD, which includes Crohn's disease and ulcerative colitis, is a disorder of the gastrointestinal tract. Inflammation can occur anywhere along the gut, but it typically affects the lining of the colon when the intestinal wall becomes irritated and sometimes ulcerated. People with this condition experience cramps, bloating and a wide range of bowel problems. There is, of yet, no known cause or cure for IBD but many patients achieve some improvement in their condition with medication or dietary changes. No one knows why IBD ups the risk of this cancer, but it is believed to be a function of chronic inflammation.

Still, it is important that those living with IBD understand their risk for colon cancer and regularly monitor their health. Steven Itzkowitz, MD, a professor of medicine, and Thomas Ullman, MD, an assistant professor of medicine, both from the Mt. Sinai School of Medicine in New York City, explain the prevalence of colon cancer and medical options available to people with IBD.

How high is the risk of colon cancer for people with IBD?
THOMAS ULLMAN, MD: You are at increased risk of developing colon cancer if you have long-standing and extensive ulcerative colitis or long-standing and extensive Crohn's colitis.

STEVEN ITZKOWITZ, MD: After having colitis for about eight years, a person's risk of colon cancer starts to go up by about a half a percent to 1 percent each year. IBD is thought to be the third-highest risk factor for colon cancer, after two hereditary syndromes: familial polyposis and Lynch syndrome.

How is colon cancer screened in patients with IBD?
STEVEN ITZKOWITZ, MD: Once you've had your colitis for about eight years, even if you have relatively few symptoms, you should be going for regular colonoscopies about every one to two years; some people say every one to three years. The colonoscopy itself turns out to be quite well tolerated. We have very good anesthetics now where people literally wake up and say, "When are we going to get started?"

How is colon cancer diagnosed in patients with IBD?
STEVEN ITZKOWITZ, MD: With patients who have inflammatory bowel disease, we may find polyps or raised growths during the colonoscopy, but there can also be precancerous or sometimes even cancerous changes that are flat and almost invisible. So we do multiple biopsies, sampling the tissue throughout the colon to try to detect these areas that are otherwise invisible.

THOMAS ULLMAN, MD: The samples are examined [under a microscope] by the pathologist to see what the cells look like and to determine the presence or absence of dysplasia, which are precancerous changes in the colon.

How are precancerous changes and colon cancers treated in people with IBD?
STEVEN ITZKOWITZ, MD: Dysplasia has different gradations: low-grade dysplasia and high-grade dysplasia. If an expert pathologist tells you have a high-grade dysplasia, there's a 45 to 65 percent likelihood that there is already cancer in the colon or will be in the near future. If you only remove a part of the colon that you think has the area of cancer, there is a very high likelihood that cancer will crop up in the future. So, most physicians would recommend that the whole colon should be removed. With low-grade dysplasia, there is a little bit more controversy. But, because of our inability to see all cancers before they become problematic in people with IBD, many doctors will recommend that you consider removing the colon.

That's why the stakes are a little bit higher for people with IBD. The surgery for colon cancer or dysplasia in inflammatory bowel disease means taking out the entire colon and rectum, whereas, in the general population, if you found a cancer or a precancerous polyp, you only have to remove that one little segment of the colon that's affected.

What surgical options are available?
STEVEN ITZKOWITZ, MD: New surgical techniques, available in the last decade, are more conducive to an active lifestyle. If we have to remove the colon and the rectum, we can create an internal pouch out of the end of the small intestine and bring that down to the muscles at the lower sphincter. The person can still be able to [go to the bathroom] normally.

Occasionally, people will need an end ileostomy, where the colon and the rectum are removed and the end of the intestine is brought out through the skin to an external appliance. Sometimes that's a better operation.

Can colon cancer be prevented in people with IBD?

STEVEN ITZKOWITZ, MD: With IBD patients, there are a few different compounds that may lower the risk of colorectal cancer. The one that has been proven to be the most efficacious is ursodeoxycholic acid (USRO), or Actigall. [This drug may prevent cancer by reducing levels of a carcinogenic substance called deoxycolate and bile acid in the colon.] So far, this has only been looked at in the high-risk group of IBD patients who also have primary sclerosing cholangitis, an inflammation of the bile ducts in the liver. In this small group of people, about 5 to 10 percent who take USRO seem to have a lower rate of cancer and dysplasia.

If you look at all IBD patients, not just the sclerosing cholangitis group, there seems to also be some evidence that the 5-aminosalicylate compounds (otherwise known as mesalamine) reduce the risk of colon cancer and dysplasia.

Then, there's folic acid, a safe, inexpensive vitamin. We don't have good scientific proof that it lowers colon cancer or dysplasia risk, but there's some circumstantial evidence that it may work in IBD, and there's pretty good evidence in the non-IBD population, that it seems to lower the risk of colon cancer.

We have to just remind our patients that even if they take these medicines, they still need to come for regular colonoscopy.

What is your colon cancer screening advice for people with IBD?

THOMAS ULLMAN, MD: We actually do a very good job of preventing cancer in ulcerative colitis and in Crohn's colitis. So the first thing that I would tell patients is, "Don't worry early on in the course of disease." Build a strong alliance with your gastroenterologist and then when the time comes—after eight years—do yourself the favor and have your annual colonoscopy.

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Lowering Your Risk of Colon Cancer

Karen Barrow

Colon cancer is the third most common cancer in the United States, and well over 100,000 people will be diagnosed with the disease this year alone. And while it is the second and third leading cause of cancer death in women and men, respectively, more and more people are being successfully treated and cured of colon cancer because of improved screening methods that can detect the cancer in its earliest stages.

“One of the most powerful weapons in preventing colorectal cancer is regular colorectal cancer screening or testing,” writes the American Cancer Society (ACS) on its website. Since it takes 10 to 15 years for an abnormal cell to develop into colorectal cancer, regular screenings can help identify and remove abnormal cells before they ever cause a problem.

The ACS recommends that those at relatively low risk for developing colorectal cancer should begin having routine colonoscopies every ten years beginning at age 50. If you have a family history of the disease, or other risk factors that increase your risk of the disease, you may need to begin regular screenings earlier at more frequent intervals.

But preventing abnormal cells from growing altogether is ideal, and while the exact cause of colon cancer is unknown, there are things you can do to lower you risk of colorectal cancer.

Measuring Your Risk
There are two types of risk factors for colorectal cancer: those you can change and those you can’t. These “uncontrollable” factors include:

• Age. Inevitably, as you grow older, your risk of colon cancer rises considerably. Yes, it is possible for a young man or woman to get colon cancer, but their risk is considerably lower than someone over the age of 50.
• Family History. If you have a first-degree relative (mother, father, sister or brother) who has had colorectal cancer or adenamotous polyps (a precursor of colorectal cancer) before the age of 60, you are considered to be at an increased risk of developing the disease. Your doctor will likely recommend that you begin colorectal cancer screening before the age of 50, sometimes as early as age 40.
• Personal History. If you have any history of colorectal cancer or colorectal polyps, your risk for colorectal cancer is increased.
• Other Diseases that Increase Risk. It you have chronic inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, you are at an increased risk for developing colon cancer. The ACS recommends that you begin getting regular colonoscopies 8 to 12 years after you were first diagnosed with inflammatory bowel disease. Additionally, people with diabetes have up to a 40 percent greater chance of being diagnosed with colon cancer.
• Ethnic Background. Jewish men and women of Eastern European descent have been found to have a higher rate of colorectal cancer due to a genetic mutation common in this group. Additionally, there is some evidence that African Americans are at an increased risk for colorectal cancer, but researchers are unsure as to why this is.

If you do have one or more of these uncontrollable risk factors, it is important that you inform your doctor. Based on what you tell him or her, your doctor may recommend that you begin regular colorectal screenings earlier and/or more frequently.

Keep in mind, though, that there are risks factors that are in your power to change. These include:

• Diet. A diet high in fat, particularly animal fats, has been found to increase your risk of colorectal cancer. To lower your risk, the ACS recommends substituting plant-based foods for animal products whenever possible. Also, be sure to have five servings of fruits and vegetables each day and several servings of food from other plant sources, such as grains, rice, pasta or cereal. “Many fruits and vegetables contain substances that interfere with the process of cancer formation,” writes the ACS.
• Exercise. Those who are not active are at a greater risk of developing colorectal cancer. Aim to do at least 20 minutes of exercise a day. It will both lower your risk of colorectal cancer and other diseases, as well as increase your overall fitness.
• Weight. Obesity is linked to a higher risk of death from colorectal cancer. If you are overweight, be sure to speak with you doctor about healthy plans to help you shed the excess pounds.
• Smoking. Smoking doesn’t just hurt your lungs; it is estimated that smoking causes 12 percent of all fatal colorectal cancers. Chemicals in cigarettes and cigars are swallowed and absorbed into the bloodstream, increasing your risk of various types of cancer.
• Alcohol intake. Heavy alcohol consumption has been linked to an increased risk of colorectal cancer. Be sure to limit alcohol intake to lower this risk.

So, no matter what your risk is, by changing your diet, exercising, maintaining a healthy weight and limiting alcohol intake and smoking, you do have to power to lower your chance of developing colorectal cancer.

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Cell Phones and Sperm

Christine Gorman

Here’s why I’m not worried about a recent report that cell phone use has been associated with low sperm count in men. A) I am a woman. B) I just spent a half hour on the phone with the first author of the report and he’s been fielding calls non-stop for the past two days on, you guessed it, a cell phone.

“I’m not giving up my cell phone,” says Ashok Agarwal, a reproductive biologist at the Cleveland Clinic in Cleveland, Ohio. Indeed, he’s probably going to have to get a new one since his cell phone stopped working this morning and he had to borrow someone else’s to talk to all the journalists from around the world who are calling him up. “Our study is not the final word,” Agarwal says. “But we were able to demonstrate some interesting findings.”

More specifically, Agarwal and his colleagues surveyed 364 men who were being evaluated at an infertility clinic in Mumbai, India. The researchers determined that those men who used their cell phones the most—four hours or more a day—had the lowest average sperm counts. A closer look also showed that fewer of the sperm were good swimmers and more of them appeared abnormal when compared to the sperm of the men who never used a cell phone.

But just because the scientists found a statistical association between heavy cell phone use and damaged sperm doesn’t necessarily mean anything. Heavy cell phone use may actually be a marker for something else that is known to affect sperm count—like sitting for long stretches or being overweight. Maybe people who use their cell phones a lot tend to be more stressed out than those who don’t.

The results, which were presented at a poster sessison of the annual meeting of the American Society for Reproductive Medicine in New Orleans, are intriguing enough, however, that they’re worth pursuing. In the next few months, Agarwal hopes to sign up a couple hundred men at the Cleveland Clinic for further study.

In the meantime, says Dr. Peter Schlegel, a urologist and board member of the American Society for Reproductive Medicine, there’s no need to throw your cell phone away. (I also talked to him on his cell phone.) “I won’t be recommending a change of behavior for my patients,” Schlegel says. But any men who are really, really worried and want to play it absolutely safe, he notes, could just stop carrying their cell phones on their belt or in a pocket.

There are plenty of other reasons to spend less time on a cell phone, especially if you’re trying to have a baby.

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Indian men don't play safe in sex

Kavita Bajeli-Datt

New Delhi - Lack of information about safe sex have made most Indian heterosexual males who visit sex workers seeking anal sex believe ignorantly that they would not catch HIV/AIDS.

This pattern of behaviour among Indian males came out in a nationwide survey conducted by Naz Foundation Internationalis, an Indian NGO based in Britain that specializes in sexual and reproductive health of homosexuals and their partners in South Asia.

The survey was conducted to find out understanding, risks and behaviours prevailing in the country, especially among gays, he said adding that sex education was absent among majority of the people covered in the survey.

"The survey was conducted in 56 cities. We surveyed sex workers, who told us that their client demand anal sex. Most men think that it is a safe way of not contracting HIV/AIDS. But they don't know that it is ten times more dangerous and risky," Arif Jafar, the foundation Executive Director said.

"The issue is not just restricted to homosexual men. Many men, who are heterosexuals, sometimes prefer to have sex with men when they are travelling. But they do not consider sex with other men risky," said Jafar.

"Knowledge of male and female bodies, of reproduction, of the sex organs was almost non-existent. This led to a variety of myths, beliefs and practices, which were accepted as true and helpful," he said.

"Condom use was determined primarily in terms of access, knowledge, shame, and sickness. With the condom equated with disease prevention, many participants either felt stigmatized through condom usage, or felt that their was no need to use condoms because either they or their sex partners were not sick," he said.

"Sexual health information and services are primarily focused on so-called heterosexual behaviour and ignore the significant levels of anal sex, irrespective of the gender of the sexual partner.

"Formative research is urgently needed to understand how to design appropriate sexual health interventions regarding male to male sexual behaviour and men having sex with men," he said.

The survey, conducted in Varanasi, Allahabad, Jaunpur, Kanpur, Ghaziabad, Agra, Tuticorin, Thirunalveli, Hubli, Bijapur, Bellary, Nalgonda, Kakinada and Hardoi, showed that most men are ignorant about safe practices because the government has not been able to come out with messages and advertisements which give a clear picture.

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STROKE - Causes, incidence, risk factors and prevention

Chitra R. Uppaluri, M.D

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack."

Alternative Names

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage
Causes, incidence, and risk factors

Every 45 seconds, someone in the United States has a stroke. A stroke can happen when:

* A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke.
* A blood vessel breaks open, causing blood to leak into the brain. This is a hemmorhagic stroke.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

ISCHEMIC STROKE

This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. (See stroke secondary to atherosclerosis.) Fatty deposits and blood platelets collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:

* A clot that stays in place in the brain is called a cerebral thrombus.
* A clot that breaks loose and moves through the bloodstream to the brain is called an cerebral embolism.

Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation. Other causes of ischemic stroke include endocarditis and the use of a mechanical heart valve. A clot can form on the artificial valve, break off, and travel to the brain. For this reason, those with mechanical heart valves must take blood thinners.

HEMORRHAGIC STROKE

A second major cause of stroke is bleeding in the brain hemorrhagic stroke. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.

STROKE RISKS

High blood pressure is the number one reason that you might have a stroke. The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease.

Certain medications increase the chances of clot formation, and therefore your chances for a stroke. Birth control pills can cause blood clots, especially in woman who smoke and who are older than 35.

Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.

Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.

See also:

* Stroke secondary to carotid dissection (bleeding from the carotid arteries)
* Stroke secondary to carotid stenosis (narrowing of the carotid arteries)
* Stroke secondary to cocaine use
* Stroke secondary to FMD (fibromuscular dysplasia)
* Stroke secondary to syphilis
* Hemorrhagic stroke
* Arteriovenous malformation (AVM)

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Usually, a SUDDEN development of one or more of the following indicates a stroke:

* Weakness or paralysis of an arm, leg, side of the face, or any part of the body
* Numbness, tingling, decreased sensation
* Vision changes
* Slurred speech, inability to speak or understand speech, difficulty reading or writing
* Swallowing difficulties or drooling
* Loss of memory
* Vertigo (spinning sensation)
* Loss of balance or coordination
* Personality changes
* Mood changes (depression, apathy)
* Drowsiness, lethargy, or loss of consciousness
* Uncontrollable eye movements or eyelid drooping

If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke.
Signs and tests

In diagnosing a stroke, knowing how the symptoms developed is important. The symptoms may be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered completed.

During the exam, your doctor will look for specific neurologic, motor, and sensory deficits. These often correspond closely to the location of the injury in the brain. An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.

Tests are performed to determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms. These tests include:

* Head CT or head MRI -- used to determine if the stroke was caused by bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke.
* ECG (electrocardiogram) -- used to diagnose underlying heart disorders.
* Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart.
* Carotid duplex (a type of ultrasound) -- used if the cause may be carotid artery stenosis (narrowing of the major blood vessels supplying blood to the brain).
* Heart monitor -- worn while in the hospital or as an outpatient to determine if a heart arrhythmia (like atrial fibrillation) may be responsible for your stroke.
* Cerebral (head) angiography -- may be done so that the doctor can identify the blood vessel responsible for the stroke. Mainly used if surgery is being considered.
* Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation.

Treatment

A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support.

The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.

IMMEDIATE TREATMENT

Thrombolytic medicine, like tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be evaluated and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

In other circumstances, blood thinners such as heparin and coumadin are used to treat strokes. Aspirin and other anti-platelet agents may be used as well.

Other medications may be needed to control associated symptoms. Analgesics (pain killers) may be needed to control severe headache. Anti-hypertensive medication may be needed to control high blood pressure.

Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.

Life support and coma treatment are performed as needed.

LONG-TERM TREATMENT

The goal of long-term treatment is to recover as much function as possible and prevent future strokes. Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy. The recovery time differs from person to person.

Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores. People should stay active within their physical limitations. Sometimes, urinary catheterization or bladder/bowel control programs may be necessary to control incontinence.

The person's safety must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions. For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.

Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.

In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors.

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.

Carotid endarterectomy (removal of plaque from the carotid arteries) may help prevent new strokes from occurring in people with large blockage in these important blood vessels.
Support Groups

Additional support and resources are available from the American Stroke Association. The toll-free phone line for stroke survivors and caregivers is 1-888-4STROKE.
Expectations (prognosis)

The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.

Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function. Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.
Complications

* Problems due to loss of mobility (joint contractures, pressure sores)
* Permanent loss of movement or sensation of a part of the body
* Bone fractures
* Muscle spasticity
* Permanent loss of brain functions
* Reduced communication or social interaction
* Reduced ability to function or care for self
* Decreased life span
* Side effects of medications
* Aspiration
* Malnutrition

Calling your health care provider

Call your local emergency number (such as 911) if someone has symptoms of a stroke. Stroke requires immediate treatment!
Prevention

To help prevent a stroke:

* Get screened for high blood pressure at least every two years, especially if you have a family history of high blood pressure.
* Have your cholesterol checked.
* Treat high blood pressure, diabetes, high cholesterol, and heart disease if present.
* Follow a low-fat diet.
* Quit smoking.
* Exercise regularly.
* Lose weight if you are overweight.
* Avoid excessive alcohol use (no more than 1 to 2 drinks per day).

If you have had a TIA or stroke in the past, or you currently have a heart arrhythmia (like atrial fibrillation), mechanical heart valve, congestive heart failure, or risk factors for stroke, your doctor may have you take aspirin or other blood thinners. Make sure you follow your doctor's instructions and take the medication.

To prevent bleeding strokes, take steps to avoid falls and injuries.

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What You Must Know about Menopause

Melanie N. Smith, M.D., Ph.D

Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.
Alternative Names

Perimenopause; Postmenopause
Causes, incidence, and risk factors

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause), you can no longer become pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly. The specific symptoms you experience and how significant (mild, moderate, or severe) varies from woman to woman.

In some women, menstrual flow comes to a sudden halt. More commonly, it tapers off. During this time, your menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 to 3 years before menstruation finally ends completely.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. When estrogen drops suddenly, as is seen when the ovaries are removed surgically (called surgical menopause), symptoms can be more severe.
Symptoms

The potential symptoms include:

* Hot flashes and skin flushing
* Night sweats
* Insomnia
* Mood swings including irritability, depression, and anxiety
* Irregular menstrual periods
* Spotting of blood in between periods
* Vaginal dryness and painful sexual intercourse
* Decreased sex drive
* Vaginal infections
* Urinary tract infections

In addition, the long-term effects of menopause include:

* Bone loss and eventual osteoporosis
* Changes in cholesterol levels and greater risk of heart disease

Signs and tests

Blood and urine tests can be used to measure hormone levels that may indicate when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

* Estradiol
* FSH
* LH

A pelvic exam may indicate changes in the vaginal lining caused by changes in estrogen levels. A bone density test may be performed to screen for low bone density levels seen with osteoporosis.
Treatment

Menopause is a natural process. It does not require treatment unless the symptoms, such as hot flashes or vaginal dryness, are particularly bothersome.

One big decision you may face is whether or not to take hormones to relieve your symptoms. Discuss this thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE REPLACEMENT THERAPY

For years, hormone replacement therapy (HRT) was the main treatment for menopause symptoms. Many physicians believed that HRT was not only good for reducing menopausal symptoms, but also reduced the risk of heart disease and bone fractures from osteoporosis. However, the results of a major study -- called the Women's Health Initiative -- has led physicians to revise their recommendations.

In fact, this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones did see some benefits. But they greatly increased their risk for breast cancer, heart attacks, strokes, and blood clots.

If your symptoms are severe, you may still want to consider HRT for short-term use (2-4 years) to reduce vaginal dryness, hot flashes, and other symptoms.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, your doctor may recommend:

* Using estrogen/progesterone regimens that do not contain the form of progesterone used in the study.
* Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill).
* Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible.
* Having frequent and regular physical exams, including breast exams and mammograms.

ALTERNATIVES TO HRT

The good news is that you can take many steps to reduce your symptoms without taking hormones:

* Dress lightly and in layers
* Avoid caffeine, alcohol, and spicy foods
* Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
* See an acupuncturist
* Use relaxation techniques like yoga, tai chi, or meditation
* Eat soy foods
* Remain sexually active to preserve elasticity of your vagina
* Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
* Use water-based lubricants during sexual intercourse

There are also some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure.
Complications

Estrogen is responsible for the buildup of the lining of the uterine cavity. During the reproductive years, this buildup occurs and then is shed (menstruation). This usually happens about a once a month.

The menopausal decrease in estrogen prevents this buildup from occurring. However, hormones produced by the adrenal glands are converted to estrogen, and sometimes this will cause postmenopausal bleeding.

This is often nothing to worry about, but because postmenopausal bleeding may also be an early indication of other problems, including cancer, a physician should always check any postmenopausal bleeding.

Decreased estrogen levels are also associated with an increased risk of developing osteoporosis and possibly an increased risk of cardiovascular disease.
Calling your health care provider

Call your health care provider if:

* You are spotting blood between periods
* You have had 12 consecutive months with no period and suddenly vaginal bleeding begins again

Prevention

Menopause is a natural and expected part of a woman's development and does not need to be prevented. However, there are ways to reduce or eliminate some of the symptoms that accompany menopause. You can also reduce your risk of long-term problems like osteoporosis and heart disease.

* DO NOT smoke -- cigarette use can cause early menopause
* Exercise regularly to strengthen your bones, including activity that works with the resistance of gravity
* Take calcium and vitamin D
* Eat a low-fat diet
* If you show early signs of bone loss, talk to your doctor about medications that can help stop further weakening
* Control your blood pressure, cholesterol, and other risk factors for heart disease

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Headache or Migraine ???

Kevin Sheth

A migraine is a type of primary headache that some people get repeatedly over time. Migraines are different from other headaches because they occur with symptoms such as nausea, vomiting, or sensitivity to light. In most people, a throbbing pain is felt only on one side of the head.

Migraines are classified as either "with aura" or "without aura." An aura is a group of neurological symptoms, usually vision disturbances that serve as warning sign. Patients who get auras typically see a flash of brightly colored or blinking lights shortly before the headache pain begins. However, most people with migraines do not have such warning signs. See also:

* Migraine without aura (no warning symptoms)
* Migraine with aura (visual disturbances before the headache starts)
* Mixed tension migraine (features of both migraines and tension headache)

Alternative Names

Headache - migraine
Causes, incidence, and risk factors

A lot of people get migraines -- about 11 out of 100. The headaches tend to start between the ages of 10 and 46 and may run in families. Migraines occur more often in women than men. Pregnancy may reduce the number of migraines attacks. At least 60 percent of women with a history of migraines have fewer such headaches during the last two trimesters of pregnancy.

Until the 1980s, scientists believed that migraines were due to changes in blood vessels within the brain. Today, most believe the attack actually begins in the brain itself, and involves various nerve pathways and chemicals inthe brain. A migraine attack can be triggered by stress, food, environmental changes, or some other factor. However, the exact chain of events remains unclear.

Migraine attacks may be triggered by:

* Allergic reactions
* Bright lights, loud noises, and certain odors or perfumes
* Physical or emotional stress
* Changes in sleep patterns
* Smoking or exposure to smoke
* Skipping meals
* Alcohol or caffeine
* Menstrual cycle fluctuations, birth control pills
* Tension headaches
* Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
* Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Symptoms

Migraine headaches, which can be dull or severe, usually:

* Feel throbbing, pounding, or pulsating
* Are worse on one side of the head
* Last 6 to 48 hours

Symptoms accompanying migraines include:

* Nausea and vomiting
* Sensitivity to light or sound
* Loss of appetite
* Fatigue
* Numbness, tingling, or weakness

Warning signs (auras) that can precede a migraine include seeing stars or zigzag lines, tunnel vision, or a temporary blind spot.

Symptoms that may linger even after the migraine has gone away include:

* Feeling mentally dull, like your thinking is not clear or sharp
* Increased need for sleep
* Neck pain

Signs and tests

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. During the physical exam, your doctor will probably not find anything wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.
Treatment

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or altering triggers. When you do get migraine symptoms, try to treat them right away. The headache may be less severe.

A good way to identify triggers is to keep a headache diary. See headache.

When migraine symptoms begin:

* Rest in a quiet, darkened room
* Drink fluids to avoid dehydration (especially if you have vomited)
* Try placing a cool cloth on your head

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that chronic usage of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

* Ergots like dihydroergotamine or ergotamine with caffeine (Cafergot)
* Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), and zolmitriptan (Zomig); these are available as a tablet, nasal spray, or self-administered injection
* Isometheptene (Midrin)
* Stronger pain relievers (narcotics)

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.
Support Groups

American Council for Headache Education - www.achenet.org

The National Migraine Association -www.migraine.org

National Headache Foundation - www.headaches.org
Expectations (prognosis)

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.
Complications

Migraine headaches generally represent no significant threat to your overall health. However, they can be chronic, recurrent, frustrating, and they may interfere with your day-to-day life.

Stroke is an extremely rare complication from severe migraines. This risk may be due to prolonged narrowing of the blood vessels, limiting blood flow to parts of the brain for an extended period of time.
Calling your health care provider

Call 911 if:

* You have unusual symptoms not experienced with a migraine before, like speech or vision problems, loss of balance, or difficulty moving a limb
* You are experiencing "the worst headache of your life"

Call your doctor immediately if:

* Your headache pattern or intensity is different
* Your headache gets worse when you lie down

Also, call your doctor if:

* Previously effective treatments no longer help
* Side effects from medication occurs (irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, extreme thirst, or others)
* You are likely to become pregnant -- some medications should not be taken when pregnant

Prevention

* Avoid smoking, caffeine, and alcohol
* Exercise regularly
* Get enough sleep each night
* Learn to relax and reduce stress -- try progressive muscle relaxation (contracting and releasing muscles throughout your body), meditation, biofeedback, or joining a support group

If you get at least three headaches per month, your doctor may prescribe medication for you to prevent recurrent migraines.

Such prescription drugs include:

* Beta-blockers such as propranolol (Inderal)
* Anti-depressants, including tricyclics like amitriptyline (Elavil) or selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft)
* Anti-convulsants such as valproic acid (Depacon, Depakene), divalproex sodium (Depakoate), or topiramate (Topamax)
* Calcium channel blockers such as verapamil

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Pregnancy - identifying fertile days

Peter Chen

Many couples spend so much time preventing an unplanned pregnancy that they assume that when they are ready for a family all they have to do is stop using birth control. Getting pregnant is not always that fast -- it can take up to a year or longer -- nor is it automatic.

Many couples today plan intercourse around days 11-14 of the woman's 28-day cycle. If a woman has irregular cycles and is not sure when she ovulates, she can buy an ovulation predictor kit at a pharmacy. These kits test LH (leutenizing hormone) in the urine and are very accurate.

If you are willing to take some extra steps, you can monitor two body functions to pinpoint your most fertile times, maximizing your chances of getting pregnant: changes in body temperature and the consistency of your cervical fluid.

This article explains how to monitor your cervical fluid and temperature, identify the changes, and learn what they mean. It may sound like a hassle, but the process is really pretty easy.

Evaluating Your Cervical Fluid

Cervical fluid plays critical roles in getting pregnant -- it protects the sperm and helps it move through the cervix toward the uterus and fallopian tubes. Like practically everything else involved with the menstrual cycle, cervical fluid changes in preparation for ovulation. You will notice clear differences in how it looks and feels over the course of the cycle.

At the beginning of your cycle, you probably will not notice any cervical fluid at all. Then it may become sticky or gummy, and then creamy and white. Finally, as ovulation approaches, it becomes more clear and stretchy, almost like egg whites. Your cervical fluid actually gives you advance notice that you are about to ovulate.

Cervical fluid can usually be felt inside the lower end of the vagina, especially on fertile days. Check cervical fluid more than once a day if possible, such as every time you use the bathroom.

Rub your fingers together to evaluate the consistency of the fluid, then refer to the stages listed below. More than one adjective is used because the conditions differ slightly among women:

* Menstrual period occurring (no cervical fluid is present)
* Vagina is dry (no cervical fluid is present)
* Sticky/rubbery fluid
* Wet/creamy/white fluid -- FERTILE
* Slippery/stretchy/clear "egg white" fluid -- VERY FERTILE
* Dry (no cervical fluid)

The cervical fluid will be slippery and stretchy on your most fertile days.

Taking Your Basal Temperature

Take your temperature in the morning before you get out of bed. Try not to move too much, as activity can raise your body temperature slightly. Use a glass basal thermometer or a digital thermometer so that you can get accuracy to the tenth of a degree. Keep the thermometer in your mouth for 5 minutes. If your temperature is between two marks, record the lower number.

Try to take your temperature at the same time every day, if possible. If using a mercury thermometer, shake it down when you are done so that you do not have to shake it in the morning and thus risk raising your temperature from the movement.

After you ovulate, your body temperature will rise and stay at an elevated level for the rest of your ovulation cycle. At the end of your cycle, it falls again. Create a chart and write down your temperature everyday. From one day to the next, your temperature will zigzag a little. These small temperature changes will seem random at first -- ignore them.

Also, ignore the occasional "fluke" temperature that is obviously way out of alignment with the others -- this can happen for any number of reasons (like stress) and is not important to finding the pattern. If you look at a complete cycle, you will probably notice a point at which the temperatures become higher than they were in the first part of your cycle. More specifically, the rise is when your temperature increases 0.2 degrees above the previous six days.

The limitation with monitoring your temperature is that by the time you are certain that you have ovulated, it is usually too late to become pregnant! You can still try to get pregnant the morning your temperature rises, but chances are slimmer. The egg is probably gone by that point.

However, temperature is still a very useful indicator of fertility. For one thing, after several cycles you may be able to see a predictable pattern and get a sense for your most fertile days. More reliably, the rise lets you know when trying to get pregnant becomes less likely. And lastly, temperature is an excellent indicator of whether you are pregnant. If your temperature does not go down at the end of the cycle, you probably succeeded and are pregnant!

NOTE: There are other factors you can use to help you track your fertility even more precisely (like the position of your cervix and how open it is). Also, there is a great deal of variety in how different women experience their fertility tracking signs. For a more in-depth explanation, there are a numbers of good reference books available.

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Obese post-menopausal women prone to breast cancer: studies

Virginie Montet

Obese post-menopausal women are more susceptible to breast cancer, and those who continue to gain weight after 50 are more likely to die from the disease, according to research presented at an obesity conference.

"There is an overwhelming number of studies that show a link between obesity and breast cancer," Cheryl Rock of the University of California, San Diego said at the annual conference of the North American Association for the Study of Obesity (NAASO).

Marilie Gammon of the University of North Carolina warned that after menopause, obese women have a 75 percent greater chance of developing breast cancer.

She also said that women should be made aware that if they continue to add pounds past the half-century mark, they are raising their chances of death.

"We have to let them know that if you continue to gain weight after the age of 50 and contracted breast cancer, you are more likely to die," Gammon said.

A person is considered obese when his or her body mass index is 30 or above.

The BMI is a measure of body fat calculated by dividing weight by height squared, with a rating between 18.5 and 24.9 considered normal for adults.

Studies show that women who gain nearly 45 pounds (20 kilos) after the age of 18 are twice as likely to develop breast cancer after menopause than those who maintain a stable weight.

For a long time, it was commonly thought that excess weight protected a woman from breast cancer, but recent studies have indicated otherwise.

"A lot of women say, 'Who cares? I'm already overweight.' But it's bad. You are more likely to die if you are diagnosed with breast cancer," Gammon said, citing in particular a study by Page Abrahamson of the University of North Carolina, published this month.

On the bright side, recent studies also have shown that women who engage in some physical activity, even modest, at the first sign of the deadly disease have a better survival rate.

"The message is that you have to maintain some physical activity," Gammon said.

"Breast cancer is a good motivator for women," she said. "They fear it. They know what it's like to fight against it more than colon cancer or renal cell cancer," which is also linked to obesity.

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A Bizarre Study Suggests That Watching TV Causes Autism

CLAUDIA WALLIS

Childhood vaccines, toxins, genes and now television watching? The alarming rise in autism rates is one of the biggest mysteries of modern medicine, but it's irresponsible to blame one factor without hard scientific proof.

Strange things happen when you apply the statistical methods of economics to medical science. You might say you get dismal science, but that's a bit glib. You certainly get some strange claims-like the contention of three economists that autism may be caused by watching too much television at a tender age. It gets stranger still when you look at the data upon which this argument is based. The as yet unpublished Cornell University study, which will be presented Friday at a health economics conference in Cambridge, Mass., is constructed from an analysis of reported autism cases, cable TV subscription data and weather reports. Yes, weather reports. And yet, it all makes some kind of sense in the realm of statistics. And it makes sense to author Gregg Easterbrook, who stirred the blogosphere this week with an article about the study on Slate, provocatively (and perhaps irresponsibly) titled "TV Really Might Cause Autism."

The alarming rise in autism rates in the U.S. and some other developed nations is one of the most anguishing mysteries of modern medicine-and source of much desperate speculation by parents. In 1970, its incidence was thought to be just 1 in 2,500; today about 1 in 170 kids born in the U.S. fall somewhere on the autism spectrum (which includes Asperger's Syndrome), according to the Centers for Disease Control and Prevention. Some of the spike can be reasonably attributed to a new, broader definition of the disorder, better detection, mandatory reporting by schools and greater awareness of autism among doctors, parents and educators. Still, there's a nagging sense among many experts that some mysterious X-factor or factors in the environment tip genetically susceptible kids into autism, though efforts to pin it on childhood vaccines, mercury or other toxins haven't panned out. Genes alone can't explain it; the identicial twin of a child with autism has only a 70% to 90% chance of being similarly afflicted.

Enter Michael Waldman, of Cornell's Johnson Graduate School of Management. He got to thinking that TV watching-already vaguely associated with ADHD-just might be factor X. That there was no medical research to support the idea didn't faze him. "I decided the only way it will get done is if I do it," he says. Waldman and fellow economists Sean Nicholson of Cornell and Nodir Adilov of Indiana University-Purdue, were also undeterred by the fact that there are no reliable large-scale data on the viewing habits of kids ages 1 to 3- the period when symptoms of autism are typically identified. They turned instead to what most scientists would consider wildly indirect measures: cable subscription data (reasoning that as more houses were wired for cable, more young kids were watching) and rainfall patterns (other research has correlated TV viewing with rainy weather).

Lo and behold, Waldman and colleagues found that reported autism cases within certain counties in California and Pennsylvania rose at rates that closely tracked cable subscriptions, rising fastest in counties with fastest growing cable. The same was true of autism and rainfall patterns in California, Pennsylvania and Washington state. Their oddly definitive conclusions: "Approximately 17% of the growth in autism in California and Pennsylvania during the 1970s and 1980s was due to the growth of cable television," and "just under 40% of autism diagnoses in the three states studied is the result of television watching due to precipitation."

Result of? Due to? How can these researchers suggest causality when no actual TV watching was ever measured? "The standard interpretation of this type of analysis is that this is cause and effect," Waldman insists, adding that the 67-page study has been read by "half-a-dozen topnotch health economists."

Could there be something to this strange piece of statistical derring- do? It's not impossible, but it would take a lot more research to tease out its true significance. Meanwhile, it's hard to say just what these correlations measure. "You have to be very definitive about what you are looking at," says Vanderbilt University geneticist Pat Levitt. "How do you know, for instance, that it's not mold or mildew in the counties that have a lot of rain?" How do you know, for that matter, that as counties get more cable access, they don't also get more pediatricians scanning for autism? Easterbrook, though intrigued by the study, concedes that it could be indoor air quality rather than television that has a bearing on the development of autism. On a more biological level there's this problem, says Drexel Univeristy epidemiologist Craig Newschaffer: "They ignore the reasonable body of evidence that suggest that the pathologic process behind autism probably starts in utero"-i.e., long before a baby is born.

The week also brought a more definitive, though less splashy finding on the causes of autism, published in the Proceedings of the National Academy of Science. A team led by Levitt found that a fairly common gene variation-one that's present in 47% of the population-is associated with an increased risk of autism. People with two copies of the gene have twice the average risk of autism; those with one copy face a slightly increased risk. The gene is intriguing because it codes for a protein that's active not only in the brain-the organ most affected by autism-but also in the immune system and the gastrointestinal tract, two systems that function poorly in many people with autism. Levitt estimates that anywhere from five to 20 genes may underlie the vulnerability to autism. There are probably many routes to the disorder, involving diverse combinations of genes and noxious environmental influences. Could Teletubbies be one of them? Conceivably, but more likely the trouble starts way before TV watching begins.

With reporting by Alice Park/New York

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New Polio Case in Kenya Jeopardizes Eradication

ELIANE ENGELER

The case, Kenya's first in 22 years, was imported from Somalia and marks a resurgence in East Africa brought on in part by anti-western policies set by Islamic clerics.

Kenya has reported its first polio case in 22 years with the infection of a 3-year-old Somali refugee girl marking a new setback in the global effort to eradicate the crippling disease, officials said Tuesday.

The case brings to 26 the number of countries in Africa, Asia and the Middle East that have been reinfected since a 2003 vaccine boycott by hard-line Nigerian Islamic clerics who claimed that the polio vaccine was part of a U.S.-led plot to render Nigerian Muslims infertile or infect them with AIDS.

World Health Organization spokeswoman Fadela Chaib said the Somali girl found infected in Kenya had a polio strain from Somalia, which has been re-infected with the virus since 2005 after it had been polio-free for three years. The virus had been imported to Somalia from Nigeria, she said. Ethiopia, which also borders on Kenya, was reinfected with the polio virus in 2004 and is currently reporting 37 cases, Chaib said.

The girl who developed the symptoms on Sept. 17 was in a refugee camp in the Dadaab area of northeastern Kenya, which recently has seen an upsurge in arrivals of Somalis fleeing violent clashes between pro-government militia and Islamic forces in southern and central Somalia. More than 34,000 Somali refugees have arrived in Kenya since the beginning of the year, said Jennifer Pagonis from the U.N. High Commissioner for Refugees.

There are currently 215 reported cases in 14 out of 19 regions in Somalia. The chaotic nation has no effective central government and little medical infrastructure. The "outbreak in Somalia and Ethiopia is widespread among the ethnic Somali population," said Chaib, adding that this had "put Kenya at high risk."

The infected girl reportedly had been vaccinated, but it is "rather common" that a vaccinated child still can get infected until immunization is completed, said Chaib. "Several vaccination rounds are necessary to really ensure optimal vaccination for children." The last polio vaccination in Kenya took place Sept. 9-12, Chaib said.

Health officials are investigating the case and preparing for additional immunization rounds, which aim at reaching all unvaccinated Kenyan and refugee children under the age of 5 in the northeastern part of the country, she said. The next round is supposed take place Nov. 3-7 and the second Dec. 1-5 and be coordinated with Somalia and Ethiopia, she added. WHO and other organizations had to give up on their 2005 deadline to eradicate the disease. The campaigners said last week that it is still possible to rid the world of polio, but that it will take at least another year.

Polio is spread when unvaccinated people — mostly children under 5 — come into contact with the feces of those with the virus, often through water. The virus attacks the central nervous system, causing paralysis, muscular atrophy and deformation and, in some cases, death.

The United Nations on Tuesday appealed for $35 million to provide food aid and other relief operations over the next six months for Somali refugees in Kenya. UNHCR finds it is difficult to keep up with the influx of refugees, Pagonis said. "We fear this figure could climb to 80,000 by the end of the year," she said,

The number of Somalis fleeing to Kenya started increasing after a radical Islamic militia began seizing control of their country. "In the past two weeks the arrival rate reached 1,000 a day on several occasions and 2,000 a day on Oct. 4 and 5," Pagonis said. The three Somali refugee camps in Dadaab, 50 miles from the Somali border, are home to about 160,000 people, most of whom have fled Somalia since the outbreak of a civil war there in 1991.

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Coping with a Dengue Fever Outbreak

Simon Robinson

It's been an interesting first few days. I arrived in New Delhi last week to take over as the Bureau Chief for South Asia after nearly eight years in Africa. India's capital is currently in the grip of one of the biggest dengue fever outbreaks for years.

More than 1700 people in Delhi have been diagnosed with dengue, a virus spread by the bite of the female Aedes Aegypti mosquito. Thirty five people have died in Delhi alone; nationally the outbreak has killed 109.

In Africa, or at least in parts of Africa, I'd become used to covering up in the evening to avoid being bitten by mosquitos carrying malaria. But Aedes Aegypti, which breeds in stagnant water, bites during the daytime so I have to learn a whole new level of discipline.

People who are unlucky enough to become infected come down with a high fever, skin rashes and agonizing joint pains. Their blood platelet count drops as well, which is what can prove fatal.

The outbreak has spread to neighboring Nepal and Pakistan. In Pakistan's port city of Karachi, 17 people have died of the disease in the past week or so.

Newspaper commentators joke that the smoke from the fireworks used in this weekend's celebrations for Diwali, the Hindu festival of lights, will scare away all the mosquitoes. Let's hope so.

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Choose Your Fish Wisely

Alice Park

There are a lot of good reasons to eat seafood—recent studies have linked the omega-3 fatty acids found in deep water fish to a lower risk of heart disease; fish are a good source of protein, and early studies hint that pregnant women who eat fish or take fish oil supplements are more likely to carry babies to full term, and to enhance their babies’ cognitive development.

But eating more fish isn’t easy. The healthy bonus that comes from fish, it seems, has a price. The same fats that make fish so good for the heart and the body also attract dangerous toxins, from dioxins to polychlorinated biphenyls (PCBs), the man-made byproducts of the electrical industry. (While PCBs have not been created since the 1970s, trace amounts still linger in waters.) In addition, the lean muscle of the ocean’s biggest and most powerful swimmers can become sinkholes for methylmercury, a potentially brain- and liver-damaging metal formed when salts are processed by certain anaerobic bacteria. Is it safe to eat fish at all? Are the benefits of eating fish enough to outweigh these risks? How much fish is safe to eat? Which kinds of fish and seafood have the most omega-3 fatty acids and the lowest levels of contaminants?

Two reports released this week may finally provide some answers for those trying to decide between surf or turf. Both the Institute of Medicine and researchers at Harvard School of Public Health report that more Americans could be benefiting from the high protein and healthier fat found in fish, and that for most people, these benefits do indeed outweigh the risks of consuming contaminants. Not surprisingly, both studies note that some populations, including pregnant women and young children who may be at greatest risk of suffering from contaminant poisoning, should avoid consuming too much of the larger fish species that are likely to have the highest levels of methylmercury or PCBs.

The IOM report, Seafood Choices, Balancing Benefits and Risks, provides recommendations for four populations—women who are or may become pregnant or who are breast-feeding; children younger than 12; adult women who are not planning to become pregnant and adult men; and adults at risk of heart disease—but the core advice for all groups is the same: it’s safe, and healthy, to eat up to two 3 oz. servings of fish each week. Young children and pregnant women, however, should make sure that these servings don’t include shark, swordfish, tilefish or king mackerel, the largest predatory species that contain the highest levels of methylmercury.

The Harvard authors, whose report appears in the Journal of the American Medical Association, also found that eating fish carries significant health benefits. Based on their review of several years of previously published studies, they found that eating 3 oz. of farmed salmon a week could reduce the risk of death from heart disease by 36% and the risk of overall death by 17%. While contaminants like methylmercury and PCBs can indeed cause neurological problems, the benefits gained from eating fish often outweigh the smaller risk these toxins pose.

What it means: While Americans are eating more fish on average today than at the turn of the century, we’re not eating the healthiest kinds of seafood. The most popular form of seafood, shrimp, is high in cholesterol and contains low levels of omega-3 fatty acids. And that cafeteria staple, fish sticks, contain very low levels of methylmercury but are equally poor sources of omega-3 oils; a 3.5 oz serving contains one-twelfth the amount of oils found in the same-sized portion of farmed salmon.

So if you’ve been eating too much of the less healthy offerings from the sea, or avoiding fish altogether because you’ve been worried about the contaminants they may contain, take some advice from the Harvard researchers. The best way to avoid the potential dangers of an all-surf diet, they say, is to vary the types of fish you eat. Atlantic herring, wild salmon, sardines and Atlantic cod are among the fish with the lowest methylmercury levels; while the larger species, like king mackerel and swordfish, contain some of the highest levels. For more on the IOM’s report, visit www.iom.edu.

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A Little Quitting Help for Smokers

Carolyn Sayre

Smoking is a tough habit to kick, with 41% of smokers trying to quit ever year and only 10% of them actually succeeding. Wouldn’t it be great if you could just pop a pill and take away those unhealthy urges?

That may be a reality someday soon. Researchers at the University of Chicago have found that in a small double blind study a new drug – naltrexone, which blocks the effects of narcotics and has been used in the past to treat heroin addicts - used in conjunction with behavior therapy and nicotine patches helps stop women lighting up. The study found that the novel treatment combo increased success rates in women smokers by nearly 50%. The results will be published in the journal of Nicotine and Tobacco Research this month.

The study’s relatively small sample size examined 110 men and women who reported smoking a pack a day – approximately 20 cigarettes – for a period of 25 years and had unsuccessfully tried to quit several times. Half of the participants took 50 milligrams for a period of eight weeks – starting three days before they tried to quit – the other half was given placebos.

The researchers defined a successful cessation as “not smoking daily for one week and not smoking even a puff at least one day in each of two consecutive weeks at any point in the trial.” After eight weeks the results were in - 62% of men and 58% of women on naltrexone stopped smoking – but in the group taking placebos 67% of men and 39% of women had quit. As a result, the research was only significant in women. In the study the drug helped assuage the women’s cravings and reduce their withdrawal symptoms.

What it Means:

It is unclear yet whether Naltrexone will be helpful in a larger population since the sample size was small. However, what is clear is that scientists are getting closer to developing one drug that really helps smokers quit. In July, a new drug – varenicline – was reported to help 40% of the study’s large sample size stop in nine weeks.

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Japan's concept of free love lost in translation

Ryann Connell

One of the more preferred adoptions of Western culture among Japanese men, Weekly Playboy opines, has been sexual liberation, which the men's weekly notes started flourishing around 1966, the year it began publishing.

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Nonetheless, in an article marking its 40th anniversary, it seems Japanese guys' ideas of "Free sex" may have been a little, well, lost in translation as a look at the Foreign Ministry's advisory on Sweden shows.

"There may have been travelers prompted by the misunderstanding that it was a country that advocates 'free sex,' but sexual attitudes in Sweden emphasize fundamental gender equality, and basic wholesomeness and what may be termed the 'sex business' is virtually unseen in Sweden," the magazine quotes the government's website as saying.

"Free Sex" is, according to Weekly Playboy, the idea that people can partake in sexual liaisons outside of a marital relationship provided there is no love involved, a state the magazine argues already exists in Japan.

Over the past four decades, Japan has witnessed the destruction of sexual taboos and a libertine attitude to the pleasures of the flesh that has led to the flourishing or such practices as enjo kosai, the euphemism to describe mostly schoolgirl prostitution but which literally translates as "compensated dating."

More recently, though, Japan has also been swept up in the whirlwind of a "pure," or true love boom, the weekly says, adding that it's probably the result of more guys obeying whatever women tell them to do.

"Recently, there have been more guys who make masochistic statements. Actions that would once have been regarded as girly are common and men find life easier if they do what women want," columnist Asato Izumi tells Weekly Playboy. "We're living in an age where it's better off for men if they choose to live like masochists."

The weakening of Japanese males has been accompanied by women becoming increasingly assertive to create something of a balance."Nowadays, it's impossible to get married unless you're rich. A guy with no money has no hope of marrying. Look at marriage statistics by income and what I'm saying becomes crystal clear. We have a reality where a part-time worker making 1 million yen a year simply can't afford to get married," economic journalist Takuro Morinaga tells Weekly Playboy. "The upshot of all this is that there's been a dramatic increase in the number of people who've simply given up on women, which is mainly the result of the huge increase in otaku-type nerds."

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The Pleasures of Medicine

DR. SCOTT HAIG

Whether chatting with grateful patients late at night or witnessing the mysterious healing powers of the human body, a physician's job can be a real high

The whole world was green. My driver's-side window let in the 3 a.m. buzz and click of a traffic signal and the surprisingly sweet smell of upper Manhattan drenched clean by the rain. Everything was so shiny and wet I had to stop a minute and just admire the green. Bone-tired but high as a kite, I still love that minute. I have never dropped acid but what drug could make that light more beautiful? I was high on 48-hours, 20 admissions, eight cases, four sets of rounds and going home. This was my training. I feel bad for the residents now — what the new restrictions on residents' hours stole they don't even know.

Sure, some of this is a glass of dirty water after a long, hard thirst, but the pleasures in medicine are intense. Never sought in themselves, the occasional delights of our field just suddenly surround us, like that green traffic light. And more than a fair share are a little lonely, happen at night and involve reflection.

If I go in for an emergency after midnight I will make a few rounds. This is often a pleasure. Patients never mind it — I hardly ever find them asleep — and they are more people, less fractures and "post-ops" in the quiet than during the bustle and noise of the day. People to visit, not patients to round — they tell jokes, show you pictures, give you cookies and gum. They'll talk about important things, hopes and repentances, their great ideas. Some will hear yours. Want to be appreciated and feel good? Visit folks in the hospital — at night.

Bodies are a source of much happiness in a medical life, particularly if you happen to be a surgeon. Much as light and gravitation are governed by consistent and perfect laws, so are the animate machines we spend our days probing and pondering. We learn this again and again as we look and poke. During carpal tunnel surgeries most of my patients are wide awake, with a local anesthetic keeping the two-inch-long opening in their palm comfortably numb while I work. Every once in a while one asks to "look inside." Not always, but when it seems safe, I tell the circulator to put a mask on the patient and pull down the drapes. And I have the pleasure of showing them around their hand.

There's quite a lot to see in a carpal tunnel. The nerve we're there to decompress is somewhat impressive — a yellow white ribbon of a thing, about the width of the rubber bands on broccoli. They can tell it's alive from the flood of sensation it brings as I touch it, ever so gently, with a smooth, blunt probe. But the glistening white tendons that lie alongside — the life in them fascinates. "Watch this thing — now slowly bend your finger — do you see how it works?" The tendon moves, rather like a pushrod in a steam engine, frictionlessly, efficiently, straight in its track. And the finger rises to the mind's command. The patient usually gets the idea, but whose idea can it be? Fear and wonder beat Charles Darwin every time at this game. An unforgettable catechism — each one who does this reminds me of it every time they see me, for years. It's a fun job.

Bodies do amazing things — bent bones straighten out (sometimes), and I have the old, crooked x-rays in the folder to prove it. Good tissues grow; I measure the circumference of a thigh and send the patient away with a physical therapy prescription. When he actually does the exercises, I measure again three months later and voila! there's more muscle there — I can prove it. The hand wouldn't close, the arm wouldn't rise, the fingers (those carpal tunnel folks again) couldn't feel — but then they work. The big secret? We physicians treat. But we all know it's someone else who actually makes the new bone, muscle, blood vessels and collagen — who heals. If you don't get a kick out of touching off what amounts to a small creative explosion, there's no hope for you in medicine. But if you do it's a kick in the pants.

Minds overcoming matter seem to make us happy. From "The Little Engine That Could" to Lance Armstrong, when we shoot straight, run fast, dance expressively, fish, sail, hunt, sing, paint or ski we impress our minds on the matter of the physical world. In these happy activities our choice, our will, changes the physical world. Though the changes might be temporary, and though nobody except the changer might notice them, the pleasant activities all produce changes that are unnatural — they would not have happened by themselves. Your timed mile won't get any faster, the ball will not go in the basket, the fish will not jump into the bucket on its own.

And every one of these unnaturally pleasant changes start with a message from your weightless, invisible mind to that most accessible part of physical reality, your body. Every doc knows the patient who seems to get better by sheer toughness, naked will, unbending before injury or disease. That patient is a lot like an athlete up against an adversary or an artist wrestling a great idea onto canvas or paper. If you like rooting for your football team or watching the inner mental war they call golf, just imagine our 50-yard-line seats at the game our patients play against Pain and Death. And they pay us to come!

There is, finally, the fun of being on the team yourself, of surrounding the woolly mammoth along with the rest of your tribe — melding minds and straining backs toward an enormous, shared goal. And despite his often saturnine tone, this writer is happy to note there remain some truly great people in America's mixed-up world of medicine. Nurses and doctors and secretaries who can make my day when the patients and the bodies (even the stop lights) still can't get me past the lawyers and the HMOs. I hope they're getting a little fun out of it too.

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Tips for discussing school safety with students

For parents hoping to shield children from news of the recent school shootings across the country, the task is nearly impossible.

Today's adolescents and teens happen upon an endless amount of news while researching homework on the Internet or talking with friends through instant messaging systems, chat rooms and blogs. Some even receive news updates on their cell phones.

So while parents' instincts might be to shy away from talking about frightening real-life stories of harm to children, chances are they will need to confront the news instead.

"Open up the conversation. If the child is saying they're not upset, you can drop the conversation," says Melissa Brymer, director of the terrorism and disaster programs at the National Center for Child Traumatic Stress at UCLA. "Some kids do need the parent or adult to take that first step."

She suggests talking at a time when you can focus on your child's verbal and nonverbal responses, perhaps after dinner. Bedtime isn't a good choice, since the child's anxiety could spiral late at night. "Explain that emergencies can happen in many different ways," says Brymer, "and that schools have crisis plans to make sure kids are safe so they can learn."

If you haven't done so already, get details on the disaster plan for your school district, including specifics on evacuation and how you can get accurate information during a crisis. Then reassure your child that you'll know how to reach him or her in an emergency.

Help children form their own plans. Brymer advises making a list of two or three trusted adults that your children can go to at school if they see a suspicious stranger or overhear students talking about committing violence. Ask if any new terms (such as "lockdown") confuse them, then discuss how you can contact each other if cell phone service is jammed.

Do they know where the nearest pay phones are, and have they ever used one? Do they know how much change is needed to make a local call? They may never need this information, but having it can be emotionally empowering.

Discuss how the people who have carried out these attacks should have dealt with their anger. "This is a prime time, what we call a teachable moment, where you can discuss how to solve problems and ways to show anger that don't involve verbally or physically hurting someone," says Marilyn Tolbert, director of laboratory schools for Texas Christian University in Fort Worth, Texas.

Tolbert also recommends reminding children that they can always talk with you or others about their anger or fear.

Remind children how rare school shootings are. "If you figure how many schools there are in the country," says Brymer, "we realize it feels more commonplace than it is. It's important to be putting it into context."

It is also useful to point out to smaller children that the images they see on television are the same shootings being repeated, not new violence. "We saw after 9/11 that very young kids who kept seeing the images of buildings crashing thought there were buildings crashing every day," says Brymer. It can also help to let them know just how far away these recent events took place from their own community.

You can express confidence in school safety, without promising that violence won't happen. "We don't want to lie to them," Tolbert says. "I would err toward the side of saying, 'I feel very comfortable at your school and you feel safe there. They're taking every precaution."' Remind your child that safety rules, such as requiring visitors to wear badges, are in place at their school to protect them.

If older children are watching a lot of news coverage of recent violence, says Brymer, you may want to limit their intake or ask again how they're feeling. Watching some coverage can be helpful to clarify misinformation they may have gotten from their peers, but consuming too much violent imagery can intensify their anxiety.

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Citrin K (HCA) is a patented extract of the Indian Brindall Berry (garcina cambogia) that has been found to dramatically increase the body's ability to convert food into glycogen. Glycogen is the body's fuel for energy consuming activities. When you have lots of glycogen in your body it triggers a signal to the brain telling it to suppress your appetite. The result is a marked decrease in the craving for fattening foods. In addition, Citrin K's active ingredient slows the production of fat. This results in your cells burning it for energy at a faster rate. Not only do you eat less fat, but you also burn it faster. This has been proven by scientific double-blind studies conducted by Anthony Conte, M.D. Those participating in the study took 500 mg of Citrin K a day. After 60 days the average weight loss was 11 pounds. We recommend that you take 1500 mg per day of this very safe product to lose weight even faster. Citron K is also known as HCA.

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Synchronizing sex: Time to harmonize your hormones

Afi-Odelia E. Scruggs

How many nights have you spent on your side of the bed awake with passion, while your partner is curled up next to you deep in sleep? Or maybe you're the one who's OK with having sex every week or so, while he's looking for it every other day.

You used to do it all the time. What happened? Has the thrill packed up and gone? Not necessarily. The problem is that you've got what therapists call desire discrepancy -- you're out of sync sexually with your better half.

If you're worried that you and your partner have fallen out of lust, consider this: You may never have been in sync at all. It just seemed that way because the novelty and excitement of having a new lover boosts the hormones that inspire desire. As a relationship continues, though, the initial infatuation disappears and each partner returns to his or her "normal" level of sexual desire- - which may be high, moderate, or low. And libido may wax and wane at different times in a person's life.

The upshot is that desire discrepancy is part of a committed, long-term relationship. "I call it normal," says Austin, Texas--based marriage and family therapist Pat Love, Ed.D., co-author of "Hot Monogamy."

Still, experts agree that desire discrepancy is nothing to shrug at. If it's not acknowledged, it can lead to feelings of rejection (if one partner begins to take the other's lack of interest personally), guilt (if the less-interested partner begins to see intimacy as an obligation or a chore), and frustration all around.

First, ditch the idea that both of you should always be passionate for each other at the same time. "In the movies, the couples are turned on before they begin touching," says couples therapist Barry McCarthy, a psychology professor at American University in Washington, D.C. "In reality, among happily married couples, only 50 percent of sexual experiences occur when both partners are desirous, aroused, and orgasmic." The rest of the time, it may take effort to get in the mood at the same time.

Also, understand that "in the mood" may mean something different for him than it does for you, says Sheryl Kingsberg, Ph.D., a clinical psychologist at Case Western Reserve University School of Medicine in Cleveland, Ohio. If a man is physically aroused, it doesn't much matter what else is going on -- he's ready. But a woman's sexual interest is more complicated.

For women, emotion and motivation play as large a role in sexual interest as physical desire does, explains Kingsberg, who researches female sexual function. A woman may need to make an emotional or intellectual connection before her body responds. Once her body and mind have caught up with each other, she'll enjoy it as much as he does.

Stress also causes different sexual reactions in men and women. "For men, sex tends to be a stress reliever," Kingsberg says. Women, however, often have to de-stress before they can get in the mood.

Say you and your partner agree that sex is good -- when you have it, that is -- but one of you would just like to have it more often. Here are some ways to build bridges to intimacy that can increase desire, passion, and, yes, even your chances of making a connection.

Confess your distress. One of the most difficult steps is simply admitting that the two of you have different levels of desire. Don't point fingers, Kingsberg says. Instead, acknowledge the discrepancy and view it as a chance to work together to solve a problem.

Try something new. It doesn't have to be anything sexual or even romantic, just something different and fun. "Passion is fueled by dopamine, and dopamine is fueled by novelty," Love says. So take up rock-climbing or sign up for a cooking class. The goal is to find an activity that the two of you can enjoy together.

Get in touch. Experts suggest that you expand your view of intimacy. Whole-body massage or cuddling on the couch can be just as sensual and pleasurable as actual intercourse. (And who knows? That closeness may even lead to sex.)

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Get on the scale daily to keep lost pounds off

Reuters Health

Losing excess weight is often easier than keeping it off. A new study shows that stepping on a scale every day, and adjusting eating and exercise habits accordingly, can go a long way in helping dieters maintain a weight loss.

"If you want to keep lost pounds off, daily weighing is critical," said Dr. Rena R. Wing in a statement accompanying the study appearing in The New England Journal of Medicine this week.

"But stepping on a scale isn't enough. You have to use that information to change your behavior, whether than means eating less or walking more. Paying attention to weight -- and taking quick action if it creeps up -- seems to be the secret to success," noted Wing, who is director of the Weight Control and Diabetes Research Center at The Miriam Hospital and professor of psychiatry and human behavior at Brown Medical School in Providence, Rhode Island.

The finding comes from a study in which Wing and colleagues split 314 successful dieters who'd lost at least 10 percent of their body weight -- averaging nearly 20 percent of their body weight or 42 pounds -- within the last two years, into a control group and two intervention groups.

Women in the control group received newsletters in the mail four times per year on the importance of eating right and exercising.

Women in the intervention groups were taught -- either in face-to-face group meetings or via an online program -- techniques known to prevent weight regain such as advice to eat breakfast, get an hour of physical activity each day and weigh themselves daily.

The women reported their weight weekly and were given a goal of maintaining their weight to within five pounds. Women in the intervention groups were also introduced to a color-based weight-monitoring system. Women who remained within three pounds of their starting weight after the weekly check-in fell into the "green zone," and received encouraging phone messages and green rewards, such as mint gum.

Gaining between three and four pounds landed women in the "yellow zone" and prompted advice to tweak their eating and exercise habits, while gaining five pounds or more landed one in the "red zone," prompting advice and encouragement to restart active weight-loss efforts.

The investigators report that significantly fewer women in the intervention groups regained five or more pounds during the 18-month long study; 72 percent of women in the control group regained five or more pounds, compared with 46 percent in the face-to-face intervention group and 55 percent in the Internet group.

"The Internet intervention worked, but the face-to-face format produced the best outcomes," Wing said.

Daily weighing was key to keeping the weight off, the authors say, noting that women in the intervention groups who stepped on the scale each day were 82 percent less likely to regain lost weight compared to those who did not weigh themselves daily.

However, in the control group, daily weighing had little impact on the amount of weight regained. This suggests, Wing said, that women in the intervention groups used the information from the scale to make constructive changes in their eating and exercise habits.

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High blood pressure and sex - Overcome the challenges

MayoClinic.com

High blood pressure often has no signs or symptoms. But the impact on your sex life may be unmistakable. Although sexual activity seldom poses cardiovascular risks — such as causing a heart attack — high blood pressure can affect your overall satisfaction with sex. Both men and women face specific challenges.
Challenges for men

Over time, high blood pressure damages the lining of your blood vessels and promotes hardening of the arteries (atherosclerosis). This means less blood flows to your penis. For some men, the decreased blood flow makes it difficult to achieve and maintain erections.

Even a single episode of erectile dysfunction can be a source of anxiety. Fears that it will happen again might lead you to avoid sex — and erode your relationship with your sexual partner.

High blood pressure can also interfere with ejaculation and reduce sexual desire. Sometimes the medications used to treat high blood pressure have similar effects.
Challenges for women

Sexual dysfunction in women hasn't been well researched. However, current studies indicate that sexual dysfunction could be even more common in women than in men. And high blood pressure — or the medications to treat it — may only increase the risk.

High blood pressure can reduce blood flow to your vagina. For some women, this leads to a decrease in sexual desire or arousal, vaginal dryness or difficulty achieving orgasm. Like men, women can experience anxiety and relationship issues due to sexual dysfunction.
Be honest with your doctor

If you have high blood pressure, you don't have to resign yourself to loss of sexual satisfaction. Start by talking with your doctor. The more your doctor knows about you, the better he or she can treat your high blood pressure — and help you maintain a satisfying sex life. Be prepared to answer questions such as:

* What medications are you taking?
* Has your relationship with your sexual partner changed recently?
* Do you have more than one sexual partner?
* Have you been feeling depressed?
* Are you facing more stress than usual?

Consider your medications

Sexual dysfunction is a side effect of some high blood pressure medications, including diuretics and beta blockers. To reduce the risk of side effects, including sexual problems, take your medication exactly as prescribed.

If that doesn't help, ask your doctor about other options. Some high blood pressure medications — such as angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers — are less likely to cause sexual side effects. To help your doctor select the most appropriate medication for you, list all the other medications you're taking now — including herbal supplements and over-the-counter drugs. Sometimes a particular combination of medications contributes to sexual problems.

If your doctor approves, you may be able to stop taking blood pressure medication temporarily to see if your sex life improves. To make sure your blood pressure remains within a safe range, you may need frequent blood pressure readings while you're not taking medication. Sometimes this can be done with a home blood pressure monitoring device.

If you're considering medication for erectile dysfunction, check with your doctor first. It's usually safe to combine the erectile dysfunction drugs sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) with high blood pressure medications. But taking these drugs with nitrates for chest pain can cause a dangerous drop in blood pressure.
Promote overall health

Staying tobacco-free, eating healthy foods and exercising regularly can reduce your blood pressure — and improve your sex life. In fact, in one study, about one-third of obese men with erectile dysfunction improved their sexual function by losing weight. Of course, a leaner body can boost your confidence and help you feel more attractive, which also bodes well for your sex life.
Set the stage for satisfying sex

Your sexual response may vary with feelings about your partner and the setting in which sex occurs. To encourage satisfying sex, initiate sex when you and your partner are feeling relaxed. Explore various ways to be physically intimate, such as massage or warm soaks in the tub. Share with each other the types of sexual activity you enjoy most. You may find that open communication is the best way to achieve sexual satisfaction.

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Revive Your Sex Drive: How to Handle 10 Top Libido Killers

Rachel Grumman

Is sex the last thing on your mind these days? Does it take you forever to get aroused? Or has reaching orgasm become a herculean task? If so, you may have female sexual dysfunction - and you're not alone. An estimated 43 percent of women reported experiencing sexual dysfunction, according to findings published in the Journal of the American Medical Association, with problems ranging from not being able to have orgasms to having zero sexual desire.

Many things can interfere with sexual pleasure and function, from medical causes, such as certain medications, to psychological issues, such as relationship strife. Most often, sexual dysfunction is born out of a combination of the two. To help you pinpoint what's taken the sizzle out of your sex drive, we've pulled together 10 top libido killers and what your next steps should be to get your sex life back on track.

1. Oral contraceptives: The trouble with the Pill is that what keeps you from getting pregnant - stopping ovulation - is also what can sap your sex drive. "The medication puts your ovaries to rest for three out of four weeks each month, but there other functions of ovaries beside making eggs - and that is making hormones," says Irwin Goldstein, MD, coeditor of the textbook Women's Sexual Function and Dysfunction: Study, Diagnosis and Treatment. The second problem is that the Pill causes the body to produce a protein called sex hormone binding globulin (SHBG), which binds itself to sex hormones, in particular testosterone, essentially sucking them up. Testosterone plays a role in vaginal blood flow and sensitivity in the opening of the vagina, so lower levels of the hormone can lead to sexual problems. What's more, the thinking was that once you stopped the Pill your body returned to its original settings, but Dr. Goldstein's research shows the Pill's effect and the SHBG protein production can continue to be higher in former Pill users than in non-Pill users.

What you can do: If you've noticed your sex drive isn't what it used to be and suspect it may be because of your birth control pill, talk to your gynecologist. He or she may switch you to another type of Pill (especially if you're on an ultra low dose, or 20 microgram, pill, which is one of the biggest offenders) or a different birth control method, such as the Mirena IUD or condoms.

2. Medications:Antidepressants - in particular, selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Paxil - are one of the best-known offenders for low libido and impaired orgasm. "Certain chemicals in the brain stimulate sexual activity, such as dopamine, norepinephrine and oxycontin, while other chemicals are inhibitory, such as serotonin," says Dr. Goldstein. SSRIs raise serotonin in the blood, which can affect libido. (Case in point: SSRIs are used "off-label" to treat men with premature ejaculation since it slows down their sexual excitement, according to Dr. Goldstein.) Other culprits include prescription blood-pressure-lowering drugs, which can interfere with nerve signals, and antihistamines, which dry up not only a runny nose but your vaginal lubrication as well, making sex uncomfortable.

What you can do: Talk to your doctor about your sex drive. He or she may be able to adjust your medication regimen, for example, keeping you on the antidepressant while adding Zestra (zestraforwomen.com), an over-the-counter topical botanical oil that, when massaged into the clitoris, labia and vaginal opening during foreplay, enhances arousal and orgasm, suggests Susan Kellogg-Spadt, PhD, CRNP, director of sexual medicine at the Pelvic Floor Institute at the Graduate Hospital in Philadelphia. The oil has been tested and found to be effective on SSRI patients. Your physician may also be able to switch you to a different antidepressant medication, such as Wellbutrin, a dopamine reuptake inhibitor, which often improves sexual function. However, Wellbutrin can have its own side effects, including insomnia, changes in appetite, heart palpitations and dry mouth. If your antihistamine is to blame, try using a water-based lubricant during sex.

3. Depression: This mood disorder is characterized by feelings of sadness, emptiness, worthlessness and fatigue that interfere with everyday life, as well as changes in sleep and eating habits. One of the hallmarks of depression is a lack of interest in sex. Although it's not fully understood why depression affects sex drive, part of the reason may be that not feeling good about yourself and your worth, in addition to having low energy levels, dampens the desire for pleasure.

What you can do: Seek help right away, especially if you have thoughts of death or suicide. Exercise can help with mild to moderate depression by boosting mood, self-esteem and energy levels while improving blood flow, including to the genitals. For moderate to severe depression, professional counseling and prescription antidepressants can help, says Dr. Kellogg-Spadt. The irony is that some of the same medications used to treat depression can reduce your sex drive (see "Medications" above). Let your physician know if your lack of sex drive doesn't change (or worsens) with treatment.

4. Poor body image:Feeling self-conscious about your curvy hips or less-than-ample breasts can diminish your sexual drive. "It doesn't matter if your guy is telling you you're the hottest thing," says Dr. Kellogg-Spadt. "Oftentimes the partner is raring to go and completely attracted. But if you don't feel beautiful, you're not going to be into it."

What you can do: Do a cuing analysis. Think of a time in your life when you felt sexually at the top of your game. What did you wear (for instance, your favorite little black dress or low-rise jeans), what was your workout routine, how did you eat, what perfume did you wear, what shoes did you slide on - and when was the last time you wore that, did that, ate that, etc.? These cues can help you get back into the mindset and habits of your sexy self. And if the little black dress doesn't fit anymore? It might be time to buy another dress you feel good in at your present weight or get back into an exercise routine. "Exercise has a direct effect on the chemicals in your brain that affect mood," says Jennifer Berman, MD, director of the Berman Women's Wellness Center in Los Angeles and coauthor of For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. In addition, working out will shape up your physique and give you more energy. If these changes don't help improve your body image, it's time to consider professional counseling to get at the root of the problem.

5. Menopause:Menopause is marked by a whole host of changes in your body. There's a decline in ovarian function that leads to an abrupt drop in estrogen levels, which play a role in vaginal lubrication. What's more, testosterone production drops by up to half, which can trigger a sudden dip in your sex drive as well as diminished sensitivity in the clitoris and a weakened ability to climax, according to Dr. Berman. Growth hormone levels, which are associated with sexual function, energy, memory and mood, also decrease. "Touch perception changes and alters as we age," adds Dr. Berman. "It takes a little more touch to feel the same amount of erotic arousal." Add to that weight gain, fatigue and difficulty sleeping, and sex can become the last thing on a menopausal woman's mind.

What you can do: First and foremost, speak with your doctor to check for a medical cause, such as high blood pressure or cholesterol. If that's been ruled out, there are many options, including starting a doctor-approved exercise regimen to improve blood flow, using the botanical oil Zestra during foreplay, self-pleasuring to promote genital blood flow and incorporating fantasy work, such as doing some erotic reading or watching erotic videos 20 to 30 minutes three times a week. "This doesn't have to be done in the presence of your partner - sometimes it's better not to - but it's to put erotic thoughts back into your daily thoughts," says Dr. Kellogg-Spadt. To combat vaginal dryness, start exercising to improve blood flow and use a water-based lubricant that feels natural to you. Your doctor may prescribe a topical estrogen therapy, which increases vaginal lubrication and elasticity. Have open communication with your partner and explain to him that your body is changing. "Let him know that it doesn't mean you're not turned on by your partner just because you have to use a lubricant," she says. Using a vibrator, which is more intense than the human hand, can also help with dulled arousal. In some cases, physicians may prescribe testosterone (in pill, cream, suppository or lozenge form) to older women with low levels of the hormone who experience a loss of well-being. Oral and topical testosterone may help increase sexual urges, although no preparations are FDA-approved yet.

6. Medical conditions: Health problems such as high blood pressure, high cholesterol, diabetes, thyroid disorders and autoimmune disorders like lupus can all change a woman's sexual desire by affecting blood flow, nerve signals and hormone levels. A recent study of 417 sexually active women ages 31 to 60 found that women with high blood pressure were twice as likely to have sexual dysfunction than women with normal blood pressure. What's more, the older the women were and the longer they had had high blood pressure, the greater the chance of sexual dysfunction.

What you can do: Let your doctor know that you are feeling a change in libido. He or she may prescribe medication to treat the health condition, which generally limits sexual side effects. In the aforementioned study, women who took drugs to treat their high blood pressure but did not reach their target goal were more likely to experience sexual dysfunction compared with women who were not taking medication. However, women who had good control of their blood pressure through medication were much less likely to have libido problems. Your doctor may also recommend lifestyle changes, such as exercising regularly and eating healthfully, which may allow you to cut back on medication. To counter vaginal dryness, use a water-based lubricant or talk to your doctor about using a topical estrogen.

7. Relationship problems: Resentment is the number one relationship issue that affects arousal and orgasm, according to Dr. Kellogg-Spadt. "It's the unspoken unhappiness and anger that lead to resentment," she says. "Men may get upset about their wives' spending habits or having to alter the amount of nights they go out with their friends or play sports, while women may resent having to move because of their man's job." All of that buried anger toward your partner can throw a wet blanket on passion.

What you can do: First speak with your health-care provider to find out if there's a physical cause behind your lagging libido. Whatever the cause, deal with the problem before there's an emotional crisis from the lack of sex and intimacy. "Don't wait until you're pressured or your partner is threatening for divorce, because then medical intervention may not be as effective under stress," says Dr. Berman. "You need to feel safe, comfortable and happy." Even if it's an old argument or slight that's cooling your passion, you and your partner need to open up the lines of communication and discuss it so you can put the grudges - and yourselves - to bed. Pick a time to talk in a quiet place where you can both air your complaints and listen to each other. If you're both too resentful to make your talks worthwhile, consider seeking professional counseling to overcome your issues.

8. Stress: When you're stressed about paying bills and meeting a deadline at work while trying to juggle your role as wife and mother, feeling sexual often falls by the wayside. Part of that is because stress is a distraction - it's hard to focus or enjoy sex when you're mentally still at work. In addition, when stress strikes, the hormone cortisol goes up, which alters the hormones (testosterone and estrogen) that influence your sex drive.

What you can do: The irony is that having sex - in particular, orgasms - is a known stress reliever. "Chemicals, such as oxycontin, are released during sex, which combat those high cortisol levels," says Dr. Kellogg-Spadt. But if you're too wound up to hit the sheets, find another way to calm anxiety, such as by exercising, which increases blood flow all over your body, including your genitals, and gives you a mental boost. Yoga and meditation are also great stress relievers. Also, make time to transition from work mode into intimacy mode with your partner by giving each other a massage, chatting after dinner, having a glass of wine or holding hands, suggests Sandra Leiblum, PhD, director of the Center for Sexual and Relationship Health at the UMDNJ Robert Wood Johnson Medical School in Piscataway, NJ, and coauthor of Getting the Sex You Want: A Woman's Guide to Becoming Proud, Passionate, and Pleased in Bed. In addition, "recognize what your conditions need to be in order to relax and enjoy sex," says Dr. Leiblum. "If at 11pm you're exhausted and worried about catching a 6am train to work the next day, that's not conducive to sex. Maybe it's better for you in the morning or the afternoon on a Saturday."

9. Childbirth and breastfeeding: Pelvic nerves and muscles may become damaged during delivery, reducing genital sensitivity, while breastfeeding lowers levels of estrogen, which keeps the vagina lubricated and flexible, making penetration painful. Breastfeeding also increases the hormone prolactin, which curbs sexual desire and lowers testosterone. Some women may have postpartum depression, which also lowers libido. What's more, having a baby is an exercise in sleep deprivation, which can leave you too exhausted just for motherly duties, never mind sex.

What you can do: Talk to your physician about your change in libido and have him or her rule out a physical cause as well as postpartum depression. If breastfeeding is to blame, know this is a temporary situation. Give yourself time to adjust to the new schedule and lack of sleep that come with a new baby and find ways to stay connected to your partner, such as by communicating and cuddling.

10. Routine in the bedroom: There's a reason people say that variety is the spice of life. Without it, anything, even sex, can get monotonous. "The novelty of a new relationship and the thrill that comes with infatuation cannot be sustained," says Dr. Berman. "All relationships go through ebbs and flows and ups and downs, so it's important to make the relationship a priority since often other things - work, the house, the kids, the in-laws - come first."

What you can do: Explore new positions through the use of erotic books or videos. "You don't have to be swinging from the chandeliers and doing Kama Sutra every night, but just be aware of not falling into a routine," says Dr. Berman. Try changing the time of day you have sex: Instead of being intimate before bed like clockwork, have a quickie before work in the morning or in the afternoon on the weekend. Even if you're not exactly in the mood, sometimes having sex can turn you on since sex itself increases blood flow as well as the emotional connection between you and your partner. Always make time to reconnect with your partner, even if it means hiring a babysitter and having a date night once a week.

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Sex during pregnancy: An unnecessary taboo?

Mayo Clinic

If you want to get pregnant, you have sex. No surprises there. But what about sex while you're pregnant? The answers aren't always as clear. Here's what you need to know about sex during pregnancy.

Is it OK to have sex during pregnancy?

As long as your pregnancy is proceeding normally, you can have sex as often as you like. But you may not always want to. At first, hormonal fluctuations, fatigue and nausea may sap your sexual desire. During the second trimester, increased blood flow to your sexual organs and breasts may rekindle your desire for sex. But by the third trimester, weight gain, back pain and other symptoms may once again dampen your enthusiasm for sex.

Can sex cause a miscarriage?

Many couples worry that sex during pregnancy will cause a miscarriage, especially in the first trimester. But sex isn't a concern. Early miscarriages are usually related to chromosomal abnormalities or other problems in the developing baby — not to anything you do or don't do.

Does sex harm the baby?

The baby is protected by the amniotic fluid in your uterus, as well as the mucous plug that blocks the cervix throughout most of your pregnancy. Your partner's penis won't touch the baby.

Are any sexual positions off-limits during pregnancy?

As your pregnancy progresses, experiment to find the most comfortable positions. There's just one caveat. Avoid lying flat on your back during sex. If your uterus compresses the veins in the back of your abdomen, you may feel lightheaded or nauseous.

What about oral sex?

If you have oral sex, make sure your partner does not blow air into your vagina. Rarely, a burst of air may block a blood vessel (air embolism) — which could be a life-threatening condition for you and the baby.

Can orgasms trigger premature labor?

Orgasms can cause uterine contractions. But these contractions are different from the contractions you'll feel during labor. Research indicates that if you have a normal pregnancy, orgasms — with or without intercourse — don't lead to premature labor or premature birth.

Are there times when sex should be avoided?

Although most women can safely have sex throughout pregnancy, sometimes it's best to be cautious.

* Preterm labor. Exposure to the prostaglandins in semen may cause contractions — which could be worrisome if you're at risk of preterm labor.
* Vaginal bleeding. Sex is not recommended if you have unexplained vaginal bleeding.
* Problems with the cervix. If your cervix begins to open prematurely (cervical incompetence), sex may pose a risk of infection.
* Problems with the placenta. If your placenta partly or completely covers your cervical opening (placenta previa), sex could lead to bleeding and preterm labor.
* Multiple babies. If you're carrying two or more babies, your doctor may advise you not to have sex late in pregnancy — although researchers have not identified any relationship between sex and preterm labor in twins.

Should my partner use a condom?

Exposure to sexually transmitted diseases during pregnancy increases the risk of infections that can affect your pregnancy and your baby's health. If you have a new sexual partner during pregnancy, use a condom when you have sex.

What if I don't want to have sex?

That's OK. There's more to a sexual relationship than intercourse. Share your needs and concerns with your partner in an open and loving way. If sex is difficult, unappealing or off-limits, try cuddling, kissing or massage.

After the baby is born, how soon can I have sex?

Whether you give birth vaginally or by C-section, your body will need time to heal. Many doctors recommend waiting six weeks before resuming intercourse. This allows time for your cervix to close and any tears or a repaired episiotomy to heal.

If you're too sore or exhausted to even think about sex, maintain intimacy in other ways. Share short phone calls throughout the day or occasional soaks in the tub. When you're ready to have sex, take it slow — and use a reliable method of contraception.

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Key data 'missing' in drug trial

Key information was absent from a research file prior to a London drug trial that left six men seriously ill, investigators have concluded.

Drug research experts from the Netherlands say UK regulators did not receive findings that might have warned them of damage TGN1412 could do.

The worst affected of the six men, Ryan Wilson, had fingers and toes amputated, and his future health is uncertain.

In The Lancet, the authors propose a system of extra checks for trial drugs.

Omissions

An expert group set up by the UK's Health Secretary is looking at how to safeguard against such adverse events when experimental drugs are tested.

A preliminary report by the group recommends the initial drug dose should be given to just one person - which was not the case in the London trial.

And it recommends drugs which affect the immune system, like the monoclonal antibody TGN1412, may be best given to people who are already ill.

The Lancet paper authors tested their own proposed list of safety checks using the case of TGN1412.

The checks include factors such as how much is known about how the experimental drug works in the lab, in animals and in humans and how predictable these effects are.

In the case of TGN1412, the scientists from the German company TeGenero reported that the site in the body where the drug binds was identical in humans beings and monkeys.

However, no detailed data on such a comparison was included.

When the Dutch researchers explored this they found clear differences between humans and monkeys.

The research file on TGN1412 also lacked information about how the drug affects certain human immune cells compared to monkey immune cells.

Dr Adam Cohen, from the Centre for Human Drug Research in Leiden, the Netherlands, said: "Essential information was absent.

"The assessors did not receive all relevant findings."

Dr Cohen and his team say drug developers need to ensure they provide all essential information, and trial assessors need to use internationally consistent ways to evaluate which human experiments should go ahead.

A spokesman for the UK's drug trial assessor, the Medicines and Healthcare products Regulatory Agency, said: "We conducted a rigorous assessment of the application by experienced assessors who concluded it was reasonable to proceed with the trial."

He said the MHRA had implemented recommendations since made by the UK's independent expert group on the way such trials are reviewed in the future.

"Clinical trials in general have an excellent safety record but it is important that we learn the lessons from the TGN 1412 incident," he added.

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Pregnant women 'oily fish alert'

Eating too much oily fish during pregnancy may increase the risk of delivering the baby too early, scientists believe.

The researchers told New Scientist magazine the harm is probably caused by high mercury levels in oily fish such as mackerel, salmon and sardines.

But experts warn it is important for pregnant women, and indeed everyone, to eat enough fish to keep healthy.

Pregnant women should eat fish twice a week, says the Food Standards Agency.

Advice

But they should avoid shark, marlin and swordfish because these fish are particularly high in mercury and other pollutants, it recommends.

Girls, women who are breastfeeding and those trying for a baby should also eat two portions of oily fish per week.

Other women, and men and boys, can eat up to four portions per week. One portion is about 140g of fish - one tuna steak, for example.

FISH
- OILY

• Salmon

• Trout

• Fresh tuna

- NON-OILY

• Haddock

• Cod

• Tinned tuna

Source: Food Standards Agency

Oily fish are high in beneficial fats such as omega 3.

Studies show eating enough fish can boost the birth weight and brain power of babies and help prevent premature labour in pregnant women.

The latest work in New Scientist, also published in the journal Environmental Health Perspectives, looked at 1,024 pregnant women living in Michigan, the US.

Dr Fei Xue and colleagues measured the amount of mercury these women had in their hair and compared this with the date that the women delivered their babies.

The women who gave birth more than two weeks early were three times as likely to have double the average mercury level in their hair samples.

On the whole, these women also tended to eat more oily fish, and particularly canned fish.

Caution

Only 44 of the women gave birth prematurely, however, and the researchers said more work was needed to corroborate their findings.

They also pointed out that the women were asked to recall how much fish they had eaten, which might be inaccurate. It is also possible that the women could have been exposed to mercury from other sources too, they said.

Dr Xue said until the risks become clearer, women could take fish oil supplements instead.

A spokeswoman from the British Nutrition Foundation said: "If pregnant women do decide to take supplements, it is important to read the label and check that the supplement does not contain high amounts of vitamin A (retinol). Too much retinol can be toxic to the developing baby."

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Lung Cancer Can Run in the Family

Serena Gordon
HealthDay Reporter

While smoking is far and away the biggest risk factor for lung cancer, having a close relative who has been diagnosed with the disease nearly doubles your risk of developing the deadly disease.

A new study in the October issue of Chest found that people with a first-degree relative -- that means mother, father or sibling -- who had lung cancer had a 95 percent higher risk of developing the disease themselves.

"Our long-term follow-up of a large-scale, population-based cohort identified a significant increase in the risk of lung cancer associated with a family history of lung cancer in a first-degree relative in a Japanese population," the study authors wrote.

Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic Health System in Baton Rouge, La., said this study confirms what's already known about family history and the risk of lung cancer, and that "it's an important thing for physicians to realize."

"As a clinician, when I have someone with lung cancer, I ask the family members, 'Who smokes cigarettes?' Then I explain that they have a two- to three-fold higher risk of lung cancer because of their family history, and this is just another reason to quit smoking because they have a genetic susceptibility to the carcinogens in tobacco," explained Brooks.

The U.S. Centers for Disease Control and Prevention estimates that more than 180,000 new cases of lung cancer are diagnosed each year in the United States, and nearly 170,000 Americans die from the disease annually. It's the second leading cause of death for men and the third leading cause of death for women, according to the CDC. Cigarette smoking is the most common cause of the disease, according to the National Institutes of Health, though not everyone who gets lung cancer is a smoker or former smoker.

The current study followed more than 102,000 middle-aged and older Japanese adults for as long as 13 years; there were more women (53,421) than men (48,834). During the study period, 791 cases of lung cancer were diagnosed.

The researchers found that having a first-degree relative with lung cancer nearly doubled the odds of developing lung cancer. The association was even stronger for women. Women who had a first-degree relative with lung cancer almost had triple the risk of lung cancer, while men with a first-degree relative with lung cancer had about a 70 percent higher risk.

Additionally, people who had never smoked had a higher risk of developing lung cancer themselves if they had a first-degree relative with the disease than did smokers with close family members with lung cancer.

Family history was also more strongly associated with a particular type of lung cancer -- squamous cell carcinoma.

Brooks and Dr. Ann G. Schwartz, who wrote an accompanying editorial in the same issue of the journal, both said it wasn't clear why family history would confer a greater risk for women than for men. Schwartz said one possibility is that women are more familiar with their family histories and may just be reporting family history more accurately. Brooks also pointed out that this finding might only apply to Japanese women and not other populations.

It's also not clear exactly why family history is associated with a greater risk for those who never smoked, though Schwartz said it may have something to do with different lung cancer types. It's possible that the type of lung cancer nonsmokers often get may also be one where the genetic susceptibility is passed from generation to generation.

While there aren't clear-cut screening guidelines in place for someone with a family history of lung cancer, Schwartz said, "You need to make your physician aware of your family history; don't discount it."

She added that she'd like to see people with a family history of the disease identified as high-risk for lung cancer and included in screening studies.

"If you have a family history of lung cancer, you have a genetic susceptibility to the carcinogens in directly inhaled and in secondhand tobacco smoke. Avoid all exposure to tobacco, quit smoking if you're a smoker," and don't let your children be exposed to tobacco smoke, Brooks said.

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Acne drug linked to depression in animal tests

Amy Norton

The active ingredient in the acne drug Accutane seems to cause depression-related behavior in mice, a study has found.

Accutane, also sold generically as isotretinoin, has been linked to reports of depression and suicidal behavior among users. However, human studies have yielded conflicting results as to whether the drug itself contributes to these problems.

Depression is a complex disorder and, therefore, difficult to pin down to a single cause. For example, Accutane users often have severe acne, which itself may lead to depression.

Because the new study was conducted in mice, researchers were able to examine the direct effects of Accutane's active ingredient on signs of depression -- which, in mice, manifests as listless, sedentary behavior.

They found that mice given the drug every day for six weeks began to show such lethargy during tests that gauged their stress responses. In contrast, the animals showed no movement problems in other situations, including tests of physical coordination.

This suggests the drug's effects were depression-related, according to the researchers, led by Dr. Kally C. O'Reilly of the University of Texas at Austin.

They report the findings in the journal Neuropsychopharmacology.

For now, it's unclear whether the results might also apply to humans, study co-author Dr. Michelle A. Lane, also of UT Austin, told Reuters Health.

These findings are "just the beginning," she explained, and more work needs to be done before a conclusive link can be made between Accutane use and depression.

The acne drug belongs to a family of compounds called retinoids, derivatives of vitamin A. It's known that retinoids can damage the developing fetal nervous system, which is why Accutane cannot be given to pregnant women.

In addition, there is growing interest in how retinoids might affect the adult brain, according to O'Reilly's team.

Based on evidence from previous research, they note, Accutane might alter the regulation of brain chemicals like dopamine and serotonin, which are implicated in depression. Another possibility is that the drug might affect the production or survival of cells in brain regions linked to depression.

This is, however, still speculation. Little is known about how Accutane may work in the human brain. One brain-scan study of acne patients found that those treated with Accutane showed lesser activity in an area of the brain related to depression, but they weren't more likely than other patients to suffer depression.

Between 1982 and 2000, the U.S. Food and Drug Administration received 431 reports of depression, suicide or suicidal behavior among Accutane users.

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India encephalitis toll hits 222

Encephalitis is killing 20 children a week on average in India's most populous state where the death toll has reached 222, health officials said.

The outbreak of "brain fever" began in June and the death toll passed 150 in mid-September in northern Uttar Pradesh.

"Three more children died of encephalitis overnight taking the toll to 222. The majority of the dead were children under 10 years of age," senior health official Umakant Prasad told AFP in the state capital Lucknow.

At least 78 children were being treated for the disease in government hospitals, he added.

"The condition of 24 children is serious," added Prasad.

Indian authorities launched a massive drive to inoculate millions of children against Japanese encephalitis, which is endemic in parts of the state, after 1,400 people -- most of them children -- died in Uttar Pradesh last year.

Prasad said the children who were now dying were not among the more than six million who had been given the vaccine.

Like last year, most of the cases have been reported from impoverished Gorakhpur district, 250 kilometers (150 miles) southeast of Lucknow.

The outbreaks usually begin with the onset of the monsoon rains during June. Mosquitoes carry the disease from pigs to humans.

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Madonna gains custody of Malawi boy

RAPHAEL TENTHANI,
Associated Press Writer

Madonna and her husband left Malawi Friday after gaining custody of a 1-year-old boy they adopted during a weeklong tour of orphanages in this impoverished southern African nation.

The private plane departed for an undisclosed destination just before 2 a.m. after a three-hour wait on the tarmac at Lilongwe airport. No reason was given for the delay.

Earlier a judge gave an interim order allowing Madonna to take the boy home with her.

The boy's father said he was happy for his son, named David, and pleased with the celebrity couple who want to be his parents.

"They are a lovely couple," said Yohame Banda, who met Madonna and her filmmaker husband in court as part of the formalities.

""She asked me many questions. She and her husband seem happy with David. I am happy for him. Madonna promised me that as the child grows she will bring him back to visit."

Madonna has yet to comment publicly since her arrival in Malawi on Oct. 4, though she has made several public appearances in support of projects she supports here to care for AIDS orphans.

Malawi law does not allow for inter-country adoptions, and generally requires people who want to adopt to spend 18 months being evaluated by Malawian child welfare workers. Malawian officials had indicated earlier such restrictions would be waived for Madonna and Ritchie, but refused to elaborate Thursday.

Madonna and her filmmaker-husband have a son, Rocco, 5, and the singer also has a daughter, Lourdes, 9.

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New HIV infections in Australia surge

MERAIAH FOLEY,
Associated Press Writer

New HIV cases in Australia surged more than 40 percent from 2000 to 2005, according to study results released Thursday, prompting fears that drug treatment advances are making people lax about practicing safe sex.

The annual survey report, issued by the National Center in HIV Epidemiology and Clinical Research, found that new HIV infections reported in Australia rose from 656 in 2000 to 930 in 2005 — a 41 percent leap. HIV is the virus that causes AIDS.

Gay men accounted for about 70 percent of the new cases. Heterosexuals made up 19 percent, while intravenous drug users and unknown transmission paths accounted for the rest.

According to the report, new infections hit an all-time high of about 1,700 in 1984, then declined steadily through the late 1990s. But in 2000, the trend apparently reversed.

It's not just HIV that is on the rise in Australia.

Around 41,300 new cases of the sexually transmitted disease chlamydia were reported in 2005, a fourfold increase over 1995.

New gonorrhea cases have almost doubled in the past decade, the study said.

"It's very possible that people are just not prioritizing safe sex as they maybe used to in the very serious HIV/AIDS era" of the late 1980s and early 90s, said the center's deputy director, John Kaldor.

"It might be here that improvements in HIV treatments have lessened the motivation for people to protect themselves sexually," Kaldor said.

Australia has about 15,000 people living with HIV, and around 70 percent are being treated with life-prolonging anti-retroviral drugs, the study found.

Don Baxter, executive director of the Australia Federation of AIDS Organizations, said widespread use of the drugs — which have been found to slow the progression of HIV to AIDS — could be a factor behind the recent rise, especially among gay men.

"The place of HIV in gay men's lives has receded enormously from where it was, because they and their friends have stopped dying," he said "So the level of attention to it is much reduced."

He said so-called "treatment optimism" could make some people more likely to take risks, or "at least rationalize having unprotected sex."

Australia had 22,361 reported cases of HIV as of the end of 2005. A further 9,872 people have been diagnosed with full-blown AIDS, and around 6,700 have died from AIDS, the report said.

The National Center in HIV Epidemiology and Clinical Research, an independent medical research institution, collaborates with the government on setting strategy to combat the spread of AIDS.

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Soccer Players at Risk for Mouth, Face Injuries

Robert Preidt

HealthDay

Amateur soccer players suffer a surprisingly high number of face and mouth injuries, a new report finds.

Oral surgeons at Ataturk University in Erzurum, Turkey, reviewed 53 cases of mouth, jaw, and facial injuries they treated over the course of a year.

Of those 53 cases, 11 (20 percent) involved amateur soccer players.

The most common soccer-related injuries were dental fractures, followed by fractures of the lower jaw, and problems with the temporomandibular joint (TMJ), which moves the jaws. One player had a broken nose.

About two-thirds of the injuries were caused when soccer players ran into one another, while the other injuries were the result of impact with equipment or the ground, the study said.

While this study found that soccer accounted for 20 percent of serious oral and craniofacial injuries in Turkey (where soccer is enormously popular), the true rate of injury in that country is probably much higher, the researchers said. They noted that soccer players who suffer eye and nose injuries would likely be seen by other medical specialists.

Mouthguards and faceguards could prevent many soccer-related mouth and facial injuries, but few soccer players use these protective devices, the researchers noted. Amateur soccer coaches and officials must do more to increase players' use of this kind of safety gear, and manufacturers need to improve the fit and comfort of the devices, the authors said.

The study was published in the current issue of the Journal of Craniofacial Surgery.

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Spinach Contamination Linked to Cattle Ranch

Amanda Gardner,
HealthDay Reporter

Three samples of cattle fecal matter from one ranch in California's Salinas Valley have tested positive for the same strain of E. coli bacteria that sickened 199 people in 26 states and left three dead after they ate contaminated spinach.

It's not certain that the ranch was the source of the outbreak, but it's an important lead in the continuing investigation, U.S. and California health officials said during a Thursday evening teleconference.

"We do not have a 'smoking cow' at this point," said Dr. Kevin Reilly, deputy director of the prevention services division for the California Department of Health Services. "We do not have a definitive cause-and-effect, but we do have an important finding."

This is the first time that a strain of E. coli implicated in an outbreak in California's produce-growing region has been linked to a likely source, Reilly said. An additional 650 other specimens are being tested for the bacteria, he said.

The ranch in question is one of four still under scrutiny in San Benito and Monterey counties. Five other ranches have been cleared, but the investigation is ongoing.

"The investigation is not concluded in any way, shape or form," Reilly said.

"It is our expectation that no farm should feel like they are off the hook," said Robert Brackett, director of the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition. "These are ready-to-eat products that are consumed without any cooking, and it is absolutely essential that all farms in the country are doing absolutely everything they can to make sure this never happens again."

The ranch that yielded the positive specimens included both a beef cattle operation as well as fields where spinach and other ready-to-eat produce were grown. The fecal-matter specimens were found half a mile to a mile from the produce fields themselves. The produce fields themselves abutted the livestock pastures, Reilly said.

It's unclear how the contaminated fecal matter could have been transported to the field, but investigators are not ruling anything out. It could have been wandering livestock, substandard worker hygiene, irrigation practices or even wild boar, officials said.

"We don't know if wild swine are playing a role or not, but we do know that on this particular ranch, there is a very large population of wild boar, and we have witnessed on this site that they have torn through fencing and under fencing and have the ability to access the field," Reilly said. "We don't know if that is the source of contamination. It is a potential source, most definitely," he added.

The proximity of fresh produce fields to farm animals has long been a concern to agricultural and health authorities, Brackett said, and is a matter that officials will continue to scrutinize. "One thing we may learn is perhaps what the minimum distance might be, but there are a lot of other considerations," he said.

The ranch in question had apparently been lacking in some so-called "good agricultural practices," including some related to the proximity issue, Reilly said. "We did find some areas of concern, the potential for problems," he confirmed.

Health officials initially narrowed the source of the E. coli outbreak to one processor, Natural Selection Foods, in San Juan Bautista, Calif.

On Sept. 15, Natural Selection Foods recalled all of its spinach products with use-by dates of Aug. 17 to Oct. 1. Four other distributors, all of whom got spinach from Natural Selection, also recalled their products.

Natural Selection processes fresh spinach for more than two dozen brands, including Earthbound Farm, Dole and Ready Pac.

The company said Thursday's announcement that the search for the source of the deadly E. coli outbreak had been linked to a cattle ranch was vindication of its operations, after repeatedly asserting its factories are clean, the Associated Press reported.

"This definitely reinforces our belief that the source was environmental," said Samantha Cabaluna, a spokeswoman for Natural Selection Foods.

Earlier this month, the U.S. Food and Drug Administration said consumers could resume eating fresh spinach.

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Six Ways To Prevent Alzheimer's Disease

Ben Kim, D.C.

Although we don't know and may never know the exact causes of Alzheimer's disease, we do know that several food and lifestyle choices are strongly linked to a decrease in one's risk for developing Alzheimer's.

What follows are six important food and lifestyle factors that can dramatically reduce your risk of developing Alzheimer's disease.

1. Drink Vegetable Juices

A study published in the September issue of the American Journal of Medicine indicates that people who drink three or more servings of fruit and vegetable juices per week have a 76 percent lower risk of developing Alzheimer's disease compared to people who drink less than one serving per week. Because some people develop a high blood sugar level and associated health challenges when they drink fruit juices on a regular basis, it is best for the masses to stick to vegetable juices. If you don't have a juicer, then eat plenty of raw vegetables.

2. Ensure Regular Intake Of Omega-3 Fatty Acids

A study published in the Journal of Neuroscience indicates that a diet high in omega-3 fatty acids, particularly docosahexaenoic acid (DHA), can dramatically slow the progression of Alzheimer's disease in mice. The consensus among neuroscientists worldwide is that consumption of foods that are rich in omega-3 fatty acids is essential to building and maintaining a healthy nervous system, the system that becomes dysfunctional in cases of Alzheimer's disease.

Some healthy foods that are rich in omega-3 fatty acids are:

* Cod liver oil
* Raw walnuts that have been soaked in water for a few hours
* Seaweed
* Purslane
* Freshly ground flax seeds
* Cold-water fish like wild salmon
* Organic eggs from free range birds

3. Strive To Reach and Maintain A Healthy Body Weight For Your Height

According to research that was presented at the 58th annual meeting of the American Academy of Neurology in April of 2006, people who are overweight when they are in their 40s have a greater risk of developing Alzheimer’s disease later in life than those who are not overweight when they are in their 40s.

4. Enjoy Activities That Mentally Stimulate You

The cells that make up your brain are similar to those that make up your muscles; they need to be exercised to stay healthy and strong. If your daily work doesn't require you to solve problems and be creative, consider adopting hobbies that do. Not only will you decrease your risk of developing Alzheimer's, you're bound to feel more alive!

5. Avoid Aluminum

According to the National Institutes of Health, "certain aluminum compounds have been found to be an important component of the neurological damage characteristics of Alzheimer's disease."

The most common sources of aluminum exposure are:

* Processed cheese and cornbread
* Some over-the-counter drugs such as antacids and buffered aspirin
* Aluminum cookware, especially when alkaline foods (like green vegetables) or acidic foods (like tomatoes) are cooked in them
* Antiperspirants

While it is impossible to completely avoid exposure to aluminum through contaminated food, air, and water, taking heed of the sources listed above can significant reduce your long term exposure.

6. Avoid Vaccines And Other Potential Sources of Mercury

While mainstream medicine and science has yet to acknowledge a link between mercury exposure and one's risk for Alzheimer's disease, a study published in a 2001 edition of the journal NeuroReport indicates that inhalation of mercury vapor can cause neurological damage that is strikingly similar to the damage that is found in people with Alzheimer's disease.

The most common sources of mercury exposure are:

* Thimerosal, a preservative that is found in many vaccines
* Amalgam dental fillings
* Seafood, particularly large fish that are high in the food chain
* Broken compact fluorescent light bulbs

Please use the link just below this article to forward this article to family and friends who may be interested in preventing Alzheimer's disease by following these recommendations. Thank you.

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Arthritis Drugs Linked To Cancer

Ben Kim

A recent study led by the Mayo Clinic and published in the Journal of the American Medical Association suggests that people with rheumatoid arthritis who take Humira or Remicade have three times the risk of developing several types of cancer and two times the risk of developing serious infections compared to people who don't take these drugs.

The Mayo Clinic study links the use of Humira or Remicade to the following types of cancer: lymphoma, skin, gastrointestinal, breast, and lung. It also suggests that higher doses of these drugs correlate to greater risk of developing cancer.

The manufacturers of Humira and Remicade mention these risks on their labels, but they have officially stated that this most recent study led by the Mayo Clinic is flawed, and that it does not prove that Humira or Remicade causes cancer or infections.

To be fair, the study also found that Humira and Remicade do appear to improve flexibility and range of movement, providing significant relief from pain and possibly increasing life expectancy.

The researchers who headed this study stress that people who take Humira or Remicade should seek medical attention right away if they experience fevers, coughing, or other symptoms that indicate the development of an infection.

Here are the key guidelines that I use to help people address rheumatoid arthritis with their food and lifestyle choices:

* Stop eating pasteurized dairy products and cooked flesh meats like beef, poultry, and pork. These foods are extremely dense in protein that is often damaged by heat and has a good chance of entering the blood stream before being broken down into amino acids. Incompletely digested protein in the blood stream can trigger an autoimmune response that is closely associated with the inflammation that accompanies rheumatoid arthritis.

* Eat mainly vegetables, fruits, and whole grains. To improve breakdown and assimilation of protein found in whole grains, it is best to soak them in water for a few hours before cooking them. Soaking whole grains in water also decreases the risk of developing mineral deficiencies that can occur due to the presence of phytic acid in unsoaked whole grains.

* Eat healthy foods that are rich in omega-3 fatty acids. Through its effect on the endocrine system, EPA, one of three omega-3 fatty acids, can decrease inflammation throughout the body. Dark green, leafy vegetables, raw walnuts, and small portions of wild, cold water fish and organic, free range eggs are healthy sources of omega-3 fatty acids. Fish oil and cod liver oil are also excellent sources of omega-3 fatty acids.

* Ensure adequate vitamin D status through sun exposure and/or healthy food sources. Vitamin D can enhance the strength and efficiency of the immune system, making it a vital nutrient when looking to prevent or treat autoimmune disorders.

* Perhaps most importantly, be sure to address emotional stressors that may be contributing to rheumatoid arthritis. Other than recreational and prescription drugs, no other factors that I know of have more impact on overall health and joint health than unaddressed chronic emotional stress.

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Is It OK To Get Pregnant If I Am Over 40?

NoahNet.com Consulting

As you get older, pregnancy poses three distinct issues. The first is whether you're able to get pregnant in the first place. A woman's fertility declines as she ages. Many factors contribute to this, but the primary one is what doctors call egg quality. When a female is born, her ovaries already contain all the eggs she will ever have in her life. As she gets older, the eggs in this dwindling supply deteriorate, as do the structures that protect them until they are ready to be used. Over time, an increasing proportion of the woman's eggs can't be fertilized at all, or are so badly damaged they die soon after fertilization. The increased incidence of other health problems -- including hormonal malfunctions, infections of the reproductive tract, and diseases such as diabetes -- also contributes to the general decline in fertility in this age group.

Even so, many women over 40 can and do get pregnant. That raises the second issue: whether your baby will be healthy. Just as egg abnormalities make it harder for an older mother to conceive, they are also responsible for the higher incidence of problems in the eggs that do make it to birth. Babies born to older mothers have an increased risk of disorders such as Down syndrome that result from genetic abnormalities in the egg. The risk of other types of birth defects rises with age as well. Older mothers are generally offered the option of testing a baby before birth for some of the more common problems.

The third issue is whether pregnancy after 40 is safe for you, the mother. Older moms have a higher risk of certain complications, such as preeclampsia (high blood pressure during pregnancy) and gestational diabetes (pregnancy-induced diabetes). Still, if you're in good health, get adequate nutrition, avoid tobacco and alcohol, and exercise regularly, you have excellent prospects for a safe pregnancy. Before you try to conceive, talk with your health care provider to determine whether you face any particular health risks, and whether there is anything you can do to improve your chances.

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Infertility - What You Should Know

What is infertility?

Infertility is defined as a couple's inability to become pregnant after 1 year of sex without using birth control. When considering whether you may have an infertility problem, however, bear in mind that "normal fertility" is defined as the ability to naturally conceive within 2 years' time. Sometimes it's a matter of determining when you are most fertile. If you are not sure when you ovulate, use this interactive tool to calculate your peak fertility.

Of all couples who have not conceived after 1 year, about half will go on to conceive naturally in the following year. 1 If you are a younger couple, this is encouraging news. However, if you are 35 or older, another year may be too long to wait before seeking testing and treatment.

A woman's fertility declines from her mid-30s into her 40s, as her egg supply ages. At the same time, her risk of miscarriage increases. Although a man's sperm count decreases with age, male fertility is not known to be greatly affected by age. 2
What causes infertility?

Infertility can be caused by problems with either the man's or woman's reproductive system, or both. Some conditions are hormonal in nature, and others are structural problems in the reproductive organs that require surgical repair.

Half of all couples tested for a cause of infertility are affected by a problem with the woman's fallopian tubes or uterus or her ability to ovulate. About one-third find that their infertility is caused by problems in the male reproductive tract. Some couples find that both partners have problems that are contributing to their infertility. 1 See illustrations of the female reproductive system and the male reproductive system.

In 10% of infertile couples, no cause is found despite thorough testing. 1
Should I be tested?

Experts usually recommend that fertility testing begin at home. By using fertility awareness and basal body temperature readings, a woman can identify her fertile period. Some couples find that they simply have been missing their most fertile days when trying to conceive.

Consider medical testing for a cause of infertility if you:

* Have noticed a physical problem (such as an absence of ejaculation or ovulation, or menstruation irregularities) or have a history of repeat miscarriages or pelvic inflammatory disease.
* Are in your mid-30s or older and have been unable to conceive after 6 months of regular sex.
* Are in your 20s to early 30s and have been unable to conceive after a year or more of regular sex.

Initial testing for a couple's cause of infertility evaluates both partners' lifestyle habits and health. Among other general health factors, your health professional will focus on sperm and egg production, checking sperm counts and ability to ovulate. If no cause is found, you can decide whether to proceed with further testing.
What kind of treatment is available?

Infertility treatment ranges from simple home treatment to specialized surgical, hormonal, and assisted reproductive technology treatments. Some of these can have high financial, physical, and emotional costs.

Before trying treatment for infertility, discuss your financial and emotional limits ahead of time and start out with a sense of how far you are willing to go with testing and treatment.

Learning about infertility:


* What causes infertility?
* Does it take longer to get pregnant after stopping hormonal birth control?
* Are there symptoms of infertility?
* What increases our risk of infertility?
* When should we see a doctor?
* Who is affected by infertility?

Being diagnosed:


* How do we identify the best days to conceive?
* Do we need to see a specialist?
* How will our doctor diagnose a cause of infertility?
* What should we consider when setting limits on infertility testing?
* Should I have infertility testing?
* Should I consider adoption as an alternative to infertility treatment?

Getting treatment:


* How is infertility treated?
* What should we consider when setting limits on infertility treatment?
* What kinds of medications are used to treat infertility?
* What questions should we consider about medication or hormone treatment?
* What kinds of surgeries are used to treat infertility?
* What questions should we consider about surgery to treat infertility?
* What is assisted reproductive technology?
* What questions should we consider about assisted reproductive technology?
* What are the odds of conceiving a multiple pregnancy with infertility treatment? What are the risks?
* Is pregnancy possible after cancer treatment?
* Should I have infertility treatment?
* Should I have a tubal procedure or in vitro fertilization for tubal infertility?

Personal considerations:


* What emotional and social issues are related to infertility?
* What ethical and legal issues are related to infertility?

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Water on the knee

Overview

Water on the knee is a general term used to describe excess fluid that accumulates in or around your knee joint. Your doctor may refer to this condition as a knee "effusion." Painful knee effusions may be the result of trauma, overuse injuries or an underlying disease or condition.

The most common cause of water on the knee is osteoarthritis. Osteoarthritis is characterized by the breakdown of joint cartilage and may affect any joint in your body, including your hips, knees, lower back and feet.

The type of fluid that builds up in your knee depends on the underlying disease, condition or type of traumatic injury that causes excess fluid to build up. This joint (synovial) fluid may contain irritating crystals, bacteria or blood.

The pain and swelling associated with water on the knee don't have to limit your mobility. Once your doctor determines the cause of this condition, he or she can recommend self-care measures and treatment to keep you on the move.

Signs and symptoms

Signs and symptoms of water on the knee depend on the cause of excess fluid buildup in the knee joint. These may include:

• Pain. With osteoarthritis, pain occurs when bearing weight on your knees. The pain typically subsides with rest.
• Swelling. One knee may appear larger than the other. Puffiness around the bony parts of your knee appears prominent when compared with your other knee.
• Stiffness. When your knee joint contains excess fluid, your range of motion may be limited. In other words, you can't bend or straighten your knee as far as you normally can.
• Bruising. If you've injured your knee, you may note bruising on the front, sides or behind your knee. Bearing weight on your knee joint may be impossible and the pain unbearable.

Causes

Your knee is the most complex joint in your body. It functions like a hinge, allowing your knee to bend and straighten. Damage to any part of your knee can cause the painful build up of excess joint fluid. Examples of traumatic injuries that cause fluid buildup in and around the knee joint are:

• Broken bones (fractures)
• Meniscus tear
• Ligament tear
• Overuse injuries

Underlying diseases and conditions that may produce fluid buildup in and around the knee joint include:

• Osteoarthritis
• Rheumatoid arthritis
• Infection
• Gout
• Pseudogout
• Kneecap (prepatellar) bursitis
• Cysts
• Tumors

The medial and lateral meniscus function as shock-absorbing cartilage in your knee joint. A tear to the meniscal cartilage can cause water on the knee.

Two of the four ligaments that connect the thighbone (femur) to the shinbone (tibia) are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). The ACL and PCL crisscross one another as they join these leg bones together. A tear in either of these ligaments can cause excess fluid buildup in your knee joint.

Risk factors

Having osteoarthritis or engaging in high-risk sports that involve rapid cut-and-run movements of the knee — football or tennis, for example — means you're more likely to develop water on the knee.

If you're overweight or obese, your body places more weight on the knee joint when you walk. This causes more wear and tear on your knee joint. Over time, your body will produce excess joint fluid.

When to seek medical advice

Having water on the knee because of an underlying condition doesn't need to limit your mobility or decrease your quality of life. See your doctor promptly if:

• You injure your knee.
• Self-care measures or prescribed medications don't relieve the pain and swelling.
• One knee becomes red and feels warm to the touch as compared to your other knee.

Screening and diagnosis

Your doctor will examine your knee thoroughly and may recommend diagnostic tests. If the underlying cause of water on the knee is unknown, he or she will want to know why you've developed this condition.

Diagnostic tests include:

• X-ray. Your doctor will request an X-ray to make sure you haven't broken or dislocated any bones or to determine if you have arthritis.
• Magnetic resonance imaging (MRI). This test detects abnormalities of the bone or knee joint, such as a tear in your ligaments, tendons or cartilage.
• Joint aspiration (arthrocentesis). During this procedure your doctor withdraws fluid from inside your knee for analysis such as cell count, culture for bacteria, and examination for crystals such as uric acid or calcium pyrophosphate dihydrate (CPPD) crystals found in gout or pseudogout.
• Blood tests. If your knee is swollen, red and warm to the touch when compared to your other knee, your doctor may be concerned about inflammation due to rheumatoid arthritis or a crystalline arthritis such as gout or pseudogout, or joint infection. Besides sending the joint fluid to the lab for analysis, he or she may request blood tests to determine your white blood cell count, erythrocyte sedimentation rate, and perhaps the level of C-reactive protein or uric acid.

Complications

Water on the knee can severely limit the mobility of your knee joint if left untreated. If your knee joint is infected, it may cause destruction of the joint or it may extend into the bone (osteomyelitis).

Treatment

Treatment of water on the knee focuses on treating the underlying disease or injury.

• Osteoarthritis. Removing fluid from your knee joint can help relieve the pressure of joint fluid buildup. After aspirating joint fluid, your doctor may inject a corticosteroid into the joint to treat inflammation.
• Gout or pseudogout. With these two conditions, uric acid or CPPD crystals deposit in joints and may cause inflammation in the joint and surrounding soft tissues. An intra-articular corticosteroid injection, nonsteroidal anti-inflammatory drugs (NSAIDs) (Motrin, Advil, others), or colchicine may be recommended for treatment of an acute attack of gout or pseudogout. Allopurinol may be started after an acute attack of gout has subsided. This medication decreases the body's production of uric acid in an attempt to prevent additional episodes of gout.
• Infection. Your doctor will prescribe antibiotics to treat the underlying infection. You may need repeated aspiration of the infected joint or surgery.
• Arthroscopic knee surgery. Using an arthroscope — a surgical tool designed to look inside your knee joint — an orthopedic surgeon examines the inside of your knee joint for wear and tear. The surgeon also may repair damage inside your knee joint with this instrument.
• Joint replacement. According to the American Academy of Orthopaedic Surgeons, only one of four people with osteoarthritis of the knee will require surgery. But if bearing weight on your knee joint becomes intolerable, your doctor may refer you to an orthopedic surgeon for knee replacement.

Prevention

Water on the knee is typically the result of a chronic health condition or traumatic injury. To prevent water on the knee, work with your doctor and other members of your health care team to manage the condition or traumatic injury that causes it. Avoiding trauma isn't always possible, but you can take safety measures — such as wearing a brace your doctor or physical therapist prescribes to protect your knee joint during physical activity.

To avoid water on the knee:

• See your doctor regularly. See your doctor regularly if you have a chronic health condition such as osteoarthritis, rheumatoid arthritis or gout.
• Follow through on your doctor's orders. Take the medications your doctor prescribes to treat the underlying disease or condition that causes water on the knee. If your doctor, physical therapist or sports trainer recommends you wear a knee brace because of a prior injury, be sure to follow through.
• Be gentle with your knees. If you're overweight or obese and plan to start an aerobic exercise program as part of a weight-loss program, avoid excess wear and tear on your knees. Select an aerobic activity that doesn't place continuous weight-bearing stress on your knee joints, such as water aerobics or swimming.

Self-care

Taking care of yourself when you have water on the knee includes:

• Rest. Avoid weight-bearing activities as much as possible when your knee is painful and swollen.
• Ice and elevation. Cold therapy can help control pain and swelling. Apply ice to your knee for 15 to 20 minutes every two to four hours. You may use a bag of ice, frozen vegetables, or an iced towel cooled down in your freezer. When you ice your knee, raise your knee higher than the level of your heart, using pillows for comfort.
• Pain medication. Acetaminophen (Tylenol, others) is often effective at relieving pain. Nonsteroidal anti-inflammatory drugs, or NSAIDs, (Advil, Motrin, others) are effective for relieving pain and inflammation. If these don't relieve the pain, ask your doctor about prescription medications.
• Muscle toning exercises. If your thigh (quadriceps) muscle or hamstring muscles are weak, your doctor may refer you to a physical therapist to learn how to strengthen these muscles to better support your knee.
• Managing your weight. Losing weight will minimize the amount of weight your knees have to support when you engage in weight-bearing activities.

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Medication possible factor in 21 deaths

AP

Panamanian authorities say they suspect a medicine taken to treat high blood pressure may be among the factors leading to the deaths of 21 people since July who have succumbed to a mysterious illness that triggers kidney failure.

The 21st victim died either late Sunday or early Monday morning, said Panamanian public health official Rosario Turner said Monday. She did not specify the exact hour of death, or the age or gender of the patient, but said officials would release more details later.

On Friday, Panama's health minister stopped sales of the medication, Lisinopril Normon, and began removing it from pharmacy shelves. About 9,000 Panamanians take the medicine.

Authorities said they did not believe the medication had been tampered with.

The drug's Spanish manufacturer, generic drug maker Normon SA, issued a statement denying that its medicine was the cause and adding that there have been no problems in other countries where it is sold.

The illness thus far mostly has affected people older than 60. Other symptoms of the illness include vomiting, diarrhea and fever.

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Alcohol and Many Medications Don't Mix

Sometimes it's easy to forget that many over-the-counter or prescription medications can cause serious interactions if taken with alcohol. If you're taking any prescription or OTC drug, check with your doctor before you have a drink.

Here is a list of medications that can cause dangerous interactions with alcohol, courtesy of the National Institute on Alcohol Abuse and Alcoholism:

Sleeping pills. Antihistamines, commonly taken for allergies, colds, and congestion. Pain relievers. Anti-anxiety drugs. Antidepressant drugs. Some medications used to treat diabetes, hypertension, and heart problems.

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MRI scans to be made safe for pacemakers

LAURAN NEERGAARD,
AP Medical Writer

More than 2 million Americans depend on pacemakers or defibrillators to keep their hearts beating right, but those lifesaving implants come with a price: They're not allowed in MRI machines, leaving these patients out of luck if they later need scans to detect cancer, stroke or myriad other ailments. That's poised to change.

Doctors at a handful of hospitals are beginning to give MRIs to certain patients despite those implants — in careful experiments of ways to shield the heart devices from potentially deadly meltdowns or misfires. And the first human study of a pacemaker specially designed to withstand MRIs is expected to begin by year's end.

The attempts come none too soon. Use of the heart implants is growing rapidly, and already hundreds of thousands of recipients every year are estimated to be turned away from MRIs that their doctors wanted to help diagnose or manage other diseases.

"It's a critical issue," says Owen Faris, a heart device specialist at the Food and Drug Administration, which has long urged manufacturers to create MRI-compatible implants.

The irony is that for most people, an MRI is super-safe. The scanner itself is a powerful magnet. Most modern implants are made with materials that aren't too magnetic, meaning an MRI won't move them around once they've healed in the body.

But MRIs are off-limits for a handful of implants — mostly pacemakers, heart-shocking defibrillators, and some brain devices — because the scans can heat them, burning surrounding tissue. Also, MRIs emit radiofrequency waves that can confuse electronic implants, leading them to either quit working or fire when they shouldn't.

Baltimore's Johns Hopkins University Hospital, a leader in the fledgling MRI trend, is getting two or three requests a day to scan pacemaker or defibrillator recipients, after scientists there reported safety steps that have allowed MRIs for more than 100 of the risky patients so far.

"Even with all these precautions, we can't guarantee that nothing adverse would happen," warns Dr. Saman Nazarian, a Hopkins cardiac electrophysiologist who monitors patients' hearts while they're inside the scanner, ready to intervene at signs of trouble.

"Our hope ... is the devices that will come out in the future will be built from the ground up to be safe."

Scientists are trying three approaches:

_Medtronic Inc. is awaiting FDA permission to begin the first patient tests of a pacemaker designed to be compatible with MRI scans. Medtronic added filters to prevent the pacemaker's heart-penetrating wires from picking up MRI signals, so that they shouldn't heat or misfire, explains Vice President Warren Watson.

_Recall how dentists cover patients' bodies with a lead apron before X-raying teeth? University of Pittsburgh researchers are preparing to test a similar shield approach, covering pacemaker recipients' chests with material that blocks MRI energy while scanning other body parts. Called an "MRI isolation blanket," it's made by a company that provides radar blockers to the military.

In laboratory tests using mannequins, the blanket kept MRIs from dangerously heating pacemaker wires, says Dr. Emanuel Kanal, the university's MRI chief and head of the American College of Radiology's MRI safety committee.

_Then there's Hopkins' method. Lead researcher Dr. Henry Halperin first exposed pacemakers and defibrillators to extra-high-dose MRIs, to winnow out 24 modern brands that withstood strong magnetic fields without getting too hot.

Animal testing identified more safety concerns. If a pacemaker wire, called a lead, goes bad, doctors sometimes just unhook it from the device's battery and let it lie quietly in the heart. It turns out that unattached leads get far hotter than attached ones; so do even attached leads if they're placed on the outside of the heart instead of inside.

So Nazarian turns away patients with those two lead problems. For other candidates, he temporarily reprograms their pacemakers or defibrillators to reduce electronic interference, and runs the MRI scanner at half-strength.

So far, no one's been harmed, the team reported in last month's journal Circulation. The MRIs have uncovered cancers and strokes, helped doctors plan artery-opening treatments — and in one patient spotted a brain disorder that other tests had missed, allowing surgery to end the woman's seizures.

For now, pacemaker patients should be wary if a doctor orders an MRI, Kanal warns. Very few medical centers have on hand the specialized equipment and specially trained electrophysiologists and radiologists needed to monitor their safety during the scan.

"It can be done, but it's not at all the state of the art."

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WHO: TB poses greatest threat to Europe

ERICA BULMAN,
Associated Press Writer

Tuberculosis has come back in a new, more deadly form to pose the disease's greatest threat to Europe since World War II, world health officials said Tuesday.

Drug-resistant strains of the disease are lurking just beyond the European Union's borders, in countries where AIDS blossomed following the collapse of the Soviet Union, according to U.N. and Red Cross health officials.

"The drug resistance that we are seeing now is without doubt the most alarming TB situation on the continent since World War II, and our message to EU leaders is: Wake up. Do not delay. Do not let this problem get further out of hand," said Markuu Niskala, secretary-general of the International Federation of Red Cross and Red Crescent Societies.

The high levels of multi-drug resistant tuberculosis in Baltic countries, Eastern Europe and Central Asia, and the emergence of a new, extremely drug-resistant strain of TB have led international health officials to create the "Stop TB Partnership in Europe" to fight the epidemic.

Tuberculosis, a respiratory illness spread by coughing and sneezing, is the world's deadliest infectious disease that is curable. The World Health Organization estimates that 1.7 million people died from TB in 2004.

Of the 20 countries in the world with the highest rates of multi-drug resistant tuberculosis, 14 are in "the European region," according to a recent global survey by the WHO and the U.S. Centers for Disease Control and Prevention.

European countries also have the highest rate of extreme drug-resistant tuberculosis known as XDR-TB.

"TB has always been low on the European Union agenda. It's a mystery there has been so little concern in addressing the TB epidemic in Europe," said Michael Luhan, an official at the Geneva-based Red Cross federation. "The purpose of this partnership is to stimulate a much greater sense of concern, engagement and commitment on the part of the European Union to address this problem in its own region."

Luhan said the bulk of technical support in the European region and central Asia is currently provided by the United States, which is also a major financial contributor.

"In the last few years, there's been more contribution from EU countries, but they still are a fraction of those provided by countries outside the region," he said.

In Europe, 50 people get sick with TB and eight people die of the disease every hour, said Pierpaolo de Colombani, a WHO tuberculosis expert. About 15 percent of all TB cases in Europe are multi-drug resistant.

But the incidence of TB varies widely from West to East. For instance, Sweden has four new cases per 100,000 people a year, compared with 177 for Tajikistan.

The rate of incidence of TB in the Western European countries that belonged to the EU before it enlarged in 2004 is 13 cases per 100,000 people every year. That number doubles in the 10 new EU members.

It doubles again to 53 in Romania and Bulgaria and yet again to 98 in the former-Soviet republics farther East.

But migration and EU expansion could change things.

"Not a large number of cases are being imported into the EU from Eastern Europe but it's not necessarily going to stay that way with continued enlargement," Luhan said.

He said TB cases in London have been increasing every year for almost 10 years. In some London areas with many immigrants, rates are as high as 100 per 100,000.

Luhan said that TB had ceased for decades to be a problem in the region, but that it doubled over the past 10 years in the former Soviet Bloc as public health systems collapsed.

If diagnosed at all, patients were treated late, with little follow up to make sure they completed their courses of medication, increasing the drug-resistance of some TB strains.

Luhan said Europe ranks with Africa as areas where TB is a big problem.

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E. coli exposes weakness in food chain

LIBBY QUAID,
AP Food and Farm Writer

The recent outbreak of E. coli in spinach from California exposed a weakness in the nation's food chain: A system that quickly delivers meat, fruits and vegetables to consumers just as easily can spread potentially deadly bacteria.

Like most food, spinach travels from the field to a central facility where it mixes with spinach from other fields. If any is tainted, the threat to people is amplified as leaves are washed, dried, bagged and shipped throughout the country.

Within days of the first reported E. coli-related case on Aug. 30, illness from the tainted California spinach had spread to two dozen states. Nearly 200 people were sickened — one-third of them in the first 72 hours. Two elderly women and a 2-year-old boy died.

"When you open a bag of spinach, do you wonder how many different plants are in there, and how many different fields it came from?" said Dr. Robert Tauxe, chief of foodborne diseases at the federal Centers for Disease Control and Prevention.

"If something went wrong on any one of those fields ... one rotten apple spoils the whole barrel," Tauxe said.

It was the 20th time lettuce or spinach has been blamed for an outbreak of illness since 1995.

On Sunday, green leaf lettuce from the same growing area, California's Salinas Valley, was recalled in more than half a dozen states after Nunes Co. Inc. discovered possible E. coli contamination of irrigation water. The bacteria hasn't been found in the company's Foxy brand lettuce. No illnesses have been reported.

Food safety advocates are calling for stringent regulations, and they say a single agency should be in charge of making sure all food is safe.

"If you raise spinach in the Salinas Valley and it's in 40 states in a few days, you can't have a system that says we won't do anything until somebody gets sick," said Carol Tucker Foreman, director of food policy for Consumer Federation and a former USDA official.

"Because look how many people get sick before you can even know it," Foreman said.

The Food and Drug Administration has repeatedly told the entire industry to get the problem under control, but FDA does not have inspection or safety programs for produce like the Agriculture Department has for meat and poultry.

While the food system is vastly centralized, "what we don't have is a centralized agency that's really in charge of ensuring that the products are safe," said Caroline Smith DeWaal, director of food safety for the Center for Science in the Public Interest.

An E. coli outbreak in 1993 was a painful demonstration of weakness in the highly centralized beef supply chain. Hundreds of people got sick and four children died after eating undercooked hamburgers from Jack in the Box restaurants.

The outbreak prompted the Agriculture Department to tighten safety standards and expand government testing. And in 1996, it replaced its old visual inspection with one that requires a scientific look at vulnerable places in the production chain and constant monitoring of those points.

Today, illnesses from E. coli are down 29 percent from when the government tracking system began a decade ago, although illness rates inched up from 2004 to 2005.

"It took a few years, but I think we have a really good handle on how to control this organism," said Randy Huffman, vice president of science for the American Meat Institute, an industry group.

The company at the center of the spinach crisis, Natural Selection Foods, has begun sampling every lot of greens and holding shipments until test results come back.

"Even if we nail this particular problem down to a certain point, I think it's really important to have that firewall in place, so no matter where it might come from, we feel like we can catch it," company spokeswoman Samantha Cabaluna said.

With beef, an important step was figuring out just how contamination happened in the first place. Government scientists discovered the primary source entered the slaughterhouse on the hides of cattle, and that it could transfer directly to the surface of the meat.

Solving that mystery may be more critical for lettuce and spinach because — unlike beef — much of leafy produce is eaten raw and not cooked to temperatures that will kill E. coli.

So far, no one has determined the cause of nine outbreaks, including the one from late August, in lettuce and spinach grown in Salinas, Calif.

In the spinach case, the FBI has searched processing plants for evidence of problems and state investigators are looking into contamination from manure, irrigation water or even workers relieving themselves in fields.

In addition, it is unknown exactly where E. coli lurks in spinach and lettuce plants. Research suggests the bacteria can get inside the stems and leaves, Tauxe said, adding that more research is needed.

It's unlikely whether FDA will ever know if the E. coli bacteria was on the surface of the tainted spinach or inside the greens themselves, because it was ground up for testing, Dr. David Acheson, chief medical officer in the FDA's Center for Food Safety and Applied Nutrition, told reporters Monday.

Tauxe said: "It took the meat industry some years to get a grip on how contamination was occurring during slaughter, and it will take some time for the produce industry to get a better handle on this."

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10 secret signs of stress

Emma Robertson,

Health columnist

Stress works in mysterious ways. Did you know humming, excessive blinking, itching and dandruff are part of our system’s reaction to tension?

Perhaps your body’s trying to tell you take time out. So, listen-up and get to know the signs so you can stress-proof your life.

BLINKING
Increased blinking is telltale evidence that we are feeling the pressure, either emotionally or physically. When in a relaxed state, the average blink rate is around 15-30 times a minute but under stress this can increase to up to 70 times a minute. The response is known as the Nixon Effect after American president Richard Nixon, whose blinking escalated to suspicious levels when under pressure during the Watergate scandal.

TEETH GRINDING
Nocturnal teeth grinding is thought to be a way of relieving tension. Clenching or grinding teeth is a recognised response to anxiety, however, most ‘grinders’ are unaware they have this symptom as the condition usually flares-up when they are fast asleep. But it’s important to wake-up to signs such as chipped teeth, tooth sensitivity, sore jaw muscles and earache because prolonged exposure to grinding can result in headaches and jaw disorders.

DANDRUFF
Stress sets off a chain reaction in our physiology and as a result plays havoc with the immune system. On the outside, our hair and skin is one of the first places to show the strain - so it’s no wonder dandruff is the most common condition affecting the scalp. Research suggests weakened immunity triggers the bacteria which cause dandruff to grow out of control, swell and irritate the top of the head. As the cells die they break down to produce the pesky white flakes which cause a snow storm on our shoulders.

DRY MOUTH
When the going gets tough, our instinctive ‘fight or flight’ response kicks in. For basic survival purposes, blood flow is diverted away from less important areas and re-routed to essential muscles in case we need to scarper sharpish. This lack of fluid causes dryness of the mouth. Stress also interferes with our breathing - we take shorter, shallow breaths which leads to stinky breath. It can even make it harder to swallow because our throat muscles go into spasm as a side-effect of the strain on our system.


POOR SEX DRIVE
Stress can sabotage your libido in more ways than one. When you’re stressed to the max, the body’s reaction is to put survival ahead of pleasure. This affects the hypothalamus gland and the body’s production of estrogens and testosterone which give us sexual desire. Women may find it hard to achieve orgasm and men can experience temporary impotence as the chemicals released when stressed reduce blood flow to the penis.

IRRITATED SKIN
Emotional stress can cause chaos with our skin as pressure prompts the release of histamines into the bloodstream. Our skin then reacts against this enzyme which results in itchiness and hives. Skin conditions such as psoriasis and eczema are also thought to worsen when tense. Studies of psychological stress show anxiety can decrease the wound-healing capacity of the immune system by up to 40%, which doubles the effect of stress on acne.

SWEATS
Perspiration doesn’t only increase but is also smellier when we’re under emotional pressure. The sympathetic nervous system kicks into action when the body is stressed which forces our heart rate, blood pressure and breathing to rocket. Our apocrine glands (responsible for smelly sweat as opposed to odourless eccrine gland sweat) also work overtime and secrete more fatty fluid into the tubule of the gland. When we’re wound up, the tubule wall contracts and pushes sweat to the surface of the skin. It’s the bacteria waiting to break down the apocrine sweat which causes body odour.

TUMMY TROUBLE
One of the first places we run to when we come under increased pressure is the toilet. Stress tampers with our biochemistry and sends a surge of hormones including adrenaline racing through our body. Our digestive and immune system temporarily shut down because these stress hormones hinder the release of the stomach acid we need to break down food. However, get ready to say hello to diarrhoea as, simultaneously, the same hormones stimulate the colon so its contents are fast-tracked through the gut.

HUMMING
Did you know humming and whistling could be your body’s natural way of soothing a stressful situation? It might seem like an innocuous habit to subconsciously slip in to when you are stressed, but humming stimulates the right side of the brain (the part used for abstract and creative thoughts) and may help you to calm down. Humming is even one of the preferred stress-busters for babies who want to calm themselves.

BAD HABITS
Nail biting, nose picking, hair twisting are common habits if you’re nervous. It’s suggested that having something in our mouths reminds us of the calming, safe feeling of sucking milk as a baby. On the face of it, such anxious habits might look unpleasant to onlookers, but these manners may trigger calming sensors in the nervous system to give an immediate rush of relief.

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Flu and flu jabs

Dr Roger Henderson, GP

What is flu?

Influenza is a highly contagious virus infection affecting the respiratory system.

What are the symptoms?

Symptoms begin after an incubation period of one to four days and include:

• a high temperature up to 390C (1030F)
• headache
• loss of appetite
• muscular aches and pains
• weakness
• prostration.
  

Symptoms often continue for about a week unless there are complications, in which case new symptoms may commence in the second week.

How is it spread?

Flu viruses can be transmitted to your hands when covering the nose and mouth when sneezing. These can then be passed on to other people through shaking hands, so washing your hands regularly is an important preventative step.

Flu viruses are transmitted by coughing and sneezing. Droplets expelled from the mouth and nose can circulate in the atmosphere and reach the respiratory passages of other people. Transmission may also occur through skin contact, particularly through shaking hands as the viruses are even transmitted to the hands when covering the nose and mouth when coughing and sneezing, and since the virus can live for a short period on the skin, frequent washing of the hands is an important preventive measure.

What viruses are responsible?

There are three main types of influenza virus, called A, B and C, although it is usually the type A virus that causes the worst epidemics. Type C influenza is mild to the extent that it is indistinguishable from a common cold. Type A influenza is usually more debilitating than type B.
How serious is it?

Nationally, some 13 million people are at increased risk of complications from flu, such as bronchitis and pneumonia. Peaks of winter mortality are closely linked to the pattern of influenza activity and result in an estimated average of 12,000 deaths each year.

Who is most at risk?

The people most at risk are:

• the elderly
• those with chronic respiratory disease such as asthma and chronic bronchitis
• those with chronic heart disease, chronic renal disease and diabetes mellitus
• those with immunosuppression due to disease or treatment
• people in long-stay residential and nursing homes.
  

What are the common complications?

Secondary infection with bacterial organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus can often cause middle ear infections and pneumonia. In vulnerable people death from haemorrhage within the lungs or septicaemia may occasionally occur.

Can you avoid it?

Living the life of a hermit would protect you, although being out of social contact for any length of time would reduce immunity to very low levels. In practice, keeping clear of people who are coughing and sneezing, and washing hands thoroughly can help, although immunization offers the best chance.

Treatment

For typical symptoms the influenza sufferer should rest in bed in a warm, well-ventilated room. Painkillers such as paracetamol or aspirin can relieve aches and pains and reduce fever. Aspirin should not be given to children under 16 years of age, unless on the advise of a doctor. Plenty of fluids prevent dehydration and steam inhalations can have a soothing effect on the lungs. Anyone in the at-risk categories should let their doctor know as soon as symptoms develop, and anyone else who develops complications should do likewise. The antiviral drug Amantadine may reduce the severity of an attack if given within 24 hours of the onset of symptoms but this is not prescribed routinely by GPs. Antibiotics will be required if secondary bacterial infection ensues. The patient can get out of bed once the fever has abated and build their strength gradually.

Immunization

Immunization against influenza is effective and safe. The World Health Organization recommends the vaccine strains by predicting those viruses most likely to cause outbreaks in any given year. UK studies show the vaccine reduces complications, cuts hospital admissions by up to 60 per cent and mortality by about 40 per cent, compared with matched controls. This year everyone aged 65 and over will be offered vaccination free of charge as will everybody in the at-risk categories, no matter what their age. A national publicity campaign has already been launched this year, and nearly 11.5 million doses of vaccine will be available for delivery through GP surgeries and health centres.

The Office for National Statistics has stated that the number of deaths due to flu in the winter of 2003 was the lowest for the last six years, which may be partly attributable to the flu vaccination programme. A spokesperson for the Centre for Communicable Diseases stated: 'The programme has been good for the elderly, but we will only be able to test it properly when we get a season of high flu activity.'

Are there any adverse reactions?

Contrary to popular belief, the flu vaccine cannot give you the flu, although it can protect you from it. Adverse reactions are rare and in nearly all cases, mild. People who are allergic to eggs and women who are pregnant should not be immunized.

Which flu viruses are in this year's vaccine?

Flu vaccine this year contains versions of three viruses, influenza A (New Caledonia type virus), influenza A (Moscow like virus) and influenza B (Sichuan like virus).

What about jabs at work?

Immunization is highly effective in preventing influenza in working adults. It reduces staff absenteeism and can reduce transmission of flu to vulnerable patients. Responsibility for occupational flu immunization rests with the employer who can provide it through the occupational health service funded by themselves for their staff. Vaccines for staff, however, should not be obtained at the expense of vaccines for the at-risk groups.

When should you call the doctor?

Young, fit, healthy people who are not in the at-risk groups can normally self-treat influenza without calling the doctor. However, the doctor should be notified if:

• complications arise
• or a high fever remains for more than 48 hours despite treatment
• or the patient is in an at-risk group.
  

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Living With a Learning Disability

Six-year-old David's favorite part of the day is story time. He loves it when Mom reads to him, and he has no trouble remembering what he hears. But David has a problem. He cannot read for himself. In fact, any task that requires visual skill frustrates him.

Sarah is in her third year of school, yet her writing is unusually sloppy. Her letters are poorly formed, and some of them are written backward. Adding to her parents' concern is the fact that Sarah has trouble even writing her own name.

Josh, a young teen, does well in every subject at school except math. The concept of numerical values completely baffles him. Just looking at numbers makes Josh angry, and when he sits down to do his math homework, his disposition rapidly deteriorates.

WHAT is wrong with David, Sarah, and Josh? Are they simply lazy, stubborn, perhaps slow-witted? Not at all. Each of these children is of normal to above-average intelligence. Yet, each one is also hampered by a learning disability. David suffers from dyslexia, a term that is applied to a number of reading problems. Sarah's extreme difficulty with writing is called dysgraphia. And Josh's inability to grasp the basic concepts of math is known as dyscalculia. These are just three learning disabilities. There are many more, and some experts estimate that altogether they affect at least 10 percent of the children in the United States.
Defining Learning Disabilities

Granted, at times most youths find learning to be a challenge. Usually, though, this does not indicate a learning disability. Instead, it simply demonstrates that all children have learning strengths and weaknesses. Some have strong hearing skills; they can absorb information quite well by listening. Others are more visually oriented; they learn better by reading. In school, however, students are clustered into a classroom and all are expected to learn regardless of the teaching method used. Hence, it is inevitable that some will have learning problems.

According to some authorities, however, there is a difference between simple learning problems and learning disabilities. It is explained that learning problems can be overcome with patience and effort. In contrast, learning disabilities are said to be more deep-rooted. "The learning disabled child's brain seems to perceive, process, or remember certain kinds of mental tasks in a faulty manner," write Drs. Paul and Esther Wender.

Still, a learning disability does not necessarily mean that a child is mentally handicapped. To explain this, the Wenders draw an analogy with tone-deaf people, who cannot distinguish differences in musical pitch. "Tone deaf people are not brain-damaged and there is nothing wrong with their hearing," Wenders write. "Nobody would suggest that tone deafness is due to laziness, poor teaching, or poor motivation." It is the same, they say, with those who are learning disabled. Often, the difficulty focuses on one particular aspect of learning.

This explains why many children with learning disabilities have average to above-average intelligence; indeed, some are extremely bright. It is this paradox that often alerts doctors to the possible presence of a learning disability. The book Why Is My Child Having Trouble at School? explains: "A child with a learning disability is functioning two or more years below the expected level for his age and his assessed IQ." In other words, the problem is not simply that the child has trouble keeping up with his peers. Rather, his performance is not on par with his own potential.

Providing Needed Help

The emotional effects of a learning disability often compound the problem. When children who are learning disabled do poorly in school, they may be seen as failures by their teachers and peers, perhaps even by their own family. Sadly, many such children develop a negative self-image that can persist as they grow. This is a valid concern, since learning disabilities generally do not go away. "Learning disabilities are life disabilities," writes Dr. Larry B. Silver. "The same disabilities that interfere with reading, writing, and arithmetic also will interfere with sports and other activities, family life, and getting along with friends."

It is essential, therefore, that children with learning disabilities receive parental support. "Children who know that their parents are strong advocates for them have a basis for developing a sense of competency and self-esteem," says the book Parenting a Child With a Learning Disability.

But to be advocates, parents must first examine their own feelings. Some parents feel guilty, as if they were somehow to blame for their child's condition. Others panic, feeling overwhelmed by the challenges set before them. Both of these reactions are unhelpful. They keep the parents immobilized and prevent the child from getting the help he needs.

So if a skilled specialist determines that your child has a learning disability, do not despair. Remember that children with learning disabilities just need extra support in a specific learning skill. Take the time to become familiar with any programs that may be available in your area for children who are learning disabled. Many schools are better equipped to deal with such situations than they were years ago.

Experts emphasize that you should praise your child for any accomplishments, no matter how small. Be generous with commendation. At the same time, do not neglect discipline. Children need structure, and this is all the more true of those who are learning disabled. Let your child know what you expect, and hold to the standards you set.

Finally, learn to view your situation realistically. The book Parenting a Child With a Learning Disability illustrates it this way: "Imagine going to your favorite restaurant and ordering veal scallopini. When the waiter puts the plate in front of you, you discover rack of lamb. They're both delicious dishes, but you were prepared for the veal. Many parents need to make a mental shift in their thinking. You might not have been prepared for the lamb, but you find it's wonderful. So it is when you raise children with special needs."

"Sit Still and Pay Attention!"

Living With Attention Deficit Hyperactivity Disorder

"All along, Jim had said that Cal was just spoiled and that if we—meaning me—cracked down on him, he'd shape up. Now here was this doctor telling us that it wasn't me, it wasn't us, it wasn't Cal's teachers: something really was wrong with our little boy."

CAL suffers from Attention Deficit Hyperactivity Disorder (ADHD), a condition characterized by inattentiveness, impulsive behavior, and hyperactivity. The disorder is estimated to affect from 3 to 5 percent of all school-age children. "Their minds are like TV sets with faulty channel selectors," says learning specialist Priscilla L. Vail. "One thought leads to another, with no structure or discipline."

Let us briefly consider three major symptoms of ADHD.

Inattentiveness: The child with ADHD cannot filter out unimportant detail and focus on one topic. Thus, he is easily distracted by extraneous sights, sounds, and smells. He is paying attention, but no single feature in his environment stands out. He cannot determine which one deserves his primary concentration.

Impulsive behavior: The ADHD child acts before he thinks, without considering the consequences. He shows poor planning and judgment, and at times his actions are dangerous. "He rushes into the street, onto the ledge, up the tree," writes Dr. Paul Wender. "As a result he receives more than his share of cuts, bruises, abrasions, and trips to the doctor."

Hyperactivity: Hyperactive children are constantly fidgeting. They cannot sit still. "Even when they are older," Dr. Gordon Serfontein writes in his book The Hidden Handicap, "careful observation will reveal some form of continuous movement involving the legs, feet, arms, hands, lips or tongue."

Yet, some children who are inattentive and impulsive are not hyperactive. Their disorder is sometimes referred to simply as Attention Deficit Disorder, or ADD. Dr. Ronald Goldberg explains that ADD "can occur without any hyperactivity at all. Or it can occur with any degree of hyperactivity—from barely noticeable, through rather annoying, to highly disabling."
What Causes ADHD?

Over the years, attention problems have been blamed on everything from bad parenting to fluorescent lighting. It is now thought that ADHD is associated with disturbances in certain brain functions. In 1990 the National Institute of Mental Health tested 25 adults with ADHD symptoms and found that they metabolized glucose more slowly in the very areas of the brain that control movement and attention. In about 40 percent of ADHD cases, the individual's genetic makeup seems to play a role. According to The Hyperactive Child Book, other factors that may be associated with ADHD are the use of alcohol or drugs by the mother during pregnancy, lead poisoning, and, in isolated cases, diet.
The ADHD Adolescent and Adult

In recent years doctors have found that ADHD is not just a childhood condition. "Typically," says Dr. Larry Silver, "parents will bring in a child for treatment and say, 'I was the same when I was a kid.' Then they'll admit they still have problems waiting in line, sitting through meetings, getting things done." It is now believed that about half of all children with ADHD carry at least some of their symptoms into adolescence and adulthood.

During adolescence, those with ADHD may shift from risky behavior to delinquency. "I used to worry that he wouldn't get into college," says the mother of an ADHD adolescent. "Now I just pray that he stays out of jail." That such fears may be valid is shown by a study comparing 103 hyperactive youths with a control group of 100 children who did not have the disorder. "By their early 20s," reports Newsweek, "the kids from the hyperactive group were twice as likely to have arrest records, five times as likely to have felony convictions and nine times as likely to have served time in prison."

For an adult, ADHD poses a unique set of problems. Dr. Edna Copeland says: "The hyperactive boy may turn into an adult who changes jobs frequently, gets fired a lot, fiddles all day and is restless." When the cause is not understood, these symptoms can strain a marriage. "In simple conversations," says the wife of a man with ADHD, "he wouldn't even hear everything I said. It's like he was always somewhere else."

Of course, these traits are common to many people—at least to a degree. "You have to ask if the symptoms have always been there," says Dr. George Dorry. For example, he notes that if a man has been forgetful only since he lost his job or since his wife gave birth, that's not a disorder.

Furthermore, if one truly has ADHD, the symptoms are pervasive—that is, they affect almost every aspect of the person's life. Such was the case with 38-year-old Gary, an intelligent, energetic man who could not seem to complete a single task without being distracted. He has already held more than 120 jobs. "I had just accepted the fact that I couldn't succeed at all," he said. But Gary and many others—children, adolescents, and adults—have been helped to cope with ADHD. How?

A Word of Caution to Parents

VIRTUALLY all children are at times inattentive, impulsive, and overactive. The presence of these traits does not always indicate ADHD. In his book Before It's Too Late, Dr. Stanton E. Samenow notes: "I have seen innumerable cases where a child who does not want to do something is excused because he is thought to suffer from a handicap or condition that is not his fault."

Dr. Richard Bromfield also sees a need for caution. "Certainly, some people diagnosed with ADHD are neurologically impaired and need medication," he writes. "But the disorder is also being named as the culprit for all sorts of abuses, hypocrisies, neglects and other societal ills that in most cases have nothing to do with ADHD. In fact, the lack of values in modern life—random violence, drug abuse and, less horrifically, unstructured and overstimulating homes—are more apt to foster ADHD-like restlessness than any neurological deficit."

It is thus with good reason that Dr. Ronald Goldberg warns against using ADHD as "a catchall concept." His advice is to "make sure no important diagnostic stone is left unturned." Symptoms that resemble ADHD may indicate any one of many physical or emotional problems. The assistance of an experienced doctor is therefore essential in making an accurate diagnosis.

Even if a diagnosis is made, parents would do well to weigh the pros and cons of medication. Ritalin can eliminate undesirable symptoms, but it can also have unpleasant side effects, such as insomnia, increased anxiety, and nervousness. Thus, Dr. Richard Bromfield cautions against being too quick to medicate a child simply to eliminate his symptoms. "Too many children, and more and more adults, are being given Ritalin inappropriately," he says. "In my experience, Ritalin use seems to depend largely on parents' and teachers' ability to tolerate children's behavior. I know of kids who have been given it more to subdue them than to meet their needs."

Parents should therefore not be too quick to label their children as having ADHD or a learning disability. Rather, they should weigh the evidence carefully, with the help of a skilled professional. If it is determined that a child has a learning disorder or ADHD, parents should take the time to become well-informed about the problem so that they can act in the best interests of their children.

Meeting The Challenge

OVER the years several treatments have been proposed for ADHD. Some of these have focused on diet. However, some studies suggest that food additives do not usually cause hyperactivity and that nutritional solutions are often ineffective. Other methods of treating ADHD are medication, behavior modification, and cognitive training.*

Medication. Since ADHD apparently involves a brain malfunction, medication for restoring the proper chemical balance has proved helpful to many.# However, medication does not take the place of learning. It merely helps the child focus his attention, giving him a foundation upon which to learn new skills.

Many adults with ADHD have likewise been aided by medication. However, caution is in order—with youths and adults—since some stimulant medication used to treat ADHD can be addictive.

Behavior modification. A child's ADHD does not absolve parents from the obligation to discipline. Though the child may have special needs in this regard, the Bible admonishes parents: "Train up a boy according to the way for him; even when he grows old he will not turn aside from it." (Proverbs 22:6) In her book Your Hyperactive Child, Barbara Ingersoll notes: "The parent who simply gives up and lets his hyperactive child 'run wild' does the child no favor. Just like any other child, the hyperactive child needs consistent discipline coupled with respect for the child as a person. This means clear limits and appropriate rewards and penalties."

It is therefore important that parents provide solid structure. Furthermore, there should be a strict routine in daily activities. Parents may wish to give the child some latitude in making up this schedule, including a time for homework, study, bath, and so forth. Then be consistent in following through. Make sure that the daily routine is adhered to. Phi Delta Kappan notes: "Physicians, psychologists, school officials, and teachers have an obligation to the child and the child's parents to explain that the classification of ADD or ADHD is not a license to get away with anything, but rather an explanation that may lead to legitimate help for the child in question."

Cognitive training. This includes helping the child to change his view of himself and his disorder. "People with attention-deficit disorder feel 'ugly, stupid, and bad' even if they are attractive, intelligent, and good-hearted," observes Dr. Ronald Goldberg. Therefore, the child with ADD or ADHD needs to have a proper view of his worth, and he needs to know that his attention difficulties can be managed. This is especially important during adolescence. By the time a person with ADHD reaches the teenage years, he may have experienced much criticism from peers, teachers, siblings, and perhaps even from parents. He now needs to set realistic goals and to judge himself fairly rather than harshly.

The above approaches to treatment can also be pursued by adults with ADHD. "Modifications are necessary based on age," writes Dr. Goldberg, "but the underpinnings of treatment—medication where appropriate, behavior modification, and cognitive [training]—remain valid approaches throughout the life cycle."

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Feds Suggest Routine HIV Testing

MIKE STOBBE

Although the recommendation raises concerns, CDC officials say regular tests will increase early diagnosis and help to prevent the virus from being spread

(ATLANTA)—Federal health officials Thursday recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, saying an HIV test should be as common as a cholesterol check.

The U.S. Centers for Disease Control and Prevention guidelines are aimed at preventing the further spread of the disease and getting needed care for an estimated 250,000 Americans who don't yet know they have it.

"We simply must improve early diagnosis," said CDC Director Dr. Julie Gerberding.

Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.

"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others," said Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention.

Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates.

"I think it's an incredible advance. I think it's courageous on the part of the CDC," said A. David Paltiel, a health policy expert at the Yale University School of Medicine.

The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover.

However, some doctors' groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures.

Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians.

"Are doctors going to do it? Probably not," Fields said.

But the recommendations were endorsed by the American Medical Association, which urged doctors to comply. The CDC said it's difficult to predict how many doctors will.

Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommended testing for all pregnant women.

Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical.

The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.

Consent for the test would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing. The CDC's guidelines say no one should be tested without their knowledge.

An American Civil Liberties Union official protested the CDC's idea of dealing with HIV on standard consent forms, and the agency's de-emphasis of pre-test counseling.

"By eliminating these safeguards, what they're calling 'routine testing' will in practice be mandatory testing," said Rose Saxe, a staff attorney with the ACLU AIDS Project.

The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.

New rapid tests cost about $15. If an initial result is positive, confirmatory tests can cost another $50 or more. Treatment for HIV can cost more than $10,000 a year.

WellPoint, the Indianapolis company that owns 14 Blue Cross and Blue Shield plans across the country, has not yet taken a position on the CDC guidelines.

It also hasn't estimated what it will cost to expand HIV testing for its 34 million members, but it traditionally covers tests recommended by the CDC, said WellPoint spokeswoman Shannon Troughton.

The recommendation, if fully implemented, could mean testing for to 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States.

The other companies are MedMira Inc. and Trinity Biotech. Standard HIV tests are done through both public health labs and private and commercial labs.

"This certainly expands the rapid HIV testing market," Spair said.

Identifying more HIV patients will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. But more diagnoses may help win bolstered funding, said John Peebles, an assistant branch chief over HIV programs at the North Carolina Department of Health and Human Resources.

"If you don't know what you need, you can't make the argument for resources," Peebles said.

The CDC has been working on the guidelines for about three years, and got input from more than 100 groups, including doctors' associations and HIV patient support groups.

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syphilis - a sexually transmitted infection

Syphilis is a sexually transmitted infection (STI). Symptoms may go away without treatment, but the disease will progress. It is usually spread when an infected person has anal, vaginal or oral sex without a condom. Babies born to mothers infected with syphilis may have serious health problems.How do I know if I have it? The only way to be sure is by having a blood test. An early symptom is usually a small painless sore. The sore can be in the mouth, vagina, anus or on the penis. You may not notice it. This sore may disappear on its own.Other symptoms may also appear, most commonly a rash. The rash often shows up on the palm of your hand, soles of your feet or the genital area.

WHAT can it do to me? If untreated, syphilis can show up many years later, causing damage to the brain, nerves, heart, eyes and blood vessels. The damage may be serious enough to cause death.Can it be treated? YESAnyone who tests positive for syphilis must be treated. Also, all of their sex partners must be tested and treated. Treatment for syphilis is free. After treatment, you should not have sex with anyone for 14 days, or until the sore(s) are completely healed.Can I get it more than once? YESYou can get syphilis any time you have sex with an infected partner. Having syphilis increases your risk of getting infected with HIV.

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Gonorrhea - a sexually transmitted infection

Gonorrhea is a sexually transmitted infection (STI) that infects both men and women. It is usually spread when an infected person has vaginal, oral or anal sex without a condom.
It can also infect the eyes of babies who are born when the mom has gonorrhea.
How do I know if I have it?
Many women and men will have NO signs or symptoms of this infection.
Women May Notice
- a new or different discharge from the vagina,
- burning when passing urine,
- sore throat,
- pain during sex,
- unusual vaginal bleeding, or
- lower abdominal pain.
Men May Notice
- discharge from the penis,
- burning when passing urine,
- sore throat, or
- pain in the testicles.
WHAT can it do to me?
In women, untreated gonorrhea may cause:
- pelvic inflammatory disease (PID) which causes lower abdominal pain, fever and aches, and can lead to…
- tubal pregnancy, or the inability to have children at all.
These conditions can be severe enough to result in hospitalization.
In men, untreated gonorrhea may cause:
- pain or swelling of the testicles,
- difficulty getting a partner pregnant.
Can it be treated? YES
All people who have gonorrhea or have sex with a person who has it should be treated with a SINGLE dose of an antibiotic. This will usually CURE the infection, especially if BOTH partners are treated at the same time. You will also be given pills for another STI called chlamydia, which people may have at the same time as gonorrhea.
Treatment is free for both you and your partner. After treatment, you should not
have sex for five to nine days. If you do have sex during this period, BE SURE TO USE A CONDOM.
Can I get it more than once? YES
You need to go to your doctor or health care practitioner to be treated EVERY TIME you come in contact with it.
REMEMBER…
Using a latex condom EVERY TIME you have sex can protect you from gonorrhea and other STIs, including AIDS.

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chlamydia - a sexually transmitted infection

Chlamydia is a sexually transmitted infection (STI) that infects both men and women. It is usually spread when an infected person has vaginal, oral or anal sex without a condom.
It can also infect the eyes or lungs of babies who are born when the mom has chlamydia.
How do I know if I have it?
Most women and many men will have NO signs or symptoms of this infection.
Women May Notice
- a new or different discharge from the vagina,
- burning when passing urine,
- itchy or sore vaginal area,
- pain during sex,
- unusual vaginal bleeding, or
- lower abdominal pain.
Men May Notice
- discharge from the penis,
- burning when passing urine,
- sore or itchy penis, or
- pain in the testicles.
WHAT can it do to me?
In women, untreated chlamydia may cause:
- pelvic inflammatory disease (PID), which causes lower abdominal pain, fever and
aches, and can lead to…
- tubal pregnancy, or the inability to have children at all.
These conditions can be severe enough to result in hospitalization.
In men, untreated chlamydia may cause:
- pain or swelling of the testicles,
- difficulty getting a partner pregnant.

Can it be treated? YES
All people who have chlamydia or have sex with a person who has it should be treated with a SINGLE dose of an antibiotic. This will usually CURE the infection, especially if BOTH partners are treated at the same time. You may also be given pills for another STI called gonorrhea, which people may have at the same time as chlamydia.
Treatment is free for both you and your partner.
After treatment, you should not have sex for five to nine days. If you do have sex during this time, BE SURE TO USE A CONDOM.
Can I get it more than once? YES
You need to go to your doctor or health care practitioner to be treated EVERY TIME you come in contact with it.
REMEMBER…
Using a latex condom EVERY TIME you have sex can protect you from chlamydia and other
STIs, including AIDS.

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Feeling Whole (and Sexy) Again: 3 Healing Ways to Cope With Post-Mastectomy Sexuality

Dr. Patti Britton

Breast cancer strikes one in nine women in America, resulting in four percent of all female deaths -- and forever changing the lives those who survive. From ravaged bodies, to strained relationships, surviving breast cancer by undergoing a mastectomy influences women's sexuality in many ways. If you have gone through a mastectomy, or know someone who has, here are solutions to five of the most common challenges for women who are courageous enough to carry on:

After a mastectomy, some women undergo breast reconstruction and easily learn to adapt to their new shape. Others with partial or total removal (when reconstruction is not possible) report that they feel "not whole," like they're not a "real woman" any more. They fear recurring medical issues or experience self-loathing every time they look at their scars in the mirror.

On the other side, are women who learn to see themselves differently. They see their own inner beauty, learning to reframe and redefine their new skin as a sign of their beauty and womanhood. Because the female breast is part of the sexual anatomy, many women feel the pressure to have perfect breasts. Here is a secret: No one has perfect breasts. (Or, if it helps, look at it this way: Everyone has perfect breasts.) As you experience mental and emotional healing, you can redirect the way that you speak about your new shape. This is your chance to claim it as perfectly beautiful just the way it is.

If there is one part of the female sexual anatomy that gets male attention it's the breasts. That's nature at work. Biologically, the breasts are a major part of the cueing patterns for attracting a mate, and of course, they also work to feed the young of our species. Because of this, there is a great sense of loss associated with a removed or altered breast. But the idea that a change in your breasts signals a loss of sex appeal is simply not true. Sexy is as sexy feels and does. We all know that men respond to visual stimulation, but they are also attracted to how a woman feels about herself. Men derive their pleasure from a woman's pleasure, and having the courage to show that you are alive sexually will get you further with a man than any "10" in a bathing suit.

Any trauma will leave you feeling endangered. Some women claim that having a mastectomy is a reminder of their mortality and find themselves living in constant anxiety about recurrence; others emerge with a spiritual awakening, saying that they regard their breast removal or alteration as a gift that allowed them understand how precious life is and taught them to live for today.

It's the same when a family member has a life-threatening illness. In my own experience, the "gift" of such an illness was the bonding that my family felt. There was a continual focus on the deliciousness of each encounter, realizing always that it could be our last. That consciousness propels you into a different state of being, a heightened sense of being alive and a deep appreciation of the experiences you do have.

To be sexual demands a lot from your body. It involves many more components than might come to mind: the brain for thinking, the emotions for feeling, the skin for sensation, the heart for pumping blood, the lungs for breathing in more air, the muscles for lifting the pelvis, arching your back, moving your lips and more. It's complex and takes energy. After a serious illness and especially after a complicated surgery, the body needs rest and recuperation. Often it is the energy-depleting long-term recovery process that shuts down the sexual appetite of many women. The medications used for long-term treatment often have debilitating effects such as nausea and hair loss, causing personal shame and diverting the focus from pleasure to coping with pain.

But if there is one thing that couples rely on during times of duress, it's sharing forms of touch like massage or caressing. If you've recently had a mastectomy, your sex drive may be low for a while. That is a natural response of a body trying to heal and using all available energy. But you deserve to feel the pleasure that your body can provide. Allow yourself to be touched. Rent a sexy movie to let yourself reawaken sensually. Or, use your spare energy to masturbate to orgasm, if you can. The flood of nature's pain killers (endorphins and oxytocin, which gives the urge to bond) released at orgasm can produce joy for your life.

Another problem for women is avoidance of intimacy after mastectomy. Whether you are alone or with a partner, this is probably the single most important time in your life to accept the caring and nurturance around you. Let it pour in. It is common for some women (and men), when they are wounded or ill, to withdraw. It can be their way of recharging their batteries or healing themselves through sleep. However, beware that if you (or a loved one) are removed emotionally and avoiding the intimacy you had before surgery, it may be a sign that you are sliding into the abyss of negative self-talk. For example, a woman might think, "I can't imagine that any man will ever want this body," so she shuts down to the possibility and stops seeing men. Or, "I want John to have a woman he can feel proud to have as his wife. I'm so ugly, I need to let him go." These are not healing thoughts. And, believe it or not, these are generally not the thoughts of reality.

If this sounds familiar to you, take the time to examine what's real and what's not during the initial phases of recovery. It's time to replace negative self-talk with positive thoughts. "I am hot no matter what size bra I wear, and when I'm ready, the right guy will want me just the way I am." Or, "I am going to talk to John and not push him away, especially now. I know that we can work through this time together. I want him to feel fulfilled, and myself too." Being sexually appealing is much more than a change in your blouse size. Your dh knows that. Your new bf will too. Face the challenge and find the courage to see yourself as a sexy woman.

When you're ready to get back on track sexually, here are three things you can do to help yourself regain your sexual spunk:

1. Use mirror work to see your whole body as womanly, complete and whole. Heal the inner wounds first and think positive thoughts about yourself: body, mind and heart.

2. Accept your new shape, but don't be afraid to experiment. From bras to surgical implants, you have the right to explore your options. For example, the sophistication of technology today permits many women to have a range of implants, such as saline pre-filled, saline inflatable, or in rare cases, silicone. Ask your surgeon what options exist for you. Or look for the new water-filled bras that simulate a full breast. They are amazingly natural looking and feel like a hanging breast. That may restore not only your self-image, but also add a sensation that balances your sense of physical self. Wear garments that flatter your new form. Treat yourself to an image consultant who can guide you to the best colors, patterns, textures and designs for your maximal beauty.

3. Explore new experiences with touch. Most Americans live touch-deprived, and even the simple act of petting a cat or dog will have an amazing impact. On the other end of the spectrum, you do not have to jump back into full sexual swing until you are ready. However, acknowledge that your body needs care and comfort -- a good rubbing helps us all feel better. Treat yourself to a new massage video (http://www.yoursexcoach.com) and enjoy the new pleasures you can feel. Above all, learn to love yourself, just the way you are. You deserve it.

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Avoiding DIY Disaster: Q&A with Karl Champley

What's the most common mistake homeowners make when they start a construction project?

They fail to organize and don't do the necessary research. We had a couple on DIY to the Rescue that almost had a real disaster. While the husband was on a business trip, the wife used a sledgehammer to tear out two load-bearing walls.

Now, I salute her for having the guts to do it, but it caused the roof to sag and her kids were swinging on live electrical wires that were left dangling. She should have talked with a structural engineer who would have explained how to install temporary bracing and replace the wall with another load-carrying member. On the show, we installed a beam to carry the roof load safely to the outside walls, and we got an electrician to relocate the wiring.

What DIY project do people usually get wrong?

Crown molding. Because it's cut upside down, compared to how it is attached to the wall, it always confuses people--even carpenters who are out of practice working with it. Another is hanging a door in an existing doorjamb. I've seen doors hung upside down, hung with 2-in. gaps and hung so that they couldn't close.

What can hurt a DIYer?

Almost anything, especially when they're not thinking. As far as power tools are concerned, I think the most dangerous is an angle grinder equipped with a metalcutting or masonry-cutting wheel. These wheels can shatter if you twist them as they cut, and that's exactly what happened to a friend of mine. He was working on a ladder using one of these tools when the wheel shattered. The flying debris struck him in the chest. I was there when it happened, and I can tell you that it was an extremely painful injury for him.

Other tools such as circular saws, miter saws and reciprocating saws can also be very dangerous--both from their cutting action and from the debris they throw. That's why I always wear safety glasses. Injury is bad in its own right, of course, but it also robs a person of the DIY initiative and the sense of accomplishment that he experiences.

Karl Champley is host of DIY to the Rescue on the DIY Network and HGTV. A construction industry veteran on two continents, he's a licensed and award-winning Master Builder in his native Australia and a home inspector in the United States.

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Back pain at work: Strategies to prevent aches, pains and injuries

MayoClinic.com

Whether it's dull and annoying or screaming for attention, back pain can make it hard to concentrate on your job.

Many occupations — such as nursing, construction or factory work — place significant demands on your back. Even routine office work can worsen back pain if you fall into risky habits.

But you can avoid back pain and injuries by paying attention to what causes them and focusing on prevention.

What causes back injuries?

Doctors and scientists aren't sure about all of the causes of back injury. In fact, most back problems are probably the result of a combination of factors. Some factors, such as family history, aren't preventable. Other factors, such as weight, fitness and flexibility, can be controlled by changing your lifestyle. Still other factors are work related, and you may or may not be able to modify these to prevent injury.

Four work-related factors are associated with increased risk of back injury:

• Force. Exerting too much force on your back may cause injury. If your job is physical in nature, you might face injury if you frequently lift or move heavy objects.
• Repetition. Repetition refers to the number of times you perform a certain movement. Overly repetitious tasks can lead to muscle fatigue or injury, particularly if they involve stretching to the end of your range of motion or awkward body positioning.
• Posture. Posture refers to your position when sitting, standing or performing a task. If, for instance, you spend most of your time in front of a computer, you may experience occasional aches and pains from sitting still for extended periods of time. On average, your body can tolerate being in one position for about 20 minutes before you feel the need to adjust.
• Stress. Pressures at work or at home not only ratchet up your stress level but can lead to muscle tension and tightness, which may in turn lead to back pain.

How to avoid injuries

Your best bet in preventing back injury is to be as fit as you can be and take steps to make your work and your working environment as safe as possible.

Be fit
Even if you move around a lot on your job or your job requires physical exertion, you still need to exercise. Regular exercise is your best bet in maintaining a healthy back. First of all, you'll keep your weight in check, and carrying around a healthy weight for your body's frame minimizes stress on your back. You can do specific strengthening and stretching exercises that target your back muscles. Regular exercise will also increase your long-term flexibility. Strong and flexible muscles will keep your back in tip-top shape.

Pay attention to posture
Poor posture stresses your back. When you slouch or stand with a swayback, you exaggerate your back's natural curves. Such posture can lead to muscle fatigue and injury. In contrast, good posture relaxes your muscles and requires minimal effort to balance your body.

• Standing posture. If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level. Don't bend forward to do desk work or handwork.
• Sitting posture. To promote comfort and good posture while sitting, choose a chair that supports your back. Adjust the chair so that your feet stay flat on the floor. If the chair doesn't support your lower back's curve, place a rolled towel or small pillow behind your lower back. Remove bulky objects, such as a wallet, from your back pockets when you sit because they disrupt balance in your lower back.

Lift properly
There's a right way and a wrong way to lift and carry a load. Some key tips for lifting the right way include letting your legs do the work, keeping objects close to your body and recruiting help if a load is too heavy.

Adjust your workspace
Look at the setup of your office or work area. Think about how you could modify repetitive job tasks to reduce physical demands. Remember that you're trying to decrease force and repetition and maintain healthy, safe postures. For instance, you might use lifting devices or adjustable equipment to help you heft loads. If you're on the phone most of the day, try a headset. Avoid cradling the phone between your shoulder and ear to free up your hands for yet another task. If you work at a computer, make sure that your monitor and chair are positioned properly.

Adopt healthy work habits
Pay attention to your surroundings and recognize your body's abilities on the job. Take these steps to prevent back pain:

• Plan your moves. Reorganize your work to eliminate high-risk, repetitive movements. Avoid unnecessary bending, twisting and reaching. Limit the time you spend carrying heavy briefcases, purses and bags. If you're carrying something heavy, know exactly where you intend to set it and whether that space is free from clutter.
• Listen to your body. If you must sit or stand for a prolonged period, change your position often. Take a 30-second timeout every 15 minutes or so to stretch, move or relax. Try standing up when you answer the phone, to stretch and change positions. If your back hurts, stop activities that aggravate it.
• Minimize hazards. Falls can seriously injure your back. Think twice before donning those high heels. Low-heeled shoes with nonslip soles are a better bet. Remove anything from your workspace that might cause you to trip.
• Work on coordination and balance. Simple enough, walking regularly for exercise can help you maintain your coordination and balance. You can also perform balance exercises to keep you steady on your feet.

Reduce stress
Being under stress causes you to tense your muscles, and this can make you more prone to injury. In addition, the more stress you feel, the lower your tolerance for pain. Try to minimize your sources of stress both on the job and at home. Develop coping mechanisms for times when you feel especially stressed. For instance, perform deep-breathing exercises, take a walk around the block or talk about your frustrations with a trusted friend.

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Viagra may aggravate severe apnea

Reuters

Viagra (sildenafil) taken at bedtime may worsen breathing problems in patients with severe obstructive sleep apnea, results of a study published in the Archives of Internal Medicine suggest.

Obstructive sleep apnea is a common problem that occurs when the soft tissues at the back of the throat collapse and close off the airway during sleep, resulting in brief moments in which breathing stops.

Impotence, also known as erectile dysfunction, is highly prevalent in patients with obstructive sleep apnea, note Dr. Suely Roizenblatt, of Federal University of Sao Paulo, Brazil, and colleagues. However, sildenafil prolongs the action of nitric oxide, which promotes upper airway congestion.

The researchers therefore examined the effects of a single 50-mg dose of sildenafil on the sleep of 14 men (average age, 53.1 years) with severe obstructive sleep apnea.

The subjects were randomly assigned to receive sildenafil or a placebo ("sugar pill") before they participated in an all-night sleep study, which included at least 7 hours of recording time). The subjects switched treatments and process was repeated the next night.

Compared with placebo, sildenafil led to a significantly increased desaturation index, the number of episodes of oxygen reduction per hour of recording time (30.3 events per hour versus 18.5 events per hour). There was also a significant increase in the percentage of total sleep time with an oxygen saturation of less than 90 percent (15.6 percent versus 7.9 percent) and a significant increase in the maximal duration of a desaturation event (72.5 s versus 48.1 seconds).

Sleep structure was also altered by sildenafil use, with in increase in stage 2 non-rapid eye movement sleep compared with placebo and a decrease in deep sleep compared with the start of the study and placebo, Dr. Roizenblatt's team reports.

Because of the small sample size, the results should not be extrapolated to all obstructive sleep apnea patients. "Nevertheless," they say, "sildenafil should be used with caution for treating erectile dysfunction in individuals with a sleep-related breathing disorder."

SOURCE: Archives of Internal Medicine, September 2006.

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Breast-feeding, intelligence link probed

TARIQ PANJA,
Associated Press Writer

Breast-fed children are more intelligent than their bottle-fed counterparts, but this has nothing to do with the content of the milk they receive, a study published in the British Medical Journal said.

For decades scientists have been looking for a correlation between feeding and intelligence, but the report says genetic and environmental factors affect a child's intellect.

Researchers, who analyzed data from more than 5,000 children and 3,000 mothers in the United States, found that mothers who breast-feed tend to be more intelligent, according to a study published Wednesday on the journal's Web site.

"When this fact was taken into account, most of the relationship between breast-feeding and the child's intelligence disappeared," said Jeff Dar, one of the report's authors.

"This research shows that intelligence is determined by factors other than breast-feeding,"

The report won't end the debate about the relationship between intelligence and breast-feeding.

"The problem is trying to show the impact of breast-feeding over and above outside variables," said Mike Woolridge, senior lecturer in infant feeding at the University of Leeds.

He said other studies on the subject have claimed a link to intelligence.

"I fundamentally believe breast-feeding builds a better, more balanced brain in terms of its chemical composition and I'm sure you can measure that in terms of brain performance," Woolridge said.

The researchers found that children who were breast-fed did better on IQ tests, but this was because their mothers were more intelligent, better educated and able to provide a more stimulating home environment.

Part of the research methodology included testing pairs of siblings, for whom feeding habits differed.

"Comparing two people from the same family like this is a good way of getting results that are less affected by family background. This confirmed the earlier results — the breast-fed child was no more intelligent," Dar said.

Dr. Chris Lucas, director of the Early Childhood Service at the New York University Child Study Center, praised the report for taking into account the impact of maternal intelligence on the findings.

"Intelligence is probably one of the most heritable things. Intelligence of a child is very much determined by the intelligence of the parents," he said. "If you don't measure the mother's intelligence, it may appear that there is a link with breast-feeding."

Dar said though his team's study found no link to intelligence, breast-feeding was "definitely the smart thing to do," because of other benefits to both mother and child, including a stronger ability to ward off infections, respiratory illnesses and protection against developing allergies.

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Beat stress, drink tea

Reuters

Regular cups of tea can help speed recovery from stress, researchers from University College London (UCL) said on Wednesday.

Men who drank black tea four times a day for six weeks were found to have lower levels of the stress hormone cortisol than a control group who drank a fake tea substitute, the researchers said in a study published in the journal Psychopharmacology.

The tea drinkers also reported a greater feeling of relaxation after performing tasks designed to raise stress levels.

Andrew Steptoe, of UCL's department of Epidemiology and Public Health, and one of the report's authors, said the findings could have important health implications.

"Slow recovery following acute stress has been associated with a greater risk of chronic illness such as coronary heart disease.

"Although it does not appear to reduce the actual levels of stress we experience, tea does seem to have a greater effect in bringing stress hormone levels back to normal."

In the study, 75 tea-drinking men were split into two groups, all giving up their normal tea, coffee and caffeinated drinks.

Half were given a fruit-flavored caffeinated tea mixture made up of the usual constituents of a cup of black tea.

The others were given a caffeinated substitute, identical in taste but without the active tea ingredients.

Neither the participants or the researchers knew who was drinking real or false tea.

At the end of six weeks the participants were given a series of tests designed to raise their stress levels, including being given five minutes to prepare and deliver a presentation.

The researchers found that stress levels, blood pressure and heart rate rose similar amounts in both groups.

But 50 minutes after the tasks cortisol levels had fallen an average of 47 percent among the tea drinkers, compared to 27 percent in the fake tea group.

Steptoe said it was not known which ingredients in tea were responsible for the effects found in the study.

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A Fresh Dose of Flu Vaccine

ALICE PARK

The FDA approves a new one, boosting the number of doses ready as another flu season approaches.

Just in time for the flu season, the Food and Drug Administration approved a new flu vaccine on Thursday, bringing the total number of flu shots manufactured in the U.S. to five. With the addition of the latest vaccine, the Department of Health and Human Services expects to have an unprecedented 110-115 million doses of the vaccine ready to protect Americans this winter.

The newest vaccine, called FluLaval, and distributed by GlaxoSmith Kline, is similar to the four other shots currently available (Fluzone, from Sanofi Pasteur and Connaught Laboratories; Fluvirin, from Novartis and Evans; FluMist , from MedImmune; and Fluarix, also from GlaxoSmith Kline). Like them, it is made by incubating strains of the influenza virus in chicken eggs. What it does contribute, however, are more doses of vaccine — a fact that federal health officials are especially keen on stressing, imm, since an unexpected shutdown of a major vaccine manufacturer in 2004 left the U.S. with a shortage of shots. "We are thrilled with the approval because it means more manufacturers and more products are on the market, which means we have more vaccine to protect the community," says Dr. Jeanne Santoli, deputy director of immunizations services at the Centers for Disease Control (CDC).

Because it is a newcomer to the market, however, FluLaval is only approved for use in adults 18 or older. That's typical of new vaccines, says Santoli, since manufacturers often test their products in adults first, then move on to safety and efficacy trials in younger children with less developed immune systems.

With FluLaval, the US will have an additional 10-15 million doses of flu vaccine available, but Santoli notes that distributing the doses doesn't mean that they all get used. " Every year, we have more doses available than are administered, " she says. " We know that's an issue; that means that there are doses that go to waste. Last year, we distributed 81-82 million doses of vaccine, and we don't think that every dose was administered. We have work to do to make sure that these doses are used, and that people get as much protection and benefit out of the vaccines as possible. "

CDC is working on improving flu vaccination efforts, supporting employer-based vaccine programs, as well as college campus campaigns to get as many people as possible vaccinated before the worst of the winter weather hits. Getting vaccinated isn't a guarantee that you will fend off a bout with the flu, but it's a smart insurance policy against those aches and fever.

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Should You Eat Before or After Exercise?

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Martica Heaner, M.A., M.Ed.

Q: Is it better to eat before or after exercising?

A: Many misconceptions surround eating and exercise. Some people avoid food before a workout because they worry they’ll get nauseated or have cramps. Others don’t eat in the morning because they think they’ll burn more fat if they move on an empty stomach. Some athletes assume that hunger pangs before practice are a good thing, because they think that their body is diverting all its energy to the workout instead of digestion.

None of these beliefs are true.

The bottom line is this: When you expend energy by exercising, you need to consume extra energy to fuel the activity. How much you should eat and at what time of day depends on the type and duration of your workout, as well as when you last ate and what was on the menu.

Ideally, how much energy your body uses (how many calories you burn) and how much energy your body takes in (how many calories you eat) should be in balance all day. Keep in mind that your body burns around 100 calories an hour at rest and during sleep, so you don’t just need energy for exercise, you need food throughout the day to fuel being alive. If you are highly active, if you eat big meals, or if you go for long periods without eating, you can upset this balance and cause extreme energy highs (surpluses) or lows (deficits.)

When you first wake up, you are likely to be low on energy. It works like this: If, the night before, you ate dinner at 7 p.m. and then nothing else until breakfast at 7 a.m., you would have gone 12 hours without added fuel. Your body may have burned around 1,100 calories during this period. Most of the fuel used would have come from your stored fat and glycogen (carbs).

But you have a limited supply of carbs because they are stored only in small amounts in your liver and muscles. Even though the body has plenty of fat stored, for fat to be “burned”, or metabolized, carbs need to be present. Often, the liver’s carb stores are nearly depleted by the morning, so many people may wake up in the morning in a state of energy deficit, where there are not enough carbs to provide energy and to help utilize fat.. So they need breakfast to infuse more energy into their body.

If you skip breakfast and do a tough workout, you launch a depleted body into even greater depletion. Say you burn 500 calories during the workout. By the time you eat later that morning, you may have dipped into an energy deficit of 1,600 calories (that is, 1,100 calories burned while you sleep, plus 500 from the workout). Now your body is famished for fuel. However, you may not feel hungry in this state (known as “ketosis”) because your body has shifted to starvation mode to preserve its resources. Diminished hunger is one of the side effects. But a lack of stomach rumblings doesn’t mean your body doesn’t need fuel—it does. In fact, at some point it will demand more fuel—you’ll likely binge and go into a huge energy surplus to compensate. This ends up being a roller-coaster calorie ride for your body.

In another scenario, if you overeat and are inactive, you can find yourself in a state of energy surplus. So let’s say you eat a big lunch at 1 p.m. (cheeseburger, fries, shake) and take in around 1,200 calories. Then you sit at your desk and burn about 500 calories until it’s time for dinner at 6. In this case, you may enter the meal in a energy surplus of 700 calories (1,200 calories from lunch, minus the 500 you burned sitting at your desk). If for dinner, you ate another big meal of 1,000 calories (fettuccini alfredo, a soda and dessert ), you could end up with a larger surplus of around 1,700 calories. If you remain sedentary for the rest of the evening, not much of that will be burned off. Then the next morning if you wake up to a big breakfast, your body stays in positive energy balance. This is a recipe for weight gain.

Dramatic calorie highs and lows aren’t good for you. Researchers at the University of Georgia studied the eating patterns of athletes and found that that men and women had higher levels of body fat when their eating patterns fluctuated wildly throughout the day, even if they were in energy balance by the end of the day. In addition, they had worse muscle mass, lower energy levels and poor mental focus compared to athletes who ate consistently over the course of the day. Those athletes who ate regular, small meals, and more before, during and after intense workout sessions, showed the best performance in their sports and were the leanest.

The moral? For optimum performance, match your energy intake to your hourly energy needs. Of course, short of living in a laboratory, there's no sure-fire way to know your precise energy-balance status. Still, you can avoid drastic energy fluctuations by eating small-to-moderate sized meals every three or four hours. And if you are going to do intense or long exercise sessions, eat more before and during to compensate.

Pre-Workout Snacks

Don’t enter a workout hungry. If you start exercising in an energy deficit, your body is likely to preserve fat and perform poorly. If you tend to bonk out midway through a hard session, low energy may be the culprit. Quick absorbing carbs with a high glycemic index will give you fast fuel. So before a tough workout, have a sports drink, juice, fruit, bread or pasta to take in some calories. Depending on the intensity and type of activity you are doing, you may be less likely to have an upset stomach if you avoid high-fiber foods at this time. Or if you have them, wait an hour or two to digest before you start your workout. If you need to grab a snack minutes before a workout, chew thoroughly and go for a quick-digesting, high-carb food. But, if you are merely going on a moderate-paced walk for 45 minutes, you probably don’t need extra food unless you’re heading out first thing in the morning. But if you are going to do two spin classes, an 8-mile run or something equally vigorous, fuel up beforehand.

During a Workout

Again, what and how much you need depends upon what you are doing. If the workout is intense and lasts from 60 to 90 minutes or longer, you probably need extra fuel. A sports drink or energy gel is the easiest absorbing solution, although bread, juice, fruit or an energy bar work too.

The Post-Exercise Energy Window

If you went on an easy walk for an hour, you don’t need to eat extra. But if you had a high-intensity workout lasting 60 to 90 minutes or longer, then it’s crucial to eat afterwards. Within the first 45 minutes post-exercise, there is a “metabolic window.” This means that enzymes that replenish muscle carbs are at their highest levels. Plus, insulin, which rebuilds protein stores, is at peak levels. So eating a carb-and-protein mix (peanut butter sandwich, yogurt with fruit, bagel with cream cheese, or a handful of nuts) at this point will maintain muscle, replenish glycogen stores and reduce the amount of fat your body stores. Even a sport drink or a piece fruit are a good idea if you don’t have something more complex available. (These calories are needed to recover, so they are less likely to be stored as excess fat.)

The problem is, it may be an hour or more before you get a chance to eat, especially if you’re at the gym and need to grab a shower before a long journey home. Missing the metabolic window is bad news: If you delay refueling, you slow carb replenishment by 50 percent and protein repair by 80 percent, according to John Ivy, an exercise physiologist at the University of Texas and the author of Nutrient Timing. And that means that you may be sluggish and fatigued during tomorrow’s workout.

Sometimes an immediate side effect of a tough workout is that you are not hungry. But, you still need some calories. So drink juice or a sports drink at the very least. If you experiment with different food options, you should be able to find something that sits well with your stomach and improves your performance.

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Computer games can boost learning

Computer games are not just a fun pastime but can also be powerful learning tools which inspire and motivate young students, according to a new report.

The Entertainment and Leisure Software Publishers Association (Elspa), in association with the Department for Education and Skills, examined the role computer and video games can play in education for the report.

It said a college in Nottinghamshire has seen achievement in key skills increase dramatically to a 94% success rate, compared to the national benchmark of just 22%, through incorporating commercial game Neverwinter Nights into its teaching plan.

Launching the report, Lord Puttnam of Queensgate said many other teaching institutions across the UK had also reported video games ability to motivate and engage, particularly with younger learners.

"Increasingly video games are being recognised as a powerful tool for learning," he said.

"Yes of course they are entertaining and a lot of fun, but they've also the ability to inspire and motivate."

Lord Puttnam said games could promote ideas, stimulate conversation, challenge thinking and encourage problem solving.

"Now what we are talking about here is computer games not just as games, but as a whole new learning form or platform of learning and one that has quite literally, unlimited learning potential," he said.

Elspa managing director Michael Rawlinson said games had the potential to help educate young and old people in both the work and school environment.

"They can be educational in the right context, whether for young people developing creative writing in a classroom or hospital staff learning how best to deal with MRSA, and if educationalists believe they can engage people in learning in a positive and constructive way, then we think this can only be positive."

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Be Cocksure - How to live to 90 and die having sex.

Hugh O'Neill,
Best Life

None of the following information about erection excellence is of the slightest personal interest to me. Even though I'm on the back nine of life, I'm blessed with function every bit as effervescent as I had when I was at JFK High. Really. I swear. It's true. Really. But apparently, studies show that lots of men my age just aren't stallions like me. And apparently, some men are ashamed to admit it.

"By age 40, about 40 percent of men have some erectile dysfunction, and the number goes up about 10 percent with each advancing decade," says Richard Spark, M.D., an associate clinical professor of medicine at Harvard medical school and author of Sexual Health for Men. Of course, the degree of the problem varies greatly. For most, Ol' Reliable still shows up, but he's not as quick to the ready position and a bit less stiff than when he wowed Annette from Theta Delta.

"Virtually all men see some age-associated decline," says Culley Carson, M.D., a professor of urology at the University of North Carolina at Chapel Hill. "But if you lead a healthy life, you can stay sexually vigorous for a long time." So, purely in the interest of public service, I asked experts how the warranty on Wonderboy could be extended.

What's that? Why worry, there's always Viagra? Well, no. It's a great drug, but it's not for everybody. Some men can't take it because it's dangerous in combination with heart medications. It also has side effects, works only in some cases, and costs about $10 a pop, so to speak. Further, Daddy's little helper takes about an hour to kick in--by which time the plane often has landed. But there's an even more compelling reason to go natural: If you live an erection-friendly life, you'll fortify most every other body part.

Four New Erection Protectors

Urologists believe that the well-tested principles that protect blood vessels also give erections their best shot at remaining bodacious. Further, because the gradual erosions of aging seem to play a role in erection strength, slowing the processes that make us old should also keep us hard. You already know the importance of exercise, weight control, and cholesterol management in staying healthy, so we won't lecture you again about them. Instead, here are some new strategies.

1. Control blood pressure.

Erectile dysfunction (ED) is both more common and more severe in men with high blood pressure. According to a study published in the Journal of Urology, chronic hypertension is the biggest threat to Iron John because it puts vessels under constant stress. "Over the years, higher pressure steals elasticity from the vessel walls, including the ones in your penis," says Ridwan Shabsigh, M.D., an associate professor of urology at Columbia University. "This makes them less able to dilate and fill with blood."

Working out and maintaining a healthy weight are the most obvious ways to moderate blood pressure. But certain foods also affect it. Avoid simple carbohydrates, such as cakes, refined pasta, and white breads. These burn quickly, which spikes blood sugar, which creates a surge of insulin, which raises blood pressure.

Instead, eat complex carbohydrates, including colorful fruits and vegetables--strawberries, blueberries, tomatoes, dark green leafy vegetables, oranges, grapes, apricots, yams, and watermelons.

All these burn more slowly and evenly.

Oatmeal's good, too: There are compelling studies linking oatmeal and oat bran to lower blood pressure. Top it with a banana, and you're set for the day. Bananas are good sources of potassium, a shortage of which has been linked to high blood pressure.

The other big factor influencing blood pressure is stress. "When you're chronically anxious, stress hormones such as epinephrine and adrenaline narrow your blood vessels and raise the pressure inside them," says Dr. Carson. "And anything that does this works against your erection."

2. Make more nitric oxide.

This is a signaling substance that starts the process of blood-vessel dilation. "It increases bloodflow, prevents fatty deposits from sticking to arteries, and reduces constriction," says John P. Cooke, M.D., an associate professor of medicine at Stanford University medical school. "An inability to produce it has been linked to impotence." Low levels of nitric oxide are seen in diabetics, smokers, and men with low levels of testosterone. There are a number of things you can do to ensure an adequate supply.

* Eat foods rich in L-arginine. This is the amino acid necessary to form nitric oxide. While there's no conclusive evidence, it can't hurt to eat foods that contain L-arginine, such as beans, fish, soy, egg whites, chicken, lean red meat, and peanuts.
* Swallow more omega-3s. These are fatty acids that improve blood pressure. Salmon and olive oil are good sources, as are walnuts.
* Build muscle. For older men, Dr. Cooke recommends isotonic exercise. Jogging, walking, and swimming rather than pushups, pullups, and bench presses are part of a pro-erection plan.

3. Defend against free radicals.

These are damaging molecules that your cells produce in the normal course of burning oxygen. They undermine the resiliency of blood vessels and, thereby, your potency. To keep them from running amok, trim the steak. The saturated fat in beef burns fast, oxidizes quickly, and produces more free radicals than our systems can handle.

Also, eat more antioxidants. Nutrients lycopene, beta-carotene, vitamin C, and vitamin E are the scourge of free radicals. Carrots, tomatoes, spinach, grapes, and zucchini are especially full of them, as is soy.

4. Stem the decline of sex hormones.

In our middle years, levels of two key cell-spackling hormones--human growth hormone (HGH) and DHEA, a precursor to testosterone--decline.

So does testosterone. Their waning leaves our cells more vulnerable to assault from free radicals and less able to repair themselves. To boost testosterone naturally, adopt these habits and maintain them for life:

* Get more sleep. Since most of our HGH is secreted while we sleep, snoozing may help you stay young and sexually sterling. Aspire to 8 hours a night.
* Have more sex. In one of life's great feedback loops, testosterone makes us want sex, and sex raises our level of testosterone. So the more erections you have, the more erections you'll have. Plus, every time fresh oxygen-rich blood enters the penis, it flushes away harmful collagens that cause scar tissue, says Dr. Shabsigh.
* Lift more weight. Generally, the more muscle mass you have, the higher your level of testosterone.

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Daily Aspirin - Should I or Shouldn't I?

The following is a true-to-life scenario described by a doctor. It reflects an all-too-frequent problem.

THE whole family was worried. Now even the doctor was too. "If his bleeding doesn't stop soon," the doctor said, "we may have to consider a blood transfusion."

The man had been slowly losing blood through his bowels for several weeks, and the problem had been diagnosed as inflammation of the stomach, or gastritis. "Are you sure you're not taking any medications?" asked the frustrated doctor.

"No. Only this natural over-the-counter stuff for my arthritis," said the man.

Suddenly the doctor pricked up his ears. "Let me see it." Carefully searching the ingredient label, he found what he was looking for. Acetylsalicylic acid! Problem solved. When the patient stopped taking the aspirin-containing compound and was given iron and some stomach-healing medicine, the bleeding stopped and his blood count slowly returned to normal.
Medication-Induced Bleeding

Gastrointestinal bleeding caused by medication is a serious medical problem today. Though many medications can be implicated, the majority of such problems come from medicines used for arthritis and pain. These include a class of medications called nonsteroidal anti-inflammatory drugs, or NSAIDS. Names may vary from one country to another.

Aspirin is present in many over-the-counter medications, and in many countries the daily use of aspirin by individuals has increased in recent years. Why?
Enthusiasm for Aspirin

In 1995 the Harvard Health Letter reported that "routine aspirin use saves lives." Citing several worldwide studies, which have been repeated many times since then, researchers concluded: "Nearly everyone who has ever had a heart attack or stroke, suffers from angina, or has undergone coronary artery bypass surgery should take one-half to one aspirin tablet daily unless they are allergic to the drug."*

Other researchers claim benefits of taking aspirin daily for men over 50 who are at risk for a heart attack and for women at risk as well. Furthermore, there are studies indicating that daily aspirin may reduce the risk of colon cancer and that large doses over a long period can help lower blood-sugar levels in diabetics.

How does aspirin work to provide these proposed benefits? Though all is not known, evidence indicates that aspirin acts to make platelets in the blood less sticky, thus interfering with the formation of blood clots. Presumably, this helps to prevent blockage of small arteries to the heart and brain, in this way preventing damage to vital organs.

With all these presumed benefits of aspirin, why doesn't everyone take it? For one thing, there is still much that is not known. Even the ideal dosage is unclear. Recommendations range from one standard tablet twice daily to as little as one baby aspirin every other day. Should the dosage for women be different from that for men? Doctors are not sure. While enteric-coated aspirin may be considered somewhat helpful, the advantage of buffered aspirin is still controversial.
Reasons for Caution

Though technically aspirin is a natural substance—American Indians obtained components of aspirin from the bark of a willow tree—it has many side effects. Besides the fact that it causes bleeding problems in some people, there are many other potential complications with aspirin, including allergic reactions in aspirin-sensitive people. Needless to say, daily aspirin usage is not for everyone.

A person who is at risk for heart attack or stroke or who has significant risk factors, however, may want to ask his or her doctor about the risks and benefits of daily aspirin use. Certainly the patient would want to make sure he or she has no bleeding problems, no aspirin intolerance, and no stomach or gastrointestinal problems. Other potential problems or medication interactions should be reviewed with the physician prior to beginning therapy.

As noted before, aspirin and aspirinlike medications carry the significant risk of bleeding. And that bleeding may be subtle, not immediately apparent, and slowly cumulative over time. Other medications too need to be considered with care, particularly other anti-inflammatory medicines. Be sure to inform your physician if you are using any of them. In most cases it would be wise to discontinue the medication prior to surgery. Perhaps even regular laboratory monitoring of blood levels would be helpful.

If we want to protect ourselves from future problems, we will heed the Bible proverb: "Shrewd is the one that has seen the calamity and proceeds to conceal himself, but the inexperienced have passed along and must suffer the penalty." (Proverbs 22:3) In this medical matter, may we be among the shrewd ones so that we suffer no penalty with our health.

Who Might Consider Taking Aspirin Daily

* People who have coronary heart disease or narrowed carotid arteries (the main blood vessels in the neck).
* People who have had a thrombotic stroke (the kind caused by clots) or a transient ischemic attack (a brief strokelike episode).
* Men over 50 with one or more of the following risk factors for cardiovascular disease: smoking, hypertension, diabetes, elevated total cholesterol level, low HDL cholesterol, severe obesity, heavy alcohol consumption, family history of early coronary disease (heart attack before age 55) or of stroke, and a sedentary lifestyle.
* Women over 50 with two or more of those risk factors.

You may wish to consult your physician before making any decisions on this matter.

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BLOODLESS MEDICINE and SURGERY - The Growing Demand

AT AGE 61, José, a Belgian from the small town of Oupeye, was told that he would need a liver transplant. "It was the shock of my life," he says. Just four decades ago, liver transplants were unthinkable. Even in the 1970's, the survival rate was only about 30 percent. Today, however, liver transplants are routinely performed, with a much higher success rate.

But there is still a major drawback. Since liver transplants often involve excessive bleeding, doctors usually administer blood transfusions during the operation. Because of his religious convictions, José did not want blood. But he did want the liver transplant. Impossible? Some might think so. But the chief surgeon felt that he and his colleagues had a good chance of operating successfully without blood. And that is precisely what they did! Just 25 days after his operation, José was back home with his wife and daughter.*

Thanks to the skills of those whom Time magazine calls "heroes of medicine," bloodless medicine and surgery is now more common than ever. But why is there such a demand for it? To answer that question, let us examine the troubled history of blood transfutions.

Blood Transfusions - A Long History of Controversy

"If red blood cells were a new drug today,
it would be very difficult to get it licensed."
—Dr. Jeffrey McCullough.

IN THE winter of 1667, a violent madman named Antoine Mauroy was brought to Jean-Baptiste Denis, eminent physician to King Louis XIV of France. Denis had the ideal "cure" for Mauroy's mania—a transfusion of calf's blood, which he thought would have a calming effect on his patient. But things did not go well for Mauroy. Granted, after a second transfusion, his condition improved. But soon madness again seized the Frenchman, and before long he was dead.

Even though it was later determined that Mauroy actually died from arsenic poisoning, Denis' experiments with animal blood provoked a heated controversy in France. Finally, in 1670 the procedure was banned. In time, the English Parliament and even the pope followed suit. Blood transfusions fell into obscurity for the next 150 years.

Early Hazards

In the 19th century, blood transfusions made a comeback. Leading the revival was an English obstetrician named James Blundell. With his improved techniques and advanced instruments—and his insistence that only human blood should be used—Blundell brought blood transfusions back into the limelight.

But in 1873, F. Gesellius, a Polish doctor, slowed the transfusion revival with a frightening discovery: More than half the transfusions performed had ended in death. Upon learning this, eminent physicians began denouncing the procedure. The popularity of transfusions once again waned.

Then, in 1878, French physician Georges Hayem perfected a saline solution, which he claimed could serve as a substitute for blood. Unlike blood, the saline solution had no side effects, did not clot, and was easy to transport. Understandably, Hayem's saline solution came to be widely used. Strangely, however, opinion soon favored blood again. Why?

In 1900, Austrian pathologist Karl Landsteiner discovered the existence of blood types, and he found that one type of blood is not always compatible with another. No wonder so many transfusions in the past had ended in tragedy! Now that could be changed, simply by making sure that the blood type of the donor was compatible with that of the recipient. With this knowledge, physicians renewed their confidence in transfusions—just in time for World War I.

		World War II saw an increase in the demand for blood
U.S. National Archives photos

Blood Transfusions and War

During World War I, blood was liberally transfused into wounded soldiers. Of course, blood clots quickly, and previously it would have been all but impossible to transport it to the battlefield. But early in the 20th century, Dr. Richard Lewisohn, of Mount Sinai Hospital in New York City, successfully experimented with an anticoagulant called sodium citrate. This exciting breakthrough was regarded by some doctors as a miracle. "It was almost as if the sun had been made to stand still," wrote Dr. Bertram M. Bernheim, a distinguished physician of his day.

World War II saw an increase in the demand for blood. The public was bombarded with posters bearing such slogans as "Give Blood Now," "Your Blood Can Save Him," and "He Gave His Blood. Will You Give Yours?" The call for blood brought great response. During World War II, some 13,000,000 units were donated in the United States. It is estimated that in London more than 68,500 gallons [260,000 L] were collected and distributed. Of course, blood transfusions carried a number of health risks, as soon became clear.

Blood Transfusions—No Medical Standard Each year in the United States alone, more than 11,000,000 units of red cells are transfused into 3,000,000 patients. In view of that large number, one would assume that there is a strict standard among physicians when it comes to administering blood. Yet, The New England Journal of Medicine notes that there is surprisingly little data "to guide decisions about transfusions." Indeed, there is a wide variation in practice, not only regarding precisely what is transfused and how much but also regarding whether a transfusion is administered at all. "Transfusion depends on the doctor, not on the patient," says the medical journal Acta Anæsthesiologica Belgica. Considering the above, it is hardly surprising that a study published in The New England Journal of Medicine found that "an estimated 66 percent of transfusions are administered inappropriately."

Blood-Borne Disease

After World War II, great strides in medicine made possible some surgeries that were previously unimaginable. Consequently, a global multibillion-dollar-a-year industry sprang up to supply the blood for transfusions, which physicians began to consider standard operating procedure.

Soon, however, concern over transfusion-related disease came to the fore. During the Korean War, for example, nearly 22 percent of those who received plasma transfusions developed hepatitis—almost triple the rate during World War II. By the 1970's, the U.S. Centers for Disease Control estimated the number of deaths from transfusion-related hepatitis at 3,500 a year. Others put the figure ten times higher.

Thanks to better screening and more careful selection of donors, the number of cases of hepatitis-B contamination declined. But then a new and sometimes fatal form of the virus—hepatitis C—took a heavy toll. It is estimated that four million Americans contracted the virus, several hundred thousand of them through blood transfusions. Granted, rigorous testing eventually reduced the prevalence of hepatitis C. Still, some fear that new dangers will appear and will only be understood when it is too late.

Another Scandal: HIV-Contaminated Blood

In the 1980's, it was found that blood can be contaminated with HIV, the virus that leads to AIDS. At first, blood bankers were loathe to consider that their supply might be tainted. Many of them initially greeted the HIV threat with skepticism. According to Dr. Bruce Evatt, "it was as though someone had wandered in from the desert and said, 'I've seen an extraterrestrial.' They listened, but they just didn't believe it."

Nevertheless, country after country has seen scandals break out exposing HIV-contaminated blood. It is estimated that in France, between 6,000 and 8,000 people were infected with HIV through transfusions that were administered between 1982 and 1985. Blood transfusions are held responsible for 10 percent of HIV infections throughout Africa and for 40 percent of the AIDS cases in Pakistan. Today, because of improved screening, HIV transmission through blood transfusions is rare in developed nations. However, such transmission continues to be a problem in developing nations that lack screening processes.

Understandably, in recent years there has been an increased interest in bloodless medicine and surgery. But is this a safe alternative?

The Growing Demand for Bloodless Medicine and Surgery

"All those dealing with blood and caring for
surgical patients have to consider bloodless surgery."
—Dr. Joachim Boldt, professor of anesthesiology, Ludwigshafen, Germany.

THE tragedy of AIDS has compelled scientists and physicians to take additional steps to make the operating room a safer place. Obviously, this has meant more stringent blood screening. But experts say that even these measures do not ensure zero-risk transfusions. "Even as society expends great resources on making the blood supply safer than ever," says the magazine Transfusion, "we believe patients will still try to avoid allogeneic [donor] transfusions simply because the blood supply can never be completely safe."

Not surprisingly, many doctors are becoming wary of administering blood. "Blood transfusions are basically no good, and we are very aggressive in avoiding them for everybody," says Dr. Alex Zapolanski, of San Francisco, California.

The general public too is becoming aware of the dangers of transfusions. Indeed, a 1996 poll revealed that 89 percent of Canadians would prefer an alternative to donated blood. "Not all patients will refuse homologous transfusions as do Jehovah's Witnesses," states the Journal of Vascular Surgery. "Nonetheless, the risks of disease transmission and immunomodulation offer clear evidence that we must find alternatives for all of our patients."

What Some Doctors Say

Dr. Joachim Boldt

'Bloodless surgery is not only for Jehovah's Witnesses but for all patients. I think that every doctor should be engaged in it.'—Dr. Joachim Boldt, professor of anesthesiology, Ludwigshafen, Germany.

"While blood transfusions are safer today than in the past, they still pose risks, including immune reactions and contracting hepatitis or sexually transmitted diseases."—Dr. Terrence J. Sacchi, clinical assistant professor of medicine.

Dr. Terrence J. Sacchi

"Most physicians have knee-jerk reactions with transfusions and just give them out liberally and indiscriminately. I don't."—Dr. Alex Zapolanski, director of cardiac surgery at the San Francisco Heart Institute.

"I don't see any conventional abdominal operation that in a normal patient routinely requires blood transfusion."—Dr. Johannes Scheele, professor of surgery, Jena, Germany.

A Preferred Method

Thankfully, there is an alternative—bloodless medicine and surgery. Many patients view it not as a last resort but as a preferred treatment, and with good reason. Stephen Geoffrey Pollard, a British consultant surgeon, notes that the morbidity and mortality rates among those who receive bloodless surgery are "at least as good as those patients who receive blood, and in many cases they are spared the postoperative infections and complications often attributable to blood."

How did bloodless medical treatment develop? In one sense the question is rather odd, since bloodless medicine actually predates the use of blood. Indeed, it was not until the early 20th century that transfusion technology had advanced to the point where it was routinely used. Nevertheless, in recent decades some have popularized the field of bloodless surgery. For example, during the 1960's noted surgeon Denton Cooley performed some of the first open-heart operations without the use of blood.

With the rise of hepatitis among transfusion recipients during the 1970's, many doctors began looking for alternatives to blood. By the 1980's a number of large medical teams were performing bloodless surgery. Then, when the AIDS epidemic broke out, these teams were repeatedly consulted by others who were eager to adopt the same techniques. During the 1990's many hospitals developed programs that offer bloodless options to their patients.

Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions. "Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products," notes D.H.W. Wong, in the Canadian Journal of Anaesthesia.

One advantage of bloodless surgery is that it promotes better-quality care. "The surgeon's skill is of the greatest importance in the prevention of blood loss," says Dr. Benjamin J. Reichstein, a director of surgery in Cleveland, Ohio. A South African legal journal says that in certain instances surgery without blood can be "quicker, cleaner and less expensive." It adds: "Certainly the aftercare treatment in many instances has proved cheaper and less time-consuming." These are just some of the reasons why there are currently more than 180 hospitals around the world that have programs specializing in bloodless medicine and surgery.

Blood and Jehovah's Witnesses

For Bible-based reasons, Jehovah's Witnesses refuse blood transfusions.* But they do accept—and vigorously pursue—medical alternatives to blood. "Jehovah's Witnesses actively seek the best in medical treatment," said Dr. Richard K. Spence, when director of surgery at a New York hospital. "As a group, they are the best educated consumers the surgeon will ever encounter."

Doctors have perfected many bloodless surgery techniques on Jehovah's Witnesses. Consider the experience of cardiovascular surgeon Denton Cooley. Over a period of 27 years, his team performed bloodless open-heart surgery on 663 of Jehovah's Witnesses. The results clearly demonstrate that cardiac operations can be successfully performed without the use of blood.

True, many have criticized Jehovah's Witnesses for their refusal of blood. But a guide published by the Association of Anaesthetists of Great Britain and Ireland calls the Witnesses' position "a sign of respect for life." In truth, the Witnesses' rigorous stand has been a major force behind safer medical treatment becoming available for all. "Jehovah's Witnesses in need of surgery have shown the way and exerted pressure for improvements in an important sector of the Norwegian health service," writes Professor Stein A. Evensen, of Norway's National Hospital.

To assist doctors in providing treatment without the use of blood, Jehovah's Witnesses have developed a helpful liaison service. Presently, more than 1,400 Hospital Liaison Committees worldwide are equipped to provide doctors and researchers with medical literature from a data base of over 3,000 articles related to bloodless medicine and surgery. "Not only Jehovah's Witnesses, but patients in general, are today less likely to be given unnecessary blood transfusions because of the work of the Witnesses' Hospital Liaison Committees," notes Dr. Charles Baron, a professor at Boston College Law School.#

The information on bloodless medicine and surgery that has been compiled by Jehovah's Witnesses has been of benefit to many in the medical field. For example, in preparing material for a book entitled Autotransfusion: Therapeutic Principles and Trends, the authors asked Jehovah's Witnesses to provide them with information about alternatives to blood transfusion. The Witnesses gladly granted their request. With gratitude the authors later stated: "In all our reading on this subject, we have never seen such a concise, complete list of strategies to avoid homologous blood transfusion."

Progress in the medical field has caused many to consider bloodless medicine. Where will this lead us? Professor Luc Montagnier, discoverer of the AIDS virus, states: "The evolution of our understanding in this field shows that blood transfusions must one day die out." In the meantime, alternatives to blood are already saving lives.

The Patient's Role Talk to your doctor about nonblood alternatives before the need for treatment arises. This is especially important for pregnant women, parents with small children, and the elderly. Put your wishes down in writing, especially if a legal document is available for such a purpose. If your physician is not willing to treat you without blood, seek a physician who will comply with your wishes. Since some alternatives to blood require time to be effective, do not postpone seeking treatment if you know that you need an operation.

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Can Fruits and Veggies Keep Your Memory Strong?

Karen Barrow

Filling your plate with fruits and vegetables may not only be a good way to keep your body healthy, it can keep your brain going strong, too.

In yet another study uncovering the benefits of fruits and vegetables, researchers from Utah State University have found that elderly men and women who consume high amounts of these foods have better memories than those who skimp on the broccoli, spinach, apples and pears.

Dr. Heidi Wengreen, a lead investigator of the study, said that this research is the first of its kind to look at diet as a means to prevent dementia. The findings were presented at the Alzheimer’s Association International Conference on Prevention of Dementia.

For the study, researchers tested the memory of over 5,000 seniors up to four times over an eight-year period. At the beginning, the participants also answered questions about their eating habits. The group of seniors with the highest intake of fruits and vegetables, five or more servings a day, scored higher on the test than the rest of the participants. Moreover, those who nibbled on plenty of veggies and fruit were able to maintain their memory over time.

"It appears that higher intake of fruits and vegetables may protect against memory loss in older adults." said Wengreen.

Previously, the same research group also found that taking daily vitamin E and C supplements also cuts the risk of Alzheimer’s. However, since the data was based on the dietary information given at the beginning of the study, Wengreen said that she is unable to say if the seniors who consumed a lot of fruits and vegetables continued to do so as the years passed.

Additionally, Wengreen also noted that the current guidelines recommend that adults eat five-and-a-half cups of fruits and vegetables every day, which is far from the amount that most American adults eat.

"Many Americans fall short of the current recommendations…even though we know they are good for us." said Wengreen, "Eating more fruits and vegetables in your later years offers benefits to both body and mind."

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5 Reasons to Walk

Start walking now. Here are the 5 most important reasons why:

1. Walking is a cardiovascular exercise - it is good for your heart. Which is enough of a reason to walk in and of itself, but walking is good for your head, too. Walking is great for clearing your mind and rejuvenating. Because it is aerobic, it helps condition your heart -- you already know this, but it can condition your mind as well since you are releasing endorphins, enjoying nature, and doing something good for yourself. Walk alone one day and just "feel" the experience. Maybe I should have called this reasons number 1 and 2 -- oh well.
   
   
2. Walking is weight bearing -- we build bone strength by carrying weight. Since your body is weight (lest I remind you), walking helps build lower body bone density which helps prevent osteoporosis. Check out my weighted WALKVEST (walkvest.com) to really build bone strength and bone density. And guess what? You need to pay attention to doing exercises that build bone density and prevent osteoporosis sooner than you think. We all begin losing bone density (it's a natural occurrence in us all) in our late 20s or early 30s. Read the stats. The bone loss process begins early -- people recognize it (unaware that it has been happening for years) when it is in the later stages and our bones are already brittle. But osteoporosis is preventable -- so start walking and do other weight bearing exercises (for your upper and lower body) now.
   
   
3. Walking is cardiovascular. Did I say that before? I believe I did. But there are even more aerobic benefits to walking, like the fact that walking helps burn excess calories so you can lose weight or maintain a healthy body weight. Should I have made this one number 1?
   
   
4. Walking is free. We like that!
   
   
5. Walking is beneficial to everyone. At any age or any fitness level, walking is a safe, effective and enjoyable exercise! OK, so this is 5, 6, and 7...just do it, you'll feel better and you'll look better!

Happy trails everyone,
Debbie Rocker

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Sleepless nights can cause worse problems than grumpiness

Kathy McCleary

Confession time: My husband has actually uttered the words "I'd rather take a nap than have sex." Is our marriage on the rocks? No, like 75 percent of adults, our problem is sleep -- he has insomnia; I snore.

We seem to be too busy to get enough sleep. On average, Americans sleep roughly 7 hours a night, 1 to 2 fewer hours per night than they did 40 years ago. And when we do hit the sack, sleep doesn't necessarily follow. No wonder my husband and I sometimes feel like zombies. Worse, there could be serious health repercussions due to our lack of shut-eye.

Do you have a sleep disorder?

How much sleep each person needs varies, though the differences may not be as great as you think, says Eve Van Cauter, Ph.D, professor of medicine at the University of Chicago. Studies have shown that sleep capacity -- how long you'll sleep if you go to bed and get up whenever you want -- is about 8 hours and 45 minutes for healthy young males (the group that's been researched most). In three separate studies, that amount varied less than 30 minutes from person to person. "A lot of people who believe they need only 4 hours of sleep are unconsciously depriving themselves," Van Cauter says.

Most people need 7 to 8 hours a night, according to Lawrence Epstein, M.D., regional medical director for Sleep HealthCenters in Boston, Massachusetts, and former president of the American Academy of Sleep Medicine.

"The idea shouldn't be to get into bed, fall asleep instantly, sleep a set number of hours, and wake up never having had your sleep disturbed," he explains. "The target should be to get an adequate amount of sleep to feel rested during the day."

How do you know you're not getting enough z's? "If you're falling asleep in 1 or 2 minutes, you're probably sleep deprived," says Thomas Roth, M.D., director of the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, Michigan.

On average, it takes most people about 15 minutes to fall asleep, though Roth notes that "it takes some people more time, some people less." Another way to tell if you're not sleeping enough is to monitor daytime sleepiness. Chronic daytime sleepiness is not normal, says Michael Twery, Ph.D., acting director of the National Center on Sleep Disorders Research. "People can live for decades and never appreciate that they have a sleep disorder and how it's affecting their lives."

The downside of running on empty

Scientists are finding more evidence that sleep deprivation can affect appetite, weight gain, diabetes risk, the strength of your immune system, and even your chance of developing depression.

In 2004, University of Chicago researchers restricted a group of men to only 4 hours of sleep per night. After just 2 nights, the men had an 18 percent decrease in leptin, a hormone that tells your brain when you are full, and a 28 percent increase in ghrelin, a hormone that triggers hunger. These results were reinforced last October by a study of almost 10,000 adults that found that people who slept fewer than 7 hours a night were more likely to be obese than those who got 7 hours of shut-eye. "

Chronic sleep deprivation causes changes in metabolism that produce a state that stimulates hunger," Epstein explains. Sleep deprivation can also affect how your body handles insulin; insulin resistance puts you at risk for weight gain and diabetes.

In a study that's still under way, Van Cauter and her colleagues are looking at chronic sleep loss in a group of normal-weight men and women under age 30. Over 6 months, those who slept fewer than 6.5 hours a night were more insulin-resistant than normal sleepers who logged 7.5 to 8 hours per night.

The short sleepers, the study shows so far, need to produce 30 to 40 percent more insulin to dispose of the same amount of glucose. Still other studies suggest that over time, sleep loss may play a role in the development of depression.

"Positive moods are lower in people with sleep loss," Van Cauter says, "and mood isn't stable over the 24-hour cycle. People have lower moods in the morning. They also have higher levels of cortisol, the stress hormone. All those changes are typical of clinical depression."

Whether it's depression, diabetes, or a bigger dress size, the threat posed by sleep deprivation is real. Sleep disorders can be treated, but often patients fail to recognize the problem -- leading to more sleepless nights.

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15 things you don't know about your penis.

Mike Zimmerman Illustration by Jason Holley

1. Smoking can shorten your penis by as much as a centimeter. Erections are all about good bloodflow, and lighting up calcifies blood vessels, stifling erectile circulation. So even if you don't care all that much about your lungs or dying young, spare the li'l guy.

2. Doctors can now grow skin for burn victims using the foreskins of circumcised infants. One foreskin can produce 23,000 square meters, which would be enough to tarp every Major League infield with human flesh.

3. An enlarged prostate gland can cause both erectile dysfunction! and premature ejaculation!. If you have an unexplained case of either, your doctor's looking forward to checking your prostate. Even if you're not.

4. The average male orgasm lasts 6 seconds. Women get 23 seconds. Which means if women were really interested in equality, they'd make sure we have four orgasms for every one of theirs.

5. The oldest known species with a penis is a hard-shelled sea creature called Colymbosathon ecplecticos. That's Greek for "amazing swimmer with large penis!." Which officially supplants Buck Naked as the best porn name, ever.

6. Circumcised foreskin can be reconstructed. Movable skin on the shaft of the penis is pulled toward the tip and set in place with tape. Later, doctors apply plastic rings, caps, and weights. Years can pass until complete coverage is attained. . . . Okay, we'll shut up now.

7. Only one man in 400 is flexible enough to give himself oral pleasure. It's estimated, however, that all 400 have given it their best shot at some point.

8. There are two types of penises. One kind expands and lengthens when becoming erect (a grower). The other appears big most of the time, but doesn't get much bigger after achieving erection (a shower).

9. An international Men's Health survey reports that 79 percent of men have growers, 21 percent have showers.

10. German researchers say the average intercourse lasts 2 minutes, 50 seconds, yet women perceive it as lasting 5 minutes, 30 seconds. Are we that good or that bad?

11. Turns out size does matter: The longer your penis!, the better "semen displacement" you'll achieve when having sex with a woman flush with competing sperm. That's according to researchers at the State University of New York, who used artificial phalluses (ahem) to test the "scooping" mechanism of the penis's coronal ridge. Next up: curing cancer.

12. The penis that's been enjoyed by the most women could be that of King Fatefehi of Tonga, who supposedly deflowered 37,800 women between the years 1770 and 1784 — that's about seven virgins a day. Go ahead, say it: It's good to be king.

13. Better-looking men may have stronger sperm. Spanish researchers showed women photos of guys who had good, average, and lousy sperm — and told them to pick the handsomest men. The women chose the best sperm producers most often.

14. No brain is necessary for ejaculation!. That order comes from the spinal cord. Finding a living vessel for said ejaculation!, however, takes hours of careful thought and, often, considerable amounts of alcohol.

15. The most common cause of penile rupture!: vigorous masturbation. Some risks are just worth taking.

Research by the editors of Men's Health Germany.

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Diabetes - Fill Your Plate to Lose Weight

Sari N. Harrar

Saundra Snow knew she had put on some weight. But in the fall of 2005, the 33-year-old was most concerned about her lack of energy. Snow was so tired after work that she couldn't get off the couch to walk her dogs, Daisy and Nacho. She had chronic headaches and occasional dizziness, couldn't remember when she'd last had a period and was depressed. Her husband was starting to worry. "You're breathing too hard," he told her one day as they walked up the three flights to the St. Meinrad, Ind., catalog company where they work.

Snow, a graphic designer, made an appointment to see her doctor, who ordered a battery of tests. "The doctor came in and said, point-blank, 'Here's the deal: You're prediabetic. You have to change your ways.' I sat there with this towel wrapped around me and said, 'Oh, crap!' "

But she answered the wake-up call. Though she claims to suffer from "the opposite of anorexia—I look in the mirror and say, 'Oh, not so bad!,' " Snow acknowledged that her double-X clothes were too snug. When she got a mail offer for a new book, The Sugar Solution (published by Rodale, Prevention's parent company), she ordered it. It was a diet, exercise and stress-reduction plan that promised weight loss, newfound energy, even protection from diseases such as diabetes, hypertension, heart disease and cancer. The secret? Controlling blood sugar.

"My fasting blood sugar was 120 and it should be under 100," says Snow. "It sounded like this program was on the money for me."

Following the book's advice, she said good-bye to cookies and candy. "I love them, but we've ended our relationship," she jokes. She switched to whole grains and filled up on vegetables, protein and fruit. She began walking daily on her treadmill ("after I cleaned the dust off"), starting at 2.5 MPH for 15 minutes, and adding time and speed every week.

Within two weeks, she felt her energy surging back. After a month, she was shedding two pounds a week. By the end of the year, she was walking 45 minutes every day, had lost 52 pounds, and had shaved 10 inches off her waist. Even better, her blood sugar is now normal (90); her cholesterol went from a high of 220 mg/dl down to 180; and her triglycerides—another blood fat closely linked to diet—dropped from 300 mg/dl to 140 mg/dl (optimal is less than 150). And her mood has improved. "The worst thing about the plan was that I was buying new clothes every month," says Snow. "It's a good problem to have."

Why It Works

To understand how you can lose weight like Saundra Snow did—and reap all the health benefits—you need to know a little about your metabolism. Everything you eat that contains carbs, from Caesar salad to a slice of cherry cheesecake, is ultimately converted into glucose—blood sugar—which is what your body's cells use for energy. Any excess is stored as fat. In the lean times (when you're on a diet and exercising, for example), your body will burn fat for energy to keep you going. That's how you lose weight.

Glucose gets into cells with the help of insulin, a hormone produced by your pancreas. This system works pretty efficiently when you're eating a variety of foods: whole grains, protein and fat, which are digested and metabolized slowly for energy over the long haul, as well as simple carbohydrates, which are digested and absorbed quickly.

But if your diet favors these fast-burning carbs, your insulin-production system has to work overtime—the pancreas must produce more insulin to open up cells and usher in all the sugar. So far, so good—but as your body realizes it's flush with fuel, two dire things happen. It stops burning fat stores for energy and it begins storing more of the food you eat as fat. So you gain weight.

Your insulin levels plummet once all the glucose is either feeding your cells or packed onto your belly and hips. But with blood sugar bottomed out too, you're left tired, moody and hungry for more sugary foods to boost your energy levels.

If your diet continually requires lots of insulin, the hormone can eventually become less efficient, a condition called insulin resistance. So your pancreas produces still more. But when extra insulin circulates, it can damage your heart and create problems. People with prediabetic conditions or diabetes are up to four times as likely as healthy people to get heart disease and are at increased risk of cancers of the breast, uterus, colon and pancreas.

The Sugar Solution is designed to keep your glucose control system steady, whether you have diabetes, are prediabetic, or are an otherwise healthy but overweight carb addict. It can even melt stubborn belly fat—the dangerous fat that increases your risk of diabetes and heart disease. In a Danish study, 25 people who raised their daily protein levels to the amount recommended in The Sugar Solution (up to 25 percent of daily calories) lost 10 percent more belly fat than dieters who ate more carbs. Aerobic exercise most days of the week—along with strength-training—also attacks abdominal fat and is an important part of this program.

The eating plan, developed by nutrition expert Ann Fittante, RD, at the Joslin Diabetes Center in Seattle, is based on the glycemic index (GI), a system that ranks foods by how much and how quickly they raise blood sugar. Eating low-GI foods frequently during the day (three meals and three snacks) has been shown to keep blood sugar levels on an even keel for hours. There's growing evidence that a low-GI eating plan can help you lose weight, keep it off, switch off cravings, and make you feel energetic, even when you're eating fewer calories.

Size Your Servings

The Sugar Solution plan helps you create filling meals that steady blood sugar with high-fiber carbohydrates—fresh fruits, vegetables and whole grains. The protein fills you up and boosts metabolism, so you'll burn more calories up to three hours after you eat.

Dairy foods help you lose weight and protect against metabolic syndrome, which raises your risk of heart attack, stroke and cancer. The plan even includes daily snacks and treats, such as wine and chocolate, to help fight the deprivation that dooms so many diets. The following are typical serving sizes.

Fruit

• 1 med whole fruit (apple, banana, peach, pear, etc.)
• 1/4 c dried fruit
• 1 c fresh, frozen, or canned fruit (berries, melon, grapes, etc.)

Vegetables

• 1 c raw, leafy vegetables
• 1/2 c cooked vegetables
• 6 oz vegetable juice

Grains

• 1 slice whole grain bread
• 1/2-1 c cooked or dry cereal
• 1/2 c cooked rice or pasta
• 3 c popcorn
• 1/2 c cooked whole grain pasta
• 1/2 c cooked quinoa or barley

Protein

• 3 oz cooked beef, pork, poultry, or fish (the size of your palm)
• 1 1/2 oz reduced-fat cheese
• 1 oz or 2 Tbsp almonds, walnuts, or cashews
• 1 Tbsp nut butter
• 1 egg
• 4 oz tofu
• 1/2 c cooked beans

Dairy

• 8 oz (1 c) 1% (or fat-free) milk
• 1 c low-fat or fat-free plain or fruit yogurt (150 calories or less per 6 to 8 oz serving)

Good fats

Get 25 percent to 30 percent of your daily calories from fat, including daily servings of the good fats your body needs most, such as olive, canola, or flaxseed oil; ground flaxseed; and avocado. The nuts mentioned under protein also provide healthy oils: walnuts, almonds, cashews, peanuts, and peanut and almond butters (these servings can be in addition to your protein servings).

• 1 oz or 2 Tbsp nuts/seeds (5+ servings per week)
• 1/8 avocado
• Limit added oils (preferably extra virgin olive oil) to 1 Tbsp per day

Treat yourself

If you're happy with your weight—or weight loss—you can have one or two treats every day. But limit each one to 80 to 150 calories.

• 1/2 oz dark chocolate (e.g., one Lindt truffle)
• Frozen yogurt, ice cream, sorbet, or sherbet: 120 calories or less per 1/2 c serving
• 4-6 oz wine
• 12 oz beer
• 1 1/2 oz liquor

The Plate Rules

At a dinner party? Out at a restaurant? You can use these two simple rules to stay on The Sugar Solution plan:

1. Fill half your plate with vegetables and/or fruit.
2. Fill the rest with roughly equal amounts of whole grains and other high-fiber carbs, lean protein and a good source of healthy fat.

Your Daily Plan

Don't worry about counting calories. On this plan, if you follow our guide to daily servings, you'll get about 1,600 calories or less (for serving sizes, see "Size Your Servings"). You'll also have one or two snacks or treats daily.

Here's a typical day:

3-4 fruits

4-6 vegetables

3-6 grains

2-4 protein

2-3 dairy

2-3 good fats

Trouble losing weight? Cut out treats and have just one 80-calorie snack a day, such as a serving of fruit, popcorn or an ounce of string cheese, plus two 25-calorie-or-less snacks (raw veggies, green salad dressed with vinegar, seltzer with lemon or lime, unsweetened tea).

Day 1

Breakfast:

1 serving Berry-Good Smoothie: Blend 1/2 c fresh or thawed frozen blueberries, 1/2 c low-fat vanilla yogurt, 1/2 c cranberry-blueberry juice, and 1 Tbsp ground flaxseed.

Snack:

• 3 c popcorn

Lunch:

• Tuna sandwich: 1/2 c tuna and 2 tsp low-fat mayo with lettuce and tomato on 2 slices whole grain bread.
• 1 c raw sugar snap peas or other raw vegetable dipped in 2 Tbsp low-fat dressing.
  

Snack:

• 1 orange

Dinner:

• 3 oz baked chicken
• 1 c polenta
• 2 c salad with 1 Tbsp low-fat dressing
• 1 c steamed broccoli and yellow squash
• 6 oz wine or extra 80-calorie snack

Snack:

• 1/2 c applesauce mixed with 1/2 c low-fat plain or vanilla yogurt and cinnamon.

Day 2

Breakfast:

• 1 egg, prepared any style with cooking spray.
• 1 whole grain English muffin spread with 2 tsp trans-free margarine.

Snack:

1 c frozen grapes

Lunch:

1 c low-sodium tomato soup made with fat-free milk. 2 c salad with 2 oz grilled chicken and 1/8 avocado, dressed with 1 Tbsp low-fat dressing. 1 sm slice corn bread

Snack:

• 2 rice cakes spread with 2 tsp all-natural peanut butter.

Dinner:

• 3 oz grilled salmon with 2 Tbsp Cilantro-Mint Yogurt: Combine 1/4 c + 2 Tbsp low-fat plain yogurt, 2 Tbsp low-fat sour cream, 1 Tbsp chopped cilantro, 2 tsp chopped mint, 1/4 tsp salt, 1/8 tsp black pepper, and a pinch of ground red pepper (optional); refrigerate leftover sauce for other meals.
• 1 c whole grain pasta tossed with sauteed red bell pepper or other veggies.
• 1 c 1% milk

Snack:

• 1/2 c sliced fruit topped with 2 Tbsp low-fat sour cream or low-fat plain or vanilla yogurt.

Day 3

Breakfast:

• 1 c high-fiber dry cereal with 1/2 c blue-berries and 2 Tbsp ground flaxseed.
• 1 c 1% milk

Snack:

• 1 slice raisin bread, toasted, with 1 tsp trans-free margarine and a sprinkle of sugar and cinnamon.

Lunch:

• Nut-butter sandwich: Spread 2 Tbsp all-natural peanut butter or other nut butter and 1/2 Tbsp blackstrap molasses or 1/2 Tbsp jam on 2 slices whole grain bread.
• Carrot and celery sticks

Snack:

• 1 banana

Dinner:

3 oz beef tenderloin 1 med baked potato with 2 Tbsp low-fat sour cream 1 c steamed green beans and carrots 2 c salad with 2 Tbsp low-fat dressing 1/2 c low-fat frozen dessert topped with 1/2 c sliced strawberries

Snack:

• 3 graham cracker squares with herb tea

Day 4

Breakfast:

Asparagus with mushroom and goat cheese omelet: Boil 4 asparagus spears for 2 to 3 minutes until crisp-tender; pat dry. Sautee sliced mushrooms in cooking spray. Whisk 2 lg eggs, 3 Tbsp 1% milk, 1 Tbsp fresh basil, 1/8 tsp black pepper, and 1/8 tsp salt. Cook omelet in 1 tsp butter. When done, sprinkle on mushrooms and 1/8 c goat cheese, fold, and serve with asparagus.

Snack:

• 1 apple

Lunch:

• 1 c low-sodium vegetable soup
• Lg salad: Mix 1 1/2 c greens, 1/2 c chopped vegetables, 1/4 c canned chickpeas (rinsed and drained), 1/2 c chopped apple or grapes, 1/8 avocado, and bean sprouts. Dress with 2 Tbsp low-fat dressing.
• 1 serving whole grain crackers or 1 sm whole grain roll

Snack:

6-8 oz low-fat plain or vanilla yogurt

Dinner:

• 1 Italian-style beef burger: Mix 1 1/2 lb extralean ground beef, 5 Tbsp grated Romano cheese, 2 Tbsp pine nuts (toasted and finely chopped), 1 tsp dried oregano, 3/4 tsp garlic powder, 1/2 tsp salt, and 1/4 tsp black pepper. Divide into 4 patties (4" diameter, 1" thick). Broil 4 to 6 minutes on each side. Serve on whole grain roll. Spread with 1 Tbsp ketchup and 2 tsp mustard and top with lettuce, tomato, and onion, if desired.
• 2 c tossed salad with 2 Tbsp low-fat dressing
• 1 c 1% milk

Snack:

• 1 serving whole grain tortilla chips (150 calories or less) and 1/8 c salsa

5 Fast Ways to Blunt Sugar

If you're knocked off the plan because of a crazy day or travel, these easy strategies can reduce the effect of a meal on your blood sugar.

Add beans: Only have time to make instant rice? Just add some beans. Throwing in a low-GI food brings down the GI rating of the entire meal.

Deploy good fat: Slather a tablespoon of peanut butter on your morning English muffin. Fat slows the absorption of sugar into the bloodstream.

Add a cheese stick, precooked chicken strips or avocado to your carb snack: A stick of string cheese or a few pieces of chicken added to a potentially blood sugar-raising snack (such as crackers or a piece of toast) will keep you full longer. Like fat, protein slows digestion and the absorption of sugars.

Have a salad with vinaigrette: Start lunch or dinner with any vinaigrette-dressed veggie medley. Arizona State University nutritionists have found that vinegar prevents blood-sugar spikes after eating. They suspect that acetic acid (the compound that makes vinegar sour) interferes with enzymes that break down carbs. Just 2 teaspoons per meal can help tame glucose.

Sprinkle on some cinnamon: As little as 1/4 teaspoon of cinnamon each day improves your body's ability to metabolize glucose, report researchers at the USDA's Beltsville Human Nutrition Research Center in Maryland. A compound in this spice called methylhydroxy chalcone polymer makes cells absorb glucose faster and convert it more easily into energy, so your blood sugar stays lower.

How to Fill Your Plate

Breakfast plates:

• Whole grain cereal and milk topped with fruit
• Two slices whole grain toast with nut butter and fruit

Lunch plates:

• Sandwich filled with 2 or 3 slices of lean meat, with a salad, fruit salad or veggies
• Black bean, lentil or other bean-based soup, with a salad or side dish of vegetables and a whole grain roll or crackers

Dinner plates:

Traditional:

• Salad or cooked veggies (half the plate)
• palm-size piece of fish, poultry, or lean meat (one-third to one-quarter of the plate)
• 1 cup of whole grain pasta, brown rice, quinoa or a medium sweet potato

Stir-fry

• Three-quarters vegetables and one-quarter meat, poultry or seafood.
• Fill three-quarters of your plate with stir-fry and one-quarter with brown rice

Adapted from The Sugar Solution.

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Can Older Cells Solve Cloning's Problems?

ALICE PARK


It goes against the current scientific conventional wisdom. But a suprising new study suggests that therapeutic cloning may be more successful using the most mature adult cells.

If there is one thing that people on both sides of the cloning debate agree upon, it's that cloning is an incredibly inefficient process. When it comes to cloning animals, like Dolly and Snuppy, the process produces a healthy animal only a dismal 1-5% of the time. This hit-or-miss dilemma wouldn't matter much if producing identical animals were its only application, but cloning is also the foundation for one of the more promising ways that stem cells might be used to treat human disease with a patient's own cells. At this rate, even cloning's most ardent supporters agree that such a method won't be very reliable � or very realistic. If therapeutic cloning, as it is known, is to become a viable treatment option, then the first thing scientists need to do is boost the cloning technique's efficiency.

Researchers at University of Connecticut may have done just that. A report released in Nature Genetics Sunday by Xiangzhong Yang and Tao Cheng showed that by using a specific type of fully mature adult cell, they could improve the chances that they would produce a cloned embryo. Yang's team relied on the same technique that was used to create both Dolly and Snuppy, but instead of starting with cells that are still capable of dividing � like the mammary cell that created Dolly and the skin cell that became Snuppy -- they used blood cells near the end of their life cycles that could no longer divide. It was these older, mature cells that produced more cloned embryos than the younger ones. "To our surprise, the fully differentiated cells were more efficient in producing cloned embryos," says Yang, a director of the University's Center for Regenerative Biology.

In fact, Yang's findings fly in the face of conventional wisdom in the cloning field, which held that cloning, which involves turning back the clock on adult cells, worked better with younger, more "embryo"-like cells. The less that the cloning process has to undo, the theory goes, the more successful the technique will be. In fact, there was good evidence to support this theory � in previous studies embryonic stem cells, which can generate all of the body's cell types, produced clones ten times more efficiently than adult stem cells, which can develop into only a restricted number of cell types. And when scientists had tried to clone fully differentiated cells, they had very little luck.

The Connecticut group's report, however, found that fully differentiated cells could prove useful in cloning, although they're still not sure why. Nearly 40% of these more mature cells developed to the blastocyst stage, at which point stem cells can be extracted, while only 4% of the more actively dividing cells did so. "That is good news for therapeutic cloning," notes Yang. From his research, Yang believes that most of the problems that occur in cloning occur after the blastocyst stage, when the embryo begins to divide to re-create all the tissue types in a developing fetus. "Based on our studies, we believe that development of a cloned embryo to the blastocyst stage is fairly normal," he says. "So cloning for [treatment] purposes is no problem."

Even Yang admits, however, that his study isn't the last word on cloning. He and his colleagues are already at work expanding this first trial, and investigating other ways to boost cloning's efficiency.

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