Healthcare News and Research
 

Better Pain Control by...Cutting Back on Opioids?
Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York.

Posted: 02/13/2012
I want to talk about a new approach to chronic pain care, based on a recent, exciting study.[1] I certainly see many people with chronic pain in my role as director of a pain center in an academic institution. Many patients do not respond to typically prescribed medications for osteoarthritis and for various neuropathic pain states. I am certain that those of you who are not working at pain centers also see patients who do not respond to available treatments that provide pain relief for other patients.
We are all concerned that sometimes we do not always have a treatment for each individual patient. We need new and improved analgesics and, absent those, at least a more creative way to benefit from what we have.

One approach to this quest has been to try to capitalize on the endocannabinoid system through the use of cannabinoids in various oral pharmacologic tactics. Some cannabinoid agents are available, but with marginal benefit. A second approach has been to develop a better, more effective, and safer way of using opioid analgesics.

The study I want to discuss, "Cannabinoid-Opioid Interaction in Chronic Pain," by Abrams and colleagues,[1] demonstrates how combining the 2 agents may provide promise. I live in New York State, where using marijuana is illegal, medically or otherwise; I am not speaking for or against this. I am merely reporting this particular study.

This study involved individuals with various chronic pain states, including musculoskeletal pain from osteoarthritis and other causes, neuropathic pain, sickle cell disease, and others. These patients were already using long-acting opioids: either time-released oxycodone twice daily at mean doses of 100 mg/day or time-released morphine twice daily at mean doses of about 120 mg/ day. More than 300 individuals were screened, and ultimately 21 of these participated in the study. Participants had to be stable on their opioid regimens before they were enrolled.

The 21 participants were managed as inpatients over 5 days. On the first day, they received 1 evening dose of vaporized cannabis; on days 2-4, they received 3 doses; and on day 5, they received a morning dose, in addition to their typical opioid regimens.

On average, these participants experienced an added 27% reduction in pain with the addition of vaporized cannabis. Pharmacokinetic studies demonstrated that although there was an effect on reducing absorption of morphine by the addition of vaporized cannabis, there was no change in the area under the curve. Therefore, the patients were exposed to a similar amount of morphine, although the peak concentration of morphine was also slightly reduced. Adding vaporized cannabis seemed to independently magnify the response the person was experiencing to the analgesia.

This brings to mind a couple of things. First, this was a limited, 5-day study; the investigators recognized this limitation. However, this shows a new and potentially very helpful combined approach to treatment that comes at an important time when we are searching for improved and novel analgesics that can provide us with additional relief for our patients, and also could spare opioid dosing.

Most important, we're looking for ways to safely treat patients who have chronic pain. This study of vaporized cannabis in addition to long-acting opioid found no significant changes in the plasma opioid level with the combination, even though it proved more effective than the opioid alone. This may be a gateway to future studies using lower doses of opioids in combinations with endocannabinoids or other agents that act on cannabinoid receptors -- or, in certain settings, use of cannabis itself.

Ultimately, this may point to a new way we can effectively treat outpatients.

References

1. Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011;90:844-851. Abstract
Medscape Neurology © 2012 WebMD, LLC

I quit smoking nearly a year and ahalf ago,if this came in pill form I could do that just not smokeing it cause I know it will put me on the path to ciggies again.Currently im takeing tramadole and useing flexerill to relax my back,recently ive been up in the amount of tramadols I can take a day but I ony take the extra pill if I really need it.I am so tired of floating thrue most of the day I just dont take anything at all dureing the day,just at bed time.

You know, I am sure there are medical merits to using canabus. Personally, I am tired of the scamming encouraged by greed and for some addiciton in this medical marijuana wars.

Why don't the States that allow the sale of medical marijuana put it in a pharmacy? All of these "dispensarys" popping up under the planning/land use decisions and local (city) ordinances are not working. Make it accountable to the State, legalize it as a medical drug and sell it out of the Pharmacy. This is how it is done with other medical prescriptions.

There is a pharmaceutical version of cannabinoids. It is FDA approved for treatment of nausea and vomiting during chemotherapy. It was approved in the early 90s. The generic name is 'dronabinol' and the brand name is 'marinol'. There are some other approved versions.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000403/

I tried it. Did not like it at all. Gave me a headache and I had no way to control how much I was taking. I think it came in 2 different doses. With smoked cannabinoids, I had control. I can take 1 or 2 tokes or smoke the whole joint depending on pain severity. I did not get the relaxed 'oh I feel better now' that I got by smoking. It didn't really get me loaded.....just a headache and maybe a tiny bit of pain relief.

Vaporized cannabis is very very different than smoking cannabis. It doesn't feel like smoke going in your lungs. I can't tell if I have actually had a dose. It has none of the problems with smoked cannabis. No tars, none of the evil nasty crap smoking gives you, no apparent risk for developing lung disease down the road.

Women at Midlife and Beyond Have Unique Health Needs

An Expert Interview With Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN

"Hot Flashes and More: Midlife Women's Health and Beyond" was presented at the 14th Annual Nurse Practitioners in Women's Healthcare (NPWH) Premier Women's Healthcare Conference. We spoke with one of the presenters, Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN.

Medscape: What percentage of women in midlife is living with symptoms related to menopause?

Dr. Alexander: Every single woman who lives long enough will experience menopause, and all of us will have some kind of symptoms; the biggest question is whether or not it is bothersome to them. All women experience vaginal atrophy over time. There are certain different symptoms that affect everybody; whether or not it is bothersome is a separate question.

Medscape: Do vasomotor symptoms associated with menopause consist only of hot flashes, or are there other symptoms as well?

Dr. Alexander: Some women get sweats and some women get chills. In Europe they call it 'hot flushes' instead of hot flashes, because their faces turn very red.

Medscape: What are some other consequences related to loss of estrogen?

Dr. Alexander: People can have psychosomatic symptoms, like mood swings, or they can have neurological symptoms like formication, where there's a sensation of bugs picking over the skin. Women sometimes have disbalance.

They can have genitourinary symptoms; they can have musculoskeletal symptoms; some women have gastrointestinal symptoms. The receptors for estrogen and progestogen are all over the body, and so symptoms can occur anyplace, in areas where those receptors become unbalanced, during and after menopause.

There are other physiologic changes that aren't so much symptoms as they are physiologic changes like loss of bone mass and increase of cardiovascular disease, although that's not really related directly to loss of estrogen — it's probably more related to estrogen-testosterone balance, or imbalance.

Medscape: What are some of the risks and benefits associated with use of hormone therapy, and which women would be considered the best candidates for it?

Dr. Alexander: We talked a lot during the session about the history of hormone therapy, and how it has swung like a pendulum over time: first it was in favor, then swung out of favor, then swung into favor, and then swung out of favor.

The most recent evidence-based (data) that we are working with include the HERS study and the WHI study. These studies have indicated that contrary to what was suggested in prior population-based observational studies, hormone therapy, estrogen therapy, or estrogen plus progesterone therapy do not confer cardiac protection, especially if taken a chunk of time after menopause.

We don't really have good data yet whether or not there might be any kind of benefit toward that if hormone therapy is started at the time of the woman transitioning towards menopause. It looks like there are a couple of theories that are evolving, if you look at one more data and start to analyze subgroups. That has suggested 2 different theories related to when one should initiate using hormone therapy; one of them was the "gap" theory, which looks at breast cancer risk, and there's some question about whether there might be a decrease in breast cancer risk if a woman holds off on starting hormone therapy for that 5 years post menopause.

The news is starting to suggest that if we start hormone therapy right at the time when a woman becomes postmenopausal, it helps to decrease, delay, or put off their risk of developing cardiovascular disease.

Now, it is very controversial; there's a lot of good data that's available. Some of the results from various different studies are rather controversial and confusing, and so it's important for people to really look hard to make sure they remain abreast of these developments.

The most immediate information that we have is what I've just described, and it's looking more and more like we really need to individualize care…if the greatest risk for her is related to heart disease, you might want to think about hormone care sooner than later if in fact she's a good candidate. If the risk factors are higher for breast cancer, you might want to wait.

Medscape: Are there any alternative therapies that you currently favor, and what are some of the risks and benefits of those, particularly when compared to hormone therapy?

Dr. Alexander: There are some alternative therapies, and nonhormonal prescription medications that can be used to try to allay symptoms related to menopause: selective serotonin reuptake inhibitors (SSRIs), selective neurotonin reuptake inhibitors (SNRIs), and the like.

The good thing is that we really have a lot of choices and we're learning a lot more about potential risks and benefits, and I think that's incredibly important. We do know that hormone therapy, estrogen therapy, or estrogen plus progesterone therapy are the single most effective for menopause-related symptoms, but it's not a good choice for every person, and it's not something that every woman feels comfortable taking because of some of the risk factors that we're learning about.

Some of the things that might be most beneficial [with hormone replacement therapy] are things like: A) when a hot flash is coming on, the woman can try to decrease its intensity, or B) possibly stop it from happening.

There are a couple of different products on the market that are available, and some of them suggest benefits that may not be borne out when we do larger head-to-head clinical trials. The other thing is that there are many different things that can trigger hot flashes, and it is really important for women to recognize that there are triggers, and if something is coming on, that they might be able to stop it…if they start to feel that hot flash, by using paced breathing.

The data [related to acupuncture] is kind of all over the place. I think the most recent meta-analysis suggested that it probably didn't have a very strong effect… The benefit of acupuncture is that it's a very well-known, well-proven, safe alternative therapy and it certainly increases relaxation and decreases pain, so if it helps lower someone's stress level and anxiety, it may help to decrease hot flashes — not so much because it's having an impact on the hot flashes directly, but more because it is decreasing some things that are possibly triggering the hot flashes to begin with.

Medscape: Which women would be considered good candidates for alternative therapies?

Dr. Alexander: Anybody.

Medscape: What screening tests should be done on all women at midlife and beyond, regardless of whether they are experiencing symptoms of menopause?

Dr. Alexander: We recommend colonoscopy for women starting at age 50 or younger if there's a family history of colon cancer that is identified before the age of 50; regular female Pap smears and annual internal exams; clinical breast exams and mammography; blood sugar and lipid screening at least every 5 years or more frequently in women at risk; PSA [prostate-specific antigen] sometime around age 40 or 50; hemoglobin around age 50; flu shots annually, pneumothorax depending on their health risk at 65, herpes zoster vaccine every 10 years; tetanus vaccine, and if there's any travel, they should have appropriate immunizations for that.

Osteoporosis is very important; some women need to be measured on a stadiometer every single year to be sure that you actually have an accurate height. Bone density screening should be done at the age of 65, unless experiencing other risk factors earlier.

For women who are experiencing menopause-related symptoms and for whom various different therapies might be being considered, there are some screenings that we do that are separate from that: clotting factor, blood cancer risk, heart disease risk, and so forth.

Medscape: Do you have any special tips for examining women at midlife and beyond?

Dr. Alexander: It's important that you maintain an open differential because even though a woman is 52 and hasn't had a menstrual period in 8 months, and has symptoms that sound like they are related to menopause, it doesn't behoove the patient or the clinic to just decide, "Those are menopause-related symptoms." You need to really make sure you go through an appropriate history and a complete physical exam and really maintain your open mind to a broad differential and potential basis for the symptoms.

Women who are at midlife are at higher risk for diabetes, just like men are, and the waxing and waning of blood sugar levels can sometimes mimic menopause-related symptoms such as hot flashes, and it's important to make sure that you screen for those other health conditions.

Dr. Alexander disclosed that she is on the speaker's bureau for Amgen.

National Association of Nurse Practitioners in Women's Healthcare (NPWH) 2011 Annual Meeting. October 12-15, 2011.

Medscape Medical News © 2012 WebMD, LLC

Available at: http://www.medscape.com/viewarticle/408896.

Can Exercise Offset Impact of Estrogen Loss?

Physical activity, so vital to good health and well being, takes on even greater importance at menopause; as the ovaries shut down, a woman loses estrogen's protective effects against bone loss. The years surrounding the menopause, which occurs at an average age of 52, when a woman undergoes the transition from a reproductive to a postreproductive state, are termed the climacteric period. Regular exercise can prevent or lessen the impact of many of the changes women experience at this time. Exercise also can decrease morbidity and mortality after menopause by lowering a woman's risk of bone fracture.

Exercise can attenuate some of the effects of aging as well as the physical changes linked to a sedentary lifestyle. Regular physical activity can reduce the symptoms and risks of cardiovascular disease, osteoporosis, obesity, and other chronic diseases such as diabetes, which become more prevalent in the postmenopausal period.[1] There is some evidence that symptoms often associated with the hormonal changes of menopause, such as hot flashes, insomnia, and depression, can also be alleviated by exercise.[2] Despite the growing body of evidence for the benefits of exercise at any age, it is estimated that only 38% of females over the age of 19 exercise regularly.[3] The public health burden of inactivity, with its associations to coronary heart disease (CHD) and all-cause mortality, is high. All women should be encouraged to exercise regularly, and clinicians should reinforce the particular benefits of exercise to patients in their menopausal and postmenopausal years.


Authors and Disclosures

Margaret Burghardt is Staff Physician at the Fowler-Kennedy Sports Medicine Clinic, University of Western Ontario Faculty of Medicine, London, Ontario, Canada. She holds a diploma in sports medicine from the Canadian Academy of Sports Medicine (CASM).

Burghardt M. Exercise at Menopause: A Critical Difference. MedGenMed 1(3), 1999. [formerly published in Medscape Women's Health eJournal 4(1), 1999].

Report shows 7.5 million children live with a parent with an alcohol use disorder
 

SAMHSA News Release
Date: 2/16/2012 12:05 AM
From: Substance Abuse and Mental Health Services Administration (SAMHSA)
Telephone: 240-276-2130

A new report shows 7.5 million children under age 18 (10.5 percent of this population) lived with a parent who has experienced an alcohol use disorder in the past year. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA) 6.1 million of these children live with two parents—with either one or both parents experiencing an alcohol use disorder in the past year.
The remaining 1.4 million of these children live in a single-parent house with a parent who has experienced an alcohol use disorder in the past year. Of these children 1.1 million lived in a single mother household and 0.3 million lived in a single father household. This study is done in conjunction with Children of Alcoholics Week, February 12-18, 2012.

“The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems later in their lives,” said SAMHSA Administrator Pamela S. Hyde. “SAMHSA and others are promoting programs that can help those with alcohol disorders find recovery – not only for themselves, but for the sake of their children. SAMHSA is also playing a key role in national efforts to prevent underage drinking and other forms of alcohol abuse.”

SAMHSA offers an on-line treatment locator service that can be accessed at www.samhsa.gov/treatment or by calling 1-800-662-HELP (4357).

There are many resources available to help children with a parent who has an alcohol problem. The National Association for Children of Alcoholics ( http://www.nacoa.org ) provides information and resources for professionals who may be in a position to help these children and their families. More resources are available at: http://www.samhsa.gov/prevention .

The report entitled, Data Spotlight: Over 7 Million Children Live with a Parent with Alcohol Problems, is based on data analyzed from SAMHSA’s 2005-2010 National Survey on Drug Use and Health (NSDUH). NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many substance abuse and behavioral health issues affecting the nation. http://www.samhsa.gov/data/spotlight...holics2012.pdf .

For more information about SAMHSA visit: http://www.samhsa.gov.


SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.


Last updated: 2/15/2012 4:16 PM

Strong Support May Protect Gay Youth From Suicide
 

Joanna Broder
February 17, 2012 — Strong social support may help protect gay, lesbian, bisexual, and transgender (LGBT) youth against suicidal thoughts, new research suggests.

The first longitudinal prospective study to examine factors predictive of suicidal ideation and self-harm in this vulnerable, high-risk population indicates that support from friends and family may offer the greatest protection.

"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," senior author Brian Mustanski, PhD, a clinical psychologist and associate professor of medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, Illinois, said in a release.

"I think it really informs us as to what sort of avenues we can take to help reduce suicide in gay youth," he told Medscape Medical News.

The study is published in the March issue of the American Journal of Preventive Medicine.

Suicide More Common in Gay Youth

Suicide is the third-leading cause of death among adolescents. However, LGBT youth are at least twice as likely to attempt suicide as their heterosexual counterparts. Contemplating suicide is a precursor of suicide attempts, prior research shows.

Understanding the risk factors for suicidal ideation is "crucial for improving prevention and treatment strategies," the authors write.

The investigators examined suicide risk factors such as depression and feelings of hopelessness in a general adolescent population along with a variety of LGBT-specific risk factors such as gay-specific victimization and gender nonconformity.

The study followed an ethnically diverse cohort of 246 Chicago-area LGBT youth aged 16 to 20 years at baseline for 2.5 years. The study population was not randomized. Participants self-identified their sexual orientation; they were recruited from a variety of sources, including flyers distributed in LGBT-identified neighborhoods and group listservs. Each participant completed a baseline interview, then 4 follow-up interviews were conducted 6 months apart.

Researchers chose to focus on suicidal ideation and self-harm as the main outcome measures, rather than suicide attempts, because different people mean different things by the phrase "suicide attempt," Dr. Mustanski said.

"By focusing specifically on these precursors that we can define much more clearly, it really gives us a much better window into what the risk and protective factors are," he said.

Self-Harm Risk

At baseline, participants were asked whether they had ever attempted suicide. They were also asked about their level of gender nonconformity, impulsivity, and sensation seeking.

During follow-up interviews, participants were asked about suicidal ideation, feelings of hopelessness, self-harm, bullying due to their sexual orientation, and level of support from family and friends.

Hierarchic linear modeling was used to examine between-person differences and within-person changes in suicidal ideation and self-harm over time.

Results showed that a history of attempted suicide (P = .05), impulsivity (P = .01), prospective LGBT victimization (P = .03), and low social support (P = .02) were all associated with an increased risk for suicidal ideation.

Prior suicide attempts (P < .01), sensation seeking (P = .04), female gender (P < .01), childhood gender nonconformity (P < .01), prospective hopelessness (P < .01), and victimization (P < .01) were all associated with greater self-harm.

On average, each experience of LGBT victimization was associated with a 2.5-fold increased risk for self-harm behavior.

"Well Done"

Commenting on the findings for Medscape Medical News, Anthony D’Augelli, PhD, a clinical and community psychologist and professor of human development and family studies at Pennsylvania State University in University Park, Pennsylvania, described the study as "extremely well done."

"There are a few longitudinal studies of this population, but none that have studied the issue of suicidality over time, so it makes it quite distinctive in that sense," said Dr. D'Augelli.

"Being LGBT as a young person is extremely stressful...the need for support is pretty intense," he added.

The other message for mental health professionals, said Dr. D'Augelli, is not to be judgmental and to use gender-neutral language when engaging with LGBT patients.

The authors and Dr. D'Augelli have disclosed no relevant financial relationships.

Am J Prev Med. 2012;42:221-228. Full article

Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to news@medscape.net.

FDA Safety and Adverse Event Reporting
 

Norgestimate and Ethinyl Estradiol Tablets: Recall - Packaging Error, Potential for Incorrect Dosing Regimen

AUDIENCE: OB/GYN, Pharmacy, Patient

ISSUE: Glenmark Generics Inc. issued a nationwide, consumer-level recall of seven (7) lots of Norgestimate and Ethinyl Estradiol Tablets USP (0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg), because of a packaging error where select blisters were rotated 180 degrees within the card, reversing the weekly tablet orientation and making the lot number and expiry date visible only on the outer pouch. As a result of this packaging error, the daily regimen for these oral contraceptives may be incorrect and could leave women without adequate contraception, and at risk for unintended pregnancy.

BACKGROUND: Norgestimate and Ethinyl Estradiol Tablets are used as an oral contraceptive, indicated for the prevention of pregnancy in women. The product was distributed to wholesalers and retail pharmacies nationwide between September 21, 2011 and December 30, 2011.

RECOMMENDATION: Consumers exposed to affected packaging should begin using a non-hormonal form of contraception immediately. Patients who have the affected product should notify their physician and return the product to the pharmacy. See the Press Release for a listing of affected lot numbers, expiration dates, and product photos.

Read the MedWatch safety alert, including a link to the Press Release, at:

http://www.fda.gov/Safety/MedWatch/S.../ucm293385.htm

You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.ht

Which foods are better for the brain?
 

Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. Based primarily on recent Medscape News coverage, the following slideshow collects some of the more prominent investigations on nutrition and the brain into a single resource to aid in counseling your patients.

Make for Malta in Depression, Stroke, and Dementia

A 2009 study published in Archives of General Psychiatry found that people who follow Mediterranean dietary patterns -- that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat (common in olive and other plan oils) -- are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare.[1]The olive oil-inclined also show a lower risk for ischemic stroke[2,3] and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.[4,5]

Fat: The Good and the Bad

A study conducted in Spain[6,7] reported that consumption of both polyunsaturated fatty acids (found in nuts, seeds, fish, and leafy green vegetables) and monounsaturated fatty acids (found in olive oil, avocados, and nuts) decreases the risk for depression over time. However, there were clear dose-response relationships between dietary intake of trans fats and depression risk, whereas other data support an association between trans fats and ischemic stroke risk.[8] Trans fats are found extensively in processed foods.

Fish Oil to Fend Off Psychosis?

Thanks to their high levels of polyunsaturated fatty acids, namely omega-3 fatty acids, fish can help fend off numerous diseases of the brain. A 2010 study correlated fish consumption with a lower risk for psychotic symptoms,[10] and concurrent work suggested that fish oil may help prevent psychosis in high-risk individuals.[11] Although data are conflicting, new research shows that the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid are beneficial in depression and postpartum depression, respectively, and other research suggests that omega-3 deficiency may be a risk factor for suicide.[12-16] Oily, cold-water fish, such as salmon, herring, and mackerel, have the highest omega-3 levels.

Berries for Oxidative Stress

Polyphenols, namely anthocyanins, found in berries and other darkly pigmented fruits and vegetables may slow cognitive decline through antioxidant and anti-inflammatory properties. A study in rats from 2010 showed that a diet high in strawberry, blueberry, or blackberry extract leads to a "reversal of age-related deficits in nerve function and behavior involving learning and memory."[17] In vitro work by the same group found that strawberry, blueberry, and acai berry extracts -- albeit in very high concentrations -- can induce autophagy, a means by which cells clear debris, such as proteins linked to mental decline and memory loss.[18] Berry anthocyanins may also reduce cardiovascular disease risk by reducing oxidative stress and attenuating inflammatory gene expression.

What Not to Eat?

Saturated fats and refined carbohydrates have highly detrimental effects on the immune system, oxidative stress, and neurotrophins, all factors that are known to play a role in depression. The study by Akbaraly and colleagues cited previously[22] showed that a diet rich in high-fat dairy foods and fried, refined, and sugary foods significantly increases risk for depression. Similar findings were seen in another study from Spain,[7] showing that intake of such foods as pizza and hamburgers increased the risk for depression over time, and in another study, women with a diet higher in processed foods were more likely to have clinical major depression or dysthymia.[17] Research published last year[37] also showed for the first time that quality of adolescents' diets was linked to mental health: Healthier diets were associated with reduced mental health symptoms and unhealthy diets with increased mental health symptoms over time. Excess salt intake has been long known to increase blood pressure and stroke risk[38,39]; however, recent data also correlate high salt intake, as well as diets high in trans or saturated fats, with impaired cognition.[40,41]

PLEASE NOTE:

**Studies and references available if interested. Did not list as there are 41 separate citations!

Let's File this under: Gee What a Surprise!
 

From Pharmacotherapy

Comparison of Prescription Drug Costs in the United States and the United Kingdom: Statins

Hershel Jick, M.D.; Andrew Wilson, M.P.H.; Peter Wiggins, M.B.; Douglas P. Chamberlin, B.A.

Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts (Dr. Jick and Mr. Chamberlin); the Tufts Center for the Study of Drug Development, Boston, Massachusetts (Mr. Wilson); and Castlemilk Group Practice, Glasgow, UK (Dr. Wiggins).

Posted: 02/19/2012; Pharmacotherapy. 2012; 32(1):1-6. © 2012 Pharmacotherapy Publications

Abstract

Study Objective To compare the annual cost of statins in the United States and in the United Kingdom.

Design Matched-cohort cost analysis.

Data Sources U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database.

Study Population We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55–64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries.

Measurements and Main Results Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic Lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric Atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%.

Conclusion The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries.

For reprints, visit http://caesar.sheridan.com/reprints/...0089&acro=PHAR. For questions or comments, contact Hershel Jick, M.D., Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: hjick@bu.edu.

Latest research hormones and women
 

New Position Statement from NAMS on Hormone Therapy
Reassuring News for Many Women
JoAnn E. Manson, MD, DrPH

This Dr. JoAnn Manson, Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School. I would like to talk with you today about a new position statement on hormone therapy from the North American Menopause Society (NAMS) that was just published in the journal Menopause.[1] This position statement is freely available on the NAMS Website, and it also is accompanied by a patient education handout that can be downloaded and may be very helpful for patient care. I would like to acknowledge that I served in the writing group for this position statement and also that I am currently serving as president of NAMS.

What is new in this 2012 position statement? First, the statement does reaffirm that hormone therapy is the most effective treatment for vasomotor symptoms and other symptoms of menopause. However, now with a decade of research findings since publication of the first results from the Women's Health Initiative (WHI), it has become clear that there are important distinctions between estrogen plus progestin and estrogen alone in terms of benefits and risks. Furthermore, the benefit/risk profile of hormone therapy can vary by a woman's age, time since menopause and her personal risk-factor profile.

One of the reasons that previous guidelines have recommended avoiding treatment with hormones for more than 5 years is that estrogen plus progestin is linked to an increased risk for breast cancer after 3-5 years. This has been seen in many types of studies. Estrogen therapy alone was associated with no increase in the risk for breast cancer in the WHI Estrogen-Alone Trial, with an average of 7 years of treatment and up to 11 years of follow-up. These findings suggest that there may be more flexibility in terms of the duration of treatment of women with hysterectomy who are taking estrogen alone.

Overall, it is suggested that treatment with hormone therapy should be individualized -- that it will depend on the severity of a woman's symptoms, impairment of quality of life, her personal risk-factor status, and her personal preferences. Women who have early surgical or natural menopause may be treated until the average age of natural menopause, around age 51, in the absence of contraindications, and even longer if necessary for symptoms. This is also highlighted in the position statement.

Evidence has been increasing that different formulations and routes of delivery (for example, transdermal or low-dose estrogen) may have different benefits and risks. Overall, we need much more research on the role of formulation and route of delivery of estrogen, but we have some evidence that the transdermal route of delivery may have some advantages, especially for women who are at increased risk for thrombosis.

The NAMS statement reaffirms that estrogen therapy (ET) represents the most effective treatment for the dryness and dyspareunia caused by genital atrophy. When the only indication for use of HT is genital atrophy, vaginal ET, including 2 marketed creams, the 2-mg estradiol 3-month ring, and 10-µg estradiol slow-release tablets, represent appropriate therapy and can be used safely as long as needed to relieve symptoms.

Vaginal ET is approved to treat genital atrophy only; however, vaginal ET also helps to prevent recurrent urinary tract infections, and the 2-mg estradiol vaginal ring in particular has been noted to benefit women with overactive bladder. Although use of a progestin to protect the endometrium is, in general, not recommended while vaginal ET is used, any bleeding that occurs during use should be evaluated.

http://www.menopause.org/psht12.pdf

http://www.medscape.com/viewarticle/759409

Menopause: The Journal of The North American Menopause Society
Vol. 19, No. 3, pp. 257/271
DOI: 10.1097/gme.0b013e31824b970a
* 2012 by The North American Menopause Society

As if women didnt have enough to worry about r.e. their health....
 

Study Links Cat Litter Box to Increased Suicide Risk

A common parasite that can lurk in the cat litter box may cause undetected brain changes in women that make them more prone to suicide, according to an international study.

Scientists have long known that pregnant women infected with the toxoplasma gondii parasite -- spread through cat feces, undercooked meat or unwashed vegetables -- could risk still birth or brain damage if transmitted to an unborn infant.

But a new study of more than 45,000 women in Denmark shows changes in their own brains after being infected by the common parasite.

The study, authored by University of Maryland School of Medicine psychiatrist and suicide neuroimmunology expert Dr. Teodor T. Postolache, was published online today in the Archives of General Psychiatry.

The study found that women infected with T. gondii were one and a half times more likely to attempt suicide than those who were not infected. As the level of antibodies in the blood rose, so did the suicide risk. The relative risk was even higher for violent suicide attempts.

"We can't say with certainty that T. gondii caused the women to try to kill themselves, but we did find a predictive association between the infection and suicide attempts later in life that warrants additional studies," said Postolache, who is director of the university's Mood and Anxiety Program and is a senior consultant on suicide prevention.

"There is still a lot we don't know," he told ABCNews.com. "We need a larger cohort and need a better understanding of the vulnerabilities that certain people have to the parasite."

Suicide is a global public health problem. An estimated 10 million attempt suicide and 1 million are successful, according to Postlache's work.

More than 60 million men, women, and children in the United States carry the toxoplasma parasite, according to the Centers for Disease Control and Prevention, but very few have symptoms.

Toxoplasmosis is considered one of the "neglected parasitic infections," a group of five parasitic diseases that have been targeted by CDC for public health action.

About one-third of the world is exposed to T. gondii, and most never experience symptoms and therefore don't know they have been infected. When humans ingest the parasite, the organism spreads from the intestine to the muscles and the brain.

Previous research on rodents shows that the parasite can reside in multiple brain structures, including the amygdala and the prefrontal cortex, which are responsible for emotional and behavioral regulation.

Rat Study Showed Parasite Changes the Brain
A 2011 study on rats infected by the parasite showed that their fear of cats disappeared. Instead, the parts of their brains associated with sexual arousal were activated. Researchers theorized that the mind-manipulating T. gondii ensures that the parasite will reach and reproduce in the gut of a cat, which it depends upon for its survival.

"The parasite does actually alter the brain of its host," Stanford University study co-author Patrick House told ABCNews.com last year. "The fact that a parasite can get into an organism, target its brain, stay there without killing the host and alter the circuitry of the brain -- we've seen this is insects and fungi, but it's the first time we've seen it in a mammalian host."

It was this and other research that led Postolache to investigate the relationship between the parasite and biological changes in the brain that might lead to suicide. He was also intrigued by studies on allergies and research that showed a connection between toxoplasmosis and schizophrenia.

"I was interested in the neuron aspects of suicide and intrigued by low-grade activation in patients who attempted suicide, as well as victims," he said. "Other studies had looked at the brain and suicide risk and impulsivity. The next question was, what could be the triggers that perpetuate this level of heightened activation in the brain?"

Postolache collaborated with Danish, German and Swedish researchers, using the Danish Cause of Death Register, which logs the causes of all deaths, including suicide. The Danish National Hospital Register was also a source of medical histories on those subjects.

They analyzed data from women who gave birth between 1992 and 1995 and whose babies were screened for T. gondii antibodies. It takes three months for antibodies to develop in babies, so when they were present, it meant their mothers had been infected.

The scientists then cross-checked the death registry to see if these women later killed themselves. They used psychiatric records to rule out women with histories of mental illness.

Postolache said there were limitations to the study and further research is needed, particularly with a larger subject group.

Dr. J. John Mann, a psychiatrist from Columbia University, said Postolache's research mirrors his work in the field of suicidal behavior.

"The relationship of the brain to the immune system is more complex than it may appear," said Mann. "The brain regulates the stress response system, which impacts the immune response."

Scientists already know that steroids like cortisone can affect the immune response. Some antibodies whose goal is to kill off cancer can also affect the brain. Oftentimes the first symptom of pancreatic cancer is depression, he said.

Research also shows that streptococcus bacteria can trigger obsessive-compulsive disorder (OCD) in some children. Sydenham's chorea, the loss of motor control that can occur after acute rheumatic fever, may also be an immune response affecting the brain, according to Mann.

Maryland researcher Postolache suspects that some individuals have a predisposition to these neurological changes.

He speculates that the parasite may disrupt neurological pathways in those who are vulnerable, so that projections of fear and depression from the amygdala are not tempered or controlled by the "braking" function of the prefrontal cortex.

But, Postolache warns that even if a direct cause were found, no antibiotics for T. gondii yet exist and it could be a decade before effective vaccines or other agents that might stop the neurological damage are developed.

Right now, the most effective weapon against T. gondii is education about handwashing, the proper cooking of food, and not using a knife exposed to raw meat on cooked meat.

He also cautions against trendy food production techniques that let animals roam free. "The risk of infection could go up," he said, "and increase the rate of toxoplasmosis."

http://gma.yahoo.com/study-links-cat...ws-health.html

Anger Attacks Rampant Among U.S. Teens
 

Brian Kearney was an angry teenager.

"There were lots of holes in my bedroom wall," said 21-year-old Kearney, recalling the "superhuman strength" that sent his VCR clear across the room. "I would say I was a little on edge."

For Kearney, who also struggled with an eating disorder in his teens, anger was a way release the pressure of high school.

"I didn't develop appropriate coping mechanisms," Kearney said.

Nearly two-thirds of American teenagers admit to having "anger attacks" that that involve destroying property, threatening or engaging in violence, a new study found. And one in 12 has intermittent explosive disorder, characterized by chronic, uncontrollable fits of rage.

"It's an enormous problem that mental health professionals have not taken seriously," said Ronald Kessler, a psychiatric epidemiologist at Harvard Medical School in Boston and lead author of the study, published Monday in the journal Archives of General Psychiatry. "I think it's clear from this study that needs to change."

"Without a really good reason, people all of a sudden feel very fearful, or very angry, and do something excessive," he said. "It's either fight or flight."

For Kearney, one wrong look could trigger a "vicious" reaction.

"I can't explain how I felt when I was in one of those fits of rage," he said. "It's almost like I would black out."

Kessler said Kearney's situation is too common to ignore.

"One in 12 kids has this problem. And people very often continue to have this problem into adulthood, affecting their education, jobs and marriages," he said. "Not to mention the criminal implications."

Although IED is listed in the American Psychiatric Association's Diagnostic and Statistical Manual, its cause – and how best to treat it – remain unknown.

"It bears studying, because what we currently know remains speculative," said Dr. Bela Sood, chair of child and adolescent psychiatry at VCU Medical Center in Richmond, Va.

Sood said IED can be hard for patients – and their parents – to handle.

"During an episode, a person goes from zero to 60," she said. "Afterward they often feel remorseful, but the deed is done."

Kearney said he would apologize to his parents after an attack but admitted the anger took a heavy toll.

"It definitely affected our relationship," he said. "But in the end I'm closer to them than I ever was."

Kearney, now a junior at Rowan University in Glassboro, N.J., patched up his relationships – and the holes in his wall – and left his troubled teenage years behind. He credits talk therapy for his victory over anger, as well as Xanax that helps quell his anxiety.

"Everything I've gone through has shaped me into the person I am today," he said. "And I think I'm a pretty good person."

http://abcnews.go.com/Health/MindMoo...ry?id=16694231

Journal for Nurse Practitioners
 

References

1. Dean L, Meyer I, Robinson K, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101–151.
2. Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. J Adv Nurs. 2006;55(4):407–415.
3. Institute of Medicine. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academy Press; 1999. http://books.nap.edu/openbook.php?record_id_6109&page_1. Accessed April 3, 2012.
4. Hutchinson M, Thompson A, Cederbaum J. Multisystem factors contributing to disparities in preventive health care among lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(3):393–402.
5. Spinks VS, Andrews J, Boyle J. Providing health care for lesbian clients. J Transcult Nurs. 2000;11(2):137–143.
6. Mravcak S. Primary care for lesbians and bisexual women. Am Fam Physician. 2006;74(2):279–286.
7. O'Hanlan KA, Dibble SL, Hagan HJJ, Davids R. Advocacy for women's health should include lesbian health. J Womens Health (Larchmt). 2004;13(2):227–234.
8. Seaver MR, Freund KM, Wright LM, Tjia J, Frayne SM. Healthcare preferences among lesbians: a focus group analysis. J Womens Health (Larchmt). 2008;17(2):215–225.
9. Dibble SL, Roberts SA, Robertson PA, Paul SM. Risk factors for ovarian cancer: lesbian and heterosexual women. Oncol Nurs Forum. 2002;29(1):E1-E7.
10. The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. 2010. http://www.jointcommission.org/Advan..._Communication. Accessed April 3, 2012.
11. Gay and Lesbian Medical Association. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT) Health. 2001. http://www.nalgap.org/PDF/Resources/...LGBTHealth.pdf.
12. Gay and Lesbian Medical Association. Lesbian, gay, bisexual, and transgender health: overview. Healthy People 2020 Web site. http://healthypeople.gov/2020/topics...spx?topicid_25. Updated November 18, 2011. Accessed November 21, 2011.
13. Bjorkman M, Malterud K. Lesbian women's experience with health care: a qualitative study. Scand J Prim Health Care. 2009;27(4):238–243.
14. Platzer H, James T. Lesbians' experiences of healthcare. Nurs Times Res. 2000;5(3):194–202.
15. Nursing Council of New Zealand. Guidelines for cultural safety, the treaty of Waitangi, and Maori health in nursing education and practice. 2005. Amended and reprinted March 2009. http://www.nursingcouncil.org.nz/dow...l-safety09.pdf. Accessed February 5, 2011.
16. Roberts SJ. Health care recommendations for lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(5):583–591.
17. Boehmer U, Bowen DJ. Examining factors linked to overweight and obesity in women of different sexual orientations. Prev Med. 2009;48(4):357–361.
18. Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health. 2001;91(6):947–952.
19. Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol. 2009;118(3):647–658.
20. Matthews AK, Hughes TL, Johnson T, Razzano LA, Cassiday R. Prediction of depressive distress in a community sample of women: the role of sexual orientation. Am J Public Health. 2002;92(7):1131–1139.
21. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49(2):115–123.
22. Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health. 2010;100(12):2426–2432.
23. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10–51.
24. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79(2):159–170.
25. Blosnich JR, Horn K. Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation. Nicotine Tob Res. 2011;13(12):1284–1295.
26. Centers for Disease Control and Prevention. HIV/AIDS among women who have sex with women. 2006. http://www.cdc.gov/hiv/topics/women/...sheets/wsw.htm. Accessed March 1, 2011.
27. Marrazzo JM, Coffey P, Bingham A. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspect Sex Reprod Health. 2005;37(1):6–12.
28. O'Hanlan KA. Health policy considerations for our sexual minority patients. Obstet Gynecol. 2006;107(3):709–714.
29. Zeidenstein L. Health issues of lesbian and bisexual women. In: Varney's Midwifery. Varney H, Kriebs JM, Gegor CL, eds. 4th ed. Sudbury: Jones and Bartlett Publishers; 2004:299–311.
30. McManus A. Creating an LGBT-friendly practice: practical implications for NPs. Am J Nurse Pract. 2008;12(4):29–38.
31. Anderson T. Nursing profession development: scope and standards of practice (2010). Nebr Nurse. 2011;44(3):8–9.
32. Makadon HJ, Mayer KH, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia: American College of Physicians Press; 2007.

Good journal article from: Journal for Nurse Practitioners
 

Part II

It is difficult to accurately capture the full effect of marginalization, discrimination, and stigmatization on the mental health of an individual or minority group. LGBT persons "are subject to unique social stressors such as prejudice, stigmatization, and antigay violence that may precipitate mental distress, mental disorders, suicidal ideation, and self-harm."[6] Matthews et al[20] studied the role of sexual orientation in predicting depressive distress in a sample of women. Their sample (N 5 829) showed "51% of lesbians and 38% of heterosexual women reported seriously considering suicide at some point in the past."[20] Also, "more than twice as many lesbians as heterosexual women in this age group (15–19) reported suicide attempts."[20]

Although research is limited, LGBT youth may also be at increased risk for suicide attempts compared to their heterosexual counterparts. Marshal et al[21] found that there is a higher rate of suicidality in sexual minority youth compared with heterosexual youth. However, in the study of LGBT youth by Mutanski et al,[22] there were similar rates of suicidality compared with youth of the same geographical areas. They also noted that mental health disorders were higher among the LGBT youth group compared with national data samples but similar when compared with ethnic/minority urban youth samples. Haas et al[23] said, "Over the last 2 decades, an increasing body of empirical research in the US and other countries has pointed to significantly elevated suicide risk among LGBT compared to heterosexual people."

Although there is limited research describing reasons for increased risk in the WSW population, it may be that many mental health issues are associated with the consequences of being a WSW living in a "heterosexual-oriented society."[7] "Heteronormativity denotes how the social life of Western culture is constructed on the assumption that all people are heterosexual, assuming the heterosexual nuclear family
norm to be natural and universal, and thereby making homosexuality socially invisible and second class."[13] It is important to understand that marginality of any kind can be a risk factor for mental health issues. Lehavot and Simoni[24] suggest screening (and referring as needed) for minority stress and the presence/absence of "coping resources" among sexual minority women.

Substance Abuse

Spinks et al[5] said, "Accurate estimates of the prevalence of substance abuse in lesbians are not available due to the marginalization and hidden nature of the population."[5] The rate of alcohol abuse in WSW is unclear and data are conflicting. Dean et al[1] identify that early studies on the gay and lesbian population recruited subjects in bars "which, not surprisingly, showed higher rates of heavy alcohol and drug use than the general population."

Many reports discussed by Roberts[16] indicate that there is more alcohol use in the lesbian community. "Data from the Women's Health Initiative study and other, smaller studies indicate that tobacco use is higher among lesbians than among the general female population."[6] This finding is in contrast with the Dibble study mentioned above. Roberts[16] said, "Reviews have concluded that smoking rates for adolescent and adult lesbians are higher than their national comparison groups, with adolescents being highest for both groups."

Blosnich and Horn[25] examined discrimination/violence and associated smoking among young adults and found that sexual minorities were more likely to experience discrimination and violence and are twice as likely to smoke when compared with heterosexuals in the same age group. It appears that there may be increased substance abuse among WSW in comparison to heterosexual women, but this, too, needs further research. Many factors may put WSW at higher risk for substance abuse or mental health issues, including social stigma, societal pressures, internalized homophobia, the "coming out" process, and discrimination.[5,6,16]

STDs and Reproductive Health/Services

Women who describe themselves as having same sex orientation may identify themselves as lesbian. However, sexual behavior is not the same as sexual orientation, and these should not be confused.[4] Obtaining an accurate sexual history is important to identify risk factors for STDs and safe sex practices. Sex practices of WSW vary widely and the most important thing a provider can do is refrain from making assumptions.

The risk for STD transmission in WSW changes based on sexual practices and the STD organism.[4] Little is known about transmission of STDs between 2 women. "Transmission of some STDs between women is known to occur; for other STDs, transmission between women is possible in theory but has not been proven."[6] Mravcak[6] provides a table in her article showing known transmission of STDs between women to include herpes simplex, genital warts associated with HPV, and trichomoniasis. Included in the table is the description of theoretical STD transmission between WSW: chlamydia, gonorrhea, syphilis, hepatitis B, and HIV.[6] Bacterial vaginosis, while not an STD, is commonly found in the WSW and their female partners[6,16] and is believed to be transmitted between women.[16]

As identified earlier in this article, most WSW have a history of male sexual partners. This fact increases STD risk for these women and their partners. However, Mravcak[6] said, "Lesbians are less likely than bisexual or heterosexual women to be tested regularly for STDs."[6] Many WSW may not believe that they are at risk for acquiring STDs and may even delay treatment when symptoms arise.[4] In addition, NPs may have inaccurate information about the risks of STDs for WSW and assume that they are not engaging in heterosexual intercourse.[4] This assumption may result in the provider choosing to omit needed routine screening for these patients.[4]

NPs need to teach safe sex practices for WSW. Some recommendations given by Mravcak[6] are to avoid contact with any visible genital lesions, cover sex toys that penetrate more than one person's vagina or anus with a new condom for each person, use a barrier during oral sex, and use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding. The Centers for Disease Control and Prevention[26] (CDC) determined, "No barrier methods for use during oral sex have been evaluated as effective by the Food and Drug Administration. However, natural rubber latex sheets, dental dams, condoms that have been cut and spread open, or plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission."

The CDC[26] also suggests the importance of knowing a partner's HIV status since there is a potential for HIV transmission through menstrual blood. For WSW at this time, oral sex does not require barrier methods if performed with a monogamous partner whose HIV status is negative and has no lesions or other risk factors.[26] Jeanne Marrazzo, MD, MPH, is a leader in infectious diseases and STD prevention and epidemiology. She and her colleagues[27] said WSW should be educated about possible STD transmission between women and education should be centered on common sex practices between WSW.

Reproductive health services are important topics to discuss with WSW patients. In the US, approximately 6 to 14 million children have parents who are lesbian or gay.[6] WSW may have children from previous relationships with men or may choose to become pregnant through a sperm bank, known donor, or heterosexual intercourse. Adoption and foster care are also options for WSW in many states. Other than dealing with societal stigma, studies have shown that children of lesbians have comparable development and life skills adjustment to children in heterosexual families.[16] "The American Psychological Association, the American Academy of Pediatricians, and the North American Council on Adoptable Children have each endorsed foster parenting, adoption, and parenting by same-gender couples, with the reassurance that their review of all the research on these children show that they develop normally."[28]

Even so, the process of starting a family can be emotionally, mentally, and financially challenging for WSW because of social stigma, discrimination, legal issues, and isolation. Zeidenstein[29] said the birth mother has unique challenges as she may have to "come out" again after becoming pregnant and once again as a lesbian mother. Zeidenstein[29] also identified that the comother can experience pain when her role as a parent is not recognized by the people in her life. Furthermore, state laws vary greatly. Legal action is required in most states for the nonbiological parent to be granted parental rights.[6] While legal implications are not within the scope of this article, it is important for NPs to encourage WSW to seek assistance from lawyers to ensure their wishes are granted and to ensure the comother has the rights of parenting she deserves. As an NP, referring WSW to agencies that are known to be nondiscriminatory can also be very helpful.[5]

Improving Practice Through Cultural Safety

NPs are responsible for creating a safe and caring atmosphere for each patient. A "safe" environment is defined by the patient. Key factors to a safe and caring context are reflection, environment, language, and knowledge. Context includes all the "in-betweens" of these 4 key factors. Most of context is made up of what is not said with words or language. A truly safe and caring health care context cannot be achieved by omitting any of the 4 elements. For example, a clinician who provides a safe environment but does not use inclusive language is not providing safe care.

Reflection of one's own feelings and possible biases about the WSW population is the first step in establishing a caring and safe patient-provider relationship. Acknowledging these feelings and examining personal biases is a necessary part of providing a safe and caring environment. McManus[30] said, "Awareness of how one's own attitudes affect clinical judgment and the development of a non-homophobic attitude are important steps in providing culturally competent care."[30] Reflection is an ongoing assessment of one's own feelings, reactions, and motivations. It cannot be done once as a single exercise; it is always evolving based on new experiences and interactions. The process of self-reflection is a personal mission of growth and development that requires continual self-evaluation.

Environment is the first factor that a WSW patient will experience. The waiting room can be a significant indicator of the level of acceptance a WSW patient can expect. The presence/absence of a posted nondiscriminatory policy, the art/pictures displayed, and the kinds of reading material available are all examples of environmental factors that a WSW patient will notice immediately. An example of a nondiscriminatory statement is: "This office appreciates the diversity of women [and men] and does not discriminate based on race, age, religion, ability, marital status, sexual orientation, gender, or perceived gender."[7]

The environment will likely affect the WSW patient's openness about her sexuality. "If the environment is perceived as completely unsafe, questioning by the provider will elicit an inaccurate history."[29] Many waiting rooms and clinics have brochures, posters, and educational materials that "reflect heterosexual experience."[29] Including posters or pictures depicting same-sex couples, brochures available that include same-sex experiences, a visible nondiscriminatory policy, and a visible symbol that the WSW population will recognize as a sign of safety are all ways to make an environment more welcoming to them.[4-6,16,30]

McManus[30] gives examples of symbols that health care providers can display to demonstrate a safe environment for the LGBT population:

**pink triangle (symbol of homosexuality in the concentration camps of Nazi Germany)
**A rainbow flag (an icon for the LGBT community since 1978, when it was first used in the San Francisco Gay Pride Parade)
**The Human Rights Campaign's equality symbol (a blue square with a yellow equal sign [5], which is well known to LGBT persons as a sign of acceptance)

Language used by the provider, staff, and in brochures and history/intake forms is also a strong indicator of safety for the WSW patient. Using inclusive, nonjudgmental, and open-ended questions are important to convey caring and safety. This provides a space for each patient to be as open as she chooses to be. A few examples of open-ended and nonjudgmental language include, "Do you have a partner or a spouse?" instead of "Do you have a husband?" or "Are you married?" Also asking, "Do you, or have you had, sexual relations with men, women, both, or none?"[4–6,16,30] This question is more likely to end with an honest response in comparison to simply asking the patient if she is sexually active.[30] "By taking a little time and asking a few sensitive questions, health care providers can create an environment of trust and inclusion."[5]

Knowledge and competency are associated with caring practice.[31] Understanding the health risks for WSW that are different than heterosexual women is valuable and necessary to provide quality care. The ability to refer patients to other providers who are known to be open and nondiscriminatory is helpful[6] and will enable patients to further trust their provider. The availability of information and resources ( Table 1 ) on WSW-specific health considerations is essential when providing care to this population.

Implications for NPS

In a qualitative study by Bjorkman and Malterud[13] on lesbian experiences with health care, 3 essential qualities were described as necessary for the health care provider: awareness, attitudes, and medical knowledge. This study reinforces the importance of personal attributes that play a role in developing a safe and caring patient-provider relationship.

Some suggestions given in the literature for providing a safe and caring health care context for the WSW population include health questionnaires that are inclusive of same-sex relationships or sexual practices, educational materials or brochures that are inclusive of same-sex relationships and sexual practices, open-ended questions from providers, a nonjudgmental approach to questions, images or posters with same-sex couples, and a nondiscriminatory statement.[6,16,30] While it is important to understand the common health disparities found in the WSW population, the population itself is full of unique individuals from every walk of life. Each individual will present a unique set of health issues and needs. Understanding the uniqueness and diversity of each woman allows the opportunity to provide individually tailored health care and best practices for this population.

In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

Good journal article from: Journal for Nurse Practitioners
 

Part I

Creating a Safe and Caring Health Care Context for Women Who Have Sex with Women
Posted: 07/12/2012; Journal for Nurse Practitioners. 2012;8(6):464 © 2012 Elsevier Science, Inc.

The purpose of this article is to introduce the concept of cultural safety as it relates to women who have sex with women and offer nurse practitioners who work with this population an integrated literature review regarding relevant research and recommended practices.

Introduction

Women who have sex with women (WSW) are a population that has long been stigmatized and marginalized within our society. Commonly, WSW are referred to as lesbian or bisexual. However, many WSW do not self-identify this way, so using the term WSW is more inclusive. This article will use WSW and lesbian interchangeably and will mention people of other sexual minorities: lesbian, gay, bisexual, and transgender (LGBT) to be compatible with references and citations.

There has been incremental improvement in the United States toward societal acceptance of the LGBT population, yet there is still stigma associated with living anything other than a heterosexual lifestyle.[1,2] Neville and Henrickson[2] posit that consequences of these attitudes lead to violence, homophobia, and heterosexism that affect the mental and physical health of the LGBT population. "Although homosexuality has been removed from the list of diagnoses in the diagnostic manual of the American Psychiatric Association, the relationship between homosexuality and sickness has proved more enduring in the minds of many providers."[1]

It is difficult to accurately estimate the size of the LGBT or WSW populations because of poor research methods, nonstandardization of terms, and the historical invisibility of the population. Different estimates are given in the literature, all of which are relatively low. The Institute of Medicine[3] (IOM) sentinel report on lesbian health from 1999 lists the estimated percentage at 2%–10% of the population. The range of 1%–10% is reflected in other references.[4–8]

Dibble et al[9] said, "Lesbians are a diverse group of women from every ethnic, religious, economic, cultural, and age group." Some agencies have brought attention to the health disparities and consequent need for culturally safe care, including the Joint Commission,[10] Healthy People 2010 and 2020,[11,12] and the IOM.[3]

Many nurse practitioners (NPs) are educated in the specific health and cultural needs of the WSW population and provide exemplary care for this group. However, although many NPs provide culturally safe care for WSW, there are also accounts of discrimination, abuse, assumptions, voyeurism, lack of knowledge, and substandard care toward the WSW population in health care.[4,5,13,14] Some WSW report that, after coming out to their health care provider, they were treated with physical roughness during their exam.[13] Some women have been denied care after their providers found out about their sexual orientation.[5] According to Bjorkman and Malterud,[13] since many health care providers assume that women are heterosexual, a woman who self-identifies as lesbian has to "choose to actively intervene and inform the professional about her lesbian orientation or passively pass as heterosexual." They also point out that the pressure to disclose sexuality is particularly present during gynecologic exams, when the provider doesn't understand when the patient reports being sexually active but not using contraception and having no possibility of being pregnant.[13]

Much of the literature on WSW identifies gaps in providing culturally safe care for this population. Cultural safety is defined as "the effective nursing practice of a person or family from another culture, and is determined by that person or family."[15] The purpose of this article is to introduce the concept of cultural safety as it relates to WSW and offer NPs who work with this population an integrated literature review regarding relevant research and recommended practice.

Literature Review

The literature review is organized by common health issues found among WSW. The issues discussed are obesity and cardiovascular disease (CVD), cancer and screening, mental health and substance abuse, and sexually transmitted diseases (STDs) and reproductive health.

Obesity and Risk for Cardiovascular Disease

Many sources suggest that WSW may tend to have higher rates of obesity than heterosexual women.[6,9,16] "Lesbians are more likely than heterosexual women to have high body mass index, waist circumference, and waist-to-hip ratio; however, they are also more likely to engage in regular exercise."[6] Boehmer and Bowen[17] also found more obesity in women of sexual minority compared to women with a male partner.

There is conflicting information on the risk of CVD for the WSW population. Roberts[16] said, "Research has found increased risk for CVD in lesbians." On the other hand, Mravcak[6] said, "There is no proven increase in the risk of CVD among lesbians and bisexual women." Risk factors for CVD in the WSW population provided by Roberts include "higher rates of obesity, smoking, alcohol use, and less intake of fruits and vegetables."[16]

Cancer and Screening

Cervical Cancer and Dysplasia. Hutchinson et al[4] said, "All women, regardless of sexual preference, are at risk for cervical cancer." Many providers are under the assumption that WSW do not need regular Papanicolaou (Pap) smears because of perceived low risk of cervical dysplasia and cancer.[6,7] This belief may also be held by many WSW themselves.[16] However, human papillomavirus (HPV), the believed cause for 90% of cervical dysplasia, can be transmitted between women.[5] Cervical neoplasia has been found in WSW with no reported history of male partners.[18] In addition, most WSW do report a history of male sexual partners.[4-7]

There has been evidence that WSW have lower rates of cervical cancer screening than do heterosexual comparison groups.[16] One study of 7,000 lesbians cited by Hutchinson et al[4] reported, "Lesbians had higher rates of abnormal Pap results than rates reported in the general US population." Clearly, best practices suggest that WSW should not be excluded from regular cervical cancer screening. Moreover, NPs may need to educate WSW that they need this screening.

Breast Cancer. Several reasons are identified in the literature why WSW may be at a higher risk to develop breast cancer than heterosexual women. It is believed that WSW do not seek preventive mammograms as often as heterosexual women, citing reasons of mistrust of health care providers, negative past experiences, and perceived homophobia in the health care setting.[4] However, the data suggesting that WSW do not receive screening mammography as much as heterosexual women is not consistent. Mravcak[6] said, "Rates of mammogram screening in lesbians and bisexual women are similar to those in heterosexual women." Also discussed in the literature are lower rates of breast self-exam (BSE) among the lesbian population.[5]

It is commonly believed that many WSW are at a higher risk for developing some cancers as a result of higher rates of nulliparity, smoking, alcohol use, and obesity.[4,16] O'Hanlan et al[7] identify these risks and the use of menopausal hormone replacement therapy as a risk. This information is not well researched and needs further study. As Spinks et al[5] pointed out, "Current research has not accurately identified the incidence of breast cancer in lesbians; however, simply being female places lesbian clients at risk." NPs need to encourage WSW to perform monthly BSE, have regular cancer screening visits with a health care provider, and screening mammograms by following the guidelines for best practices as suggested for all women.

Ovarian Cancer. There is little research available about the occurrence of ovarian cancer in WSW compared to the general population of women. Dibble et al[9] performed a study on risk factors for ovarian cancer for lesbians and heterosexual women. This study of over 1,000 women found, "As expected from previous reports, the lesbians had significantly fewer pregnancies, miscarriages, and abortions and lower use of birth control pills. These variables place lesbians at a higher risk for developing ovarian cancer."[9] "Whether women are at increased risk for ovarian cancer secondary to exposure to HRT [hormone replacement therapy] is not clear. The prevalence of HRT usage among lesbians is unknown."[9] In addition, the authors suggest it would be helpful to include sexual orientation in tumor registry data.[9]

Mental Health

Mravcak[6] said, "Most lesbians and bisexual women are emotionally healthy and well-adjusted." However, mental illness, especially depression, occurs in the WSW population. Depression is the most common mental illness reported in WSW[16] and has shown in some studies to occur in higher rates in WSW than in heterosexual women.[19]

Sexism Everywhere: Gender Differences in Salaries of Physician Researchers
 

By Reshma Jagsi, MD, DPhil; Kent A. Griffith, MS; Abigail Stewart, PhD; Dana Sambuco, MPPA; Rochelle DeCastro, MS; Peter A. Ubel, MD
[+] Author Affiliations

JAMA. 2012;307(22):2410-2417. doi:10.1001/jama.2012.6183
ABSTRACT
Objectives: To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors.

Design and Setting: A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address.

Participants: The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary.

Main Outcome Measures A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research.

Results: The mean salary within our cohort was $167 669 ($158 417-$176 922) for women and $200 433 ( $194 249-$206 617) for men. Male gender was associated with higher salary (+$13 399) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12 194 higher than observed.

Conclusion: Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.

http://jama.jamanetwork.com/article....icleid=1182859

The Relationship Between Marriage and Mental Health
 

July 23, 2012

Robin W. Simon, PhD

Professor of Sociology, Wake Forest University, Winston-Salem, NC

First published in Psychiatry Weekly, Volume 7, Issue 14, July 23, 2012

Introduction
The connection between social relationships and mental health is a fundamental component of both the sociological and psychiatric literatures. Robin W. Simon, PhD, is a sociologist whose work has focused on social relationships—especially marriage—and mental health for 25 years.

Why is Marriage Associated with Mental Health?
“Sociologists have long been interested in the link between social relationships and mental health,” explains Dr. Simon. “Let’s take marriage as an example. At this point, hundreds of studies document a robust relationship between marriage and improved mental health: married people report significantly fewer symptoms of depression and are significantly less likely to abuse substances than their non-married counterparts. This is because marriage provides social support—including emotional, financial, and instrumental support. Also, married people have greater psychosocial (or coping) resources than the non-married—higher self-esteem and greater mastery. Social support and psychosocial resources not only increase emotional well-being but also buffer the negative emotional effects of stressors that people experience during the life course.”

There are, of course, many nuances in this narrative. For instance, poor marital quality can lead to lower levels of well-being among the married than the non-married, because marital conflict is highly stressful. However, although it was believed for decades that men derive greater benefit from marriage than women, Dr. Simon’s 2002 study1 and other sociological research show that the mental health advantage of marriage is evident among both genders. At the same time, it appears that marriage is less beneficial for individuals with a mentally ill than an emotionally healthy spouse.2

The Direction of the Relationship Between Marriage and Mental Health
The psychiatric literature recognizes the protective effects of marriage for mental illness. For example, among adults with schizophrenia, being in a marital or cohabiting relationship is associated with a 5-year delay in experiencing a first episode of psychosis (FEP) and higher quality of life, and is a significant predictor of symptom remission within 1 year of FEP.3,4

There is a debate about whether a person’s depression increases the risk of marital loss through divorce, or whether a marital loss itself (including cases where a spouse dies) is largely responsible for depression onset.

The former scenario fits into the hypothesis known as social selection, which states—to summarize it roughly—that healthy individuals gravitate toward intimate relationships and are seen as desirable partners. This view assumes that people who marry are more likely to have better mental health, anyway, and that “the healthiest, most robust people select into marriage,” says Dr. Simon. The alternative hypothesis—the perspective that most sociologists embrace—is social causation, which holds that marriage wards off mental illness and improves mental health by virtue of its built-in support system.

In a 2002 study1 Dr. Simon analyzed longitudinal data from a large nationally representative sample to examine, among other things, both the social causation and selection hypotheses of the relationship between marital status and mental health.

“In this study I examined whether a change in marital status between study onset and endpoint caused a change in mental health,” explains Dr. Simon. “I found that people who became divorced and widowed during the study experienced a significant decline in mental health between data points, which supports the social causation hypothesis. But those who divorced also reported more symptoms before the actual divorce. This latter finding could be interpreted as evidence that people who experience mental health problems are more likely to get divorced (in agreement with the social selection hypothesis). I argued, however, that some of these people might have been experiencing marital conflict at study onset, increasing symptoms of depression and alcohol abuse. In terms of marital gain, people who got married during the study reported a significant decrease in symptoms of depression and alcohol abuse, but there was no evidence that mentally robust people are more likely to marry than their less healthy peers.”

In an era where cohabitation and state-sanctioned same-sex marriage are increasingly common, do the mental health benefits of marriage apply exclusively to heterosexual marriages?

Unfortunately, there are no existing national data sets that would allow us to answer this question. Studies addressing this issue are underway, however, and Dr. Simon predicts that there would be no difference in the mental health benefits of marriage between individuals in heterosexual and same-sex marriages. “If anything,” she says, “marriage may be even more protective for people in same-sex marriages, because they fought long and hard for their partnerships to be recognized by the state.” As for cohabitation, Dr. Simon says that studies show that cohabitation, too, is good for mental health, “though not as good as marriage.”

“We still have much to learn about why marriage in particular, and social relationships in general, improve mental health,” concludes Dr. Simon, “but sociological research on this topic is clear; having a deep emotional connection with another person provides individuals with social support and coping resources, a sense of purpose and meaning in life, an important social identity, and feelings of social integration and mattering—which are all important for both the development and maintenance of mental health.”Disclosure: Dr. Simon reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.

References:

1. Simon RW. Revisiting the relationships among gender, marital status, and mental health. AJS. 2002;107:1065-1096.

2. Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord. 2005;7:431-440.

3. Nyer M, Kasckow J, Fellows I, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22:172-179.

4. Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42:595-606.

5. Bulloch AG, Williams JV, Lavorato DH, Patten SB. The relationship between major depression and marital disruption is bidirectional. Depress Anxiety. 2009;26:1172-1177.

Topol on 5 Devices Physicians Need to Know About
Eric J. Topol, MD

I'm Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org. In this series I will detail the driving forces behind what I believe is the biggest shakeup in the history of medicine.

What I'll be doing in these segments is outlining the parts of my book that represent the digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. In this segment, I'd like to play the role of Dr. Gizmodo and show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

Let me just run through some of these. This is 2012, obviously, and this is something that we're going to build upon. You're used to wireless devices that can be used for fitness and health, but these are now breaking the medical sphere. One device you may have already noticed turns your smartphone into an electrocardiogram (ECG). The ECG adaptor comes in the form of a case that fits on the back of a smartphone or in a credit card-size version. Both contain 2 sensors. With the first model, you put the smartphone into the case and then pull up the app -- in this case I'm using the AliveCor app -- and put 2 fingers on each of the sensors to set up a circuit for the heart rhythm. Soon you'll see an ECG. What's great about this is you don't just get a cardiogram, which would be like a lead II equivalent; using the "credit card" version, you get all the V-leads across the chest as well. I have found this to be really helpful. It even helped me diagnose an anterior wall myocardial infarction in a passenger on a flight. It was supposed to be a nonstop flight, but, because of my diagnosis, it wound up stopping along the way. As an aside, after the passenger was taken off the plane to get reperfusion catheter-based therapy at a hospital, the pilots and flight attendants all wanted to have their cardiograms checked.

The second device I will show you is another adaptation of the smartphone, but this one is for measuring blood glucose. Obviously we do that now with finger-sticks, but the whole idea is to get away from finger-sticks. I'm wearing a sensor right now that can be worn on the arm. It also can be worn on the abdomen. What's nice about this is that I can just turn on my phone, and every minute I get an update of my blood glucose right on the opening screen of the phone. It's a really nice tool, because then I can look at the trends over the course of 3, 6, 12, or even 24 hours. It plays a big behavioral modification type of a role, because when you're looking at your phone, as you would be for checking email or surfing the Web, you also are integrating what you eat and your activity with how your glucose responds. This is going to be very helpful for patients -- not only those with diabetes, but also those who are at risk for diabetes, have metabolic syndrome, or are considered to be in the prediabetic state.

The third device I'd like to talk about is another device from the cardiovascular arena that comes in the form of an adhesive patch. It's called the iRhythm, and I tried this out on myself. It's really a neat device, because the results are sent by mail to the patient. You put it on your chest for 2 weeks, and then you mail it back. It's the Netflix equivalent of a cardiovascular exam. The company then sends the patient 2 weeks' worth of heart rhythm detection. I think it's a far better, practical way, as compared to the Holter monitor wireless device. It's not as time-continuous as the ECG or glucose device, but it's in that spectrum.

I want to now explain a fourth device, which I use on my iPad. This device allows physicians the ability to monitor patients in the intensive care unit on their iPads. I use it to monitor patients at the Scripps ICU. You can use it for any ICU that allows for the electronic transmission of data. Right now, I'm monitoring 4 patients simultaneously. You can change the field to monitor up to 8 patients simultaneously. This is a great way to monitor patients in the ICU because you can do it remotely and from anywhere in the world where you have access to the Web. This is just to give you a sense of what this innovative software sensor can do to change the face of medicine.

Finally, I wanted to describe is something that I've become reliant upon, and that's this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven't used a stethoscope for over 2 years to listen to a patient's heart. What's really striking about this is that it's a real stethoscope. "Scope" means look into. "Steth" is the chest. And so now I carry this in my pocket, and it's just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I'm sharing their image on the Vscan while I'm acquiring it and it only takes about a minute. We validated its usefulness in an Annals of Internal Medicine paper, in July 2011,[1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation.

These are just a few of the gadgets that give you a feel for the innovative, transformative, and really radical changes that will be seen going forward in medicine. We'll be back soon with more on The Creative Destruction of Medicine. Until next time, I'm Dr. Eric Topol.

http://www.medscape.com/viewarticle/765017?src=ptalk

www.medscape.com
From Heartwire

Polypill for Primary Prevention: Largest-Yet Reductions in BP, Cholesterol in Small UK Trial

Lisa Nainggolan
July 19, 2012 (London, United Kingdom) — Results of the first trial to look at the effects of a polypill given to people solely on the basis of age for the primary prevention of CVD have shown the largest reductions in blood pressure and cholesterol levels of any polypill study to date [1].

On average, participants--who were aged >50--experienced a 12% reduction in BP and 39% fall in LDL cholesterol during the 12-week study, achieving levels typical of people aged 20, says lead author Dr David S Wald (Wolfson Institute of Preventive Medicine, London, UK), who together with colleagues, report the findings in PLoS One. "The health implications of our results are large. If people took the polypill long term from age 50, an estimated 28% would avoid or delay a heart attack or stroke during their lifetime and gain, on average, 11 years of life free of cardiovascular events," he told heartwire .

If people took the polypill long term from age 50, an estimated 28% would avoid or delay a heart attack or stroke during their lifetime.

Wald says the vision of his group at the Wolfson Institute is that everyone over a certain age, say 50 or 55 years, will take the polypill without necessarily having to see a doctor. They hope to file for UK regulatory approval for this use of their polypill, manufactured by the Indian company Cipla, within a year or so, once two further ongoing trials in India are completed.

The notion of a polypill for CVD prevention has been much debated since it was first proposed by Drs Nicholas Wald (a coauthor of the current study) and Malcolm Law (Wolfson Institute of Preventive Medicine) in 2003. A number of different formulations have been tested, in both primary and secondary prevention populations, and there are a handful of groups working on this concept worldwide. The idea is not without its detractors, however, with some arguing that the approach to give a polypill to all, as suggested by Wald et al, is far too radical. Many others working in the field believe the polypill is best placed as a treatment for secondary prevention, because those people would already be taking the individual components of a polypill. But critics feel that the global polypill approach is altogether misplaced and argue that individual risk assessment and reduction are the cornerstones of preventive cardiology.

Unique Crossover Design Gives the Most Accurate Results to Date

Wald says the polypill used in their study is three-layered and "easy to swallow"; it contains three BP-lowering medications--a calcium channel blocker, amlodipine 2.5 mg; an angiotensin-receptor blocker, losartan 25 mg; and a diuretic, hydrochlorothiazide 12.5 mg--along with the lipid-lowering simvastatin 40 mg.

Inventors Have Patents, Would License Polypill

Wald says there are four main groups working on the polypill worldwide, including his in London. The others are groups led by Dr Salim Yusuf (McMaster University, Hamilton, ON), who are working with another Indian company, Cadila Pharmaceuticals; an Australian consortium led by Dr Anthony Rodgers (George Institute for Global Health, Sydney, Australia), who are developing the red heart pill with a third Indian firm, Dr Reddy's Laboratories; and a Spanish team, led by Dr Valentin Fuster (Mount Sinai Medical Center, New York, NY), who are working with the Spanish company Ferrer Pharmaceuticals.

The inventors of the polypill, Nicholas Wald and Law, have a patent granted in Europe and Canada, and one pending in the US, that covers all formulations currently being tested by other groups, says David Wald.

"So, in terms of approvals and marketing, any other polypill would need to seek a license from us or they would be infringing the patent in those markets," he explains. "But in all other countries, there is freedom to operate, and that was always our intention, that the intellectual property would remain free to developing countries." He told heartwire that he and Nicholas Wald have invested in development of the polypill and would hope to recover that investment, "but our overwhelming motivation is the public health objective."

Wald explains why aspirin was not included in their formulation: "We took a decision to leave aspirin out of a CVD prevention polypill because it is the only component that runs a reasonable chance of serious harm. Of course it's also useful in preventing heart attacks and strokes, but once you have achieved the large BP and cholesterol reductions that we have shown in our trial, the residual benefit you get from aspirin does not justify its risk in CVD prevention."

Aspirin is the only component of a polypill that runs a reasonable chance of serious harm.

In total, 86 participants who were already enrolled in a CVD-prevention program at the Wolfson Institute and had previously been taking the individual components of the polypill were randomized to the polypill or placebo for 12 weeks. They then crossed over and took the other treatment. Mean within-person differences in BP and LDL cholesterol at the end of each 12-week period were determined, and 84 of 86 participants completed the study.

The mean systolic BP reduction was 17.9 mm Hg, diastolic BP fell by 9.8 mm Hg, and LDL was cut by 1.4 mmol/L; these results are almost identical to those predicted when the polypill was first proposed by Wald and Law, say the researchers.

Although the trial was too short to assess the impact on CV events, sustained reductions in BP and cholesterol of this magnitude would reduce ischemic heart disease events by 72% and stroke by 64%, they estimate.

The fact that this is the only crossover trial of a polypill is an important design issue, says Wald, "because it has allowed us to produce highly accurate estimates of effectiveness, with a relatively small number of participants." Previous trials that used a parallel-group design have shown smaller effects, he notes, with as many as a quarter of participants in such trials not adhering to the allocated treatment. "We believe that our results are the most accurate, direct, observations of the use of a polypill to date," he notes.

We believe that our results are the most accurate, direct, observations of the use of a polypill to date.

However, the trial design also means there are some limitations, he says. First, the high adherence rate observed (98%) is likely a result of those in the trial previously having taken the individual components of the polypill and, as such, this adherence rate cannot be used to estimate compliance in the general population. Second, "the results on tolerability cannot be used to estimate the prevalence of side effects in people who have not previously taken polypill components," he says.

Side effects were more frequent with the polypill than placebo (29% vs 13%, p=0.01), although none were serious enough to cause discontinuation. Myalgia was more common with the polypill compared with placebo (11% vs 1.2%, respectively).

'No-Fuss' Approach Starting to Be Embraced by Medics

"Scientifically, age is the dominant risk factor in predicting whether somebody will or won't have a heart attack or stroke, so it makes sense to use it in the selection of people who are offered the polypill," Wald commented. "Information on a person's BP and cholesterol adds very little extra information and is not worth the cost and complexity."

I do not believe that everybody would choose to take [the polypill], but it's really up to the regulatory agencies to make it clinically available and the medical profession.

The idea that a polypill could be an acceptable treatment offered purely on the basis of age "is one that was initially rejected by the medical community, but now it is starting to be embraced," he notes. "People like the idea of a no-fuss approach to having access to preventive treatment that does not necessarily involve going to your doctor and certainly does not involve being labeled as a patient."

"I do not believe that everybody would choose to take [the polypill], but it's really up to the regulatory agencies to make it generally available, and the medical profession to provide people with the information on its effectiveness and the possibility of its side effects, then let individuals choose for themselves," he concludes.

Nicholas Wald jointly holds European and Canadian patents (EU1272220 priority date April 10, 2000) for a combination pill for CVD prevention (pending in the USA) and, together with David Wald, has an interest in its development. Cipla provided the pills used in their crossover trial free of charge.

References

1. Wald DS, Morris JK, Wald NJ. Randomized polypill crossover trial in people aged 50 and over. PLoS ONE 2012; 7:e41297. Available here.
Heartwire © 2012 Medscape

'Brain-Eating Amoeba' Infections Prompts Warning About Neti Pots
 

Two cases of people in Louisiana who died after contracting "brain-eating amoeba" infections from their own household water systems are prompting health officials to warn about a popular home remedy for treating sinus problems and allergies.

People who use neti pots to irrigate their nasal passages and sinuses should use only water that has been boiled, filtered or distilled, said the researchers at the Centers for Disease Control and Prevention who investigated the unrelated cases, which occurred months apart in 2011 in different parts of Louisiana.

The cases are the first evidence reported in the U.S. of municipal, disinfected tap water used in nasal irrigation causing infections of Naegleria fowleri, as the amoebas are properly called. The infections which pass into the brain from the nose are almost always deadly, with only one report of a survivor ever documented in the U.S., according to the CDC.

Infections have only been known to occur in cases in where water is forced up the nose, Yoder said. There have not been any cases where people contracted the infections by bathing or showering, and "there is certainly not a risk with drinking water," he said.

Pass it on: Neti pot users should use only sterile water, which has been boiled, distilled or filtered, the CDC says.

http://news.yahoo.com/brain-eating-a...111807585.html

I'm not sure if this thread is the best place for this, but I couldn't think of where else would be.

I just found out that the "shingles" vaccine age limit has been lowered from 60 to 50. If you don't know what it is, check into it (zoster virus). If you have ever had chickenpox you carry the virus in your system. It usually only affects people who are over 60 years of age or have some compromise in their immune system.

Even if you do not fit into this group you can get it. I have had it twice, both times in my forties, five years apart and had no other health issues. You don't want to get it. Check with your health care provider to see if it would be a good idea for you.

This change was made in March 2011, I have been told by two different pharmacies since then that the age was still 60. This is incorrect, you can now get it a participating Costco pharmacies (and probably others). Check your insurance, because this one isn't cheap without it. $188.00 Ouch.

Not giving medical advice, just encouraging folks to check into it this vaccine season and learn about it.

I think this is the best place for this tidbit of happy information.

I get my health care at the San Francisco Veterans Administration Medical Center. Today at the VA it was Transgender Awareness Day and there was a half day mini conference (with CME/CEU) on Transgender Health with 3 presentations.It was a great conference and I talked about all of it in the Trans News thread, but I wanted to post this part here for a wider audience....

Marci Bowers, MD is probably the best known surgeon who does Sex Reassignment Surgery was one of the presenters. The best and most interesting thing I heard from her had to do with female genital mutilation/female circumcision. It seems the damage can be repaired and a woman will end up with normal looking and functioning genitalia. Yes it can be fixed with what she called 'a simple surgery'.The clitoris works and they can have vaginal penetration and even deliver a baby. She is the only surgeon (she knows about) in the US that is doing this surgery and she does every one of them pro bono. There are surgeons who Europe who do it and she went to Paris and trained. I was stunned and so were the rest of the audience.

Angelina Jolie underwent a double mastectomy
 

Op Ed piece in NYTimes today, May 14, 2013:

Angelina Jolie's doctors estimated that She had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.

She recently underwent a double mastectomy to try to proactively beat the odds due to having an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting breast CA, on average. Her mom died of breast CA at age 56.


http://www.nytimes.com/2013/05/14/op...ice.html?_r=3&

Dementia rates drop sharply, as predicted

By Gina Kolata

A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend that researchers say is probably occurring across developed countries and that could have major social and economic implications for families and societies.

Another recent study, conducted in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who had reached their 90s a decade earlier. Nearly one-quarter of those assessed in 2010 scored at the highest level, a rate twice that of those tested in 1998. The percentage of subjects severely impaired fell to 17 percent from 22 percent.

The British study, published on Tuesday in The Lancet, and the Danish one, which was released last week, also in The Lancet, soften alarms sounded by advocacy groups and some public health officials who have forecast a rapid rise in the number of people with dementia, as well as in the costs of caring for them. The projections assumed the odds of getting dementia would be unchanged.

Yet experts on aging said the studies also confirmed something they had suspected but had had difficulty proving: that dementia rates would fall and mental acuity improve as the population grew healthier and better educated. The incidence of dementia is lower among those better educated, as well as among those who control their blood pressure and cholesterol, possibly because some dementia is caused by ministrokes and other vascular damage. So as populations controlled cardiovascular risk factors better and had more years of schooling, it made sense that the risk of dementia might decrease. A half-dozen previous studies had hinted that the rate was falling, but they had flaws that led some to doubt the conclusions.

Researchers said the two new studies were the strongest, most credible evidence yet that their hunch had been right. Dallas Anderson, an expert on the epidemiology of dementia at the National Institute on Aging, the principal financer of dementia research in the United States, said the new studies were “rigorous and are strong evidence.” He added that he expected that the same trends were occurring in the United States but that studies were necessary to confirm them.

“It’s terrific news,” said Dr. P. Murali Doraiswamy, an Alzheimer’s researcher at Duke University, who was not involved in the new studies. It means, he said, that the common assumption that every successive generation will have the same risk for dementia does not hold true.

The new studies offer hope amid a cascade of bad news about Alzheimer’s disease and dementia. Major clinical trials of drugs to treat Alzheimer’s have failed. And a recent analysis by the RAND Corporation — based on an assumption that dementia rates would remain steady — concluded that the number of people with dementia would double in the next 30 years as the baby boom generation aged, as would the costs of caring for them. But its lead author, Michael D. Hurd, a principal senior researcher at RAND, said in an interview that his projections of future cases and costs could be off if the falling dementia rates found in Britain held true in the United States.

Dr. Marcel Olde Rikkert of Radboud University Nijmegen Medical Center in the Netherlands, who wrote an editorial to accompany the Danish study, said estimates of the risk of dementia in older people “urgently need a reset.”

But Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association, an advocacy group, was not convinced that the trends were real or that they held for the United States.

The studies assessed dementia, which includes Alzheimer’s disease but also other conditions that can make mental functioning deteriorate. Richard Suzman, the director of the division of behavioral and social research at the National Institute on Aging, said it was not possible to know from the new studies whether Alzheimer’s was becoming more or less prevalent.

The British researchers, led by Dr. Carol Brayne of the Cambridge Institute of Public Health, took advantage of a large study that tested 7,635 randomly selected people, ages 65 and older, for dementia between 1984 and 1994. The subjects lived in Cambridgeshire, Newcastle and Nottingham. Then, between 2008 and 2011, the researchers assessed a similar randomly selected group living in the same areas.

“We had the same population, the same geographic area, the same methods,” Dr. Brayne said. “That was one of the appeals.”

But Dr. Carrillo questioned the data because many subjects had declined to be assessed: the researchers assessed 80 percent of the group it approached in the first round and 56 percent of those approached in the second. Her concern is reasonable, Dr. Brayne said, but the researchers addressed it by analyzing the data to see if the refusals might have skewed the results. They did not.

In the Danish study, Dr. Kaare Christensen of the University of Southern Denmark in Odense and his colleagues compared the physical health and mental functioning of two groups of elderly Danish people. The first consisted of 2,262 people born in 1905 who were assessed at age 93. The second was composed of 1,584 people born in 1915 and assessed at age 95. In addition to examining the subjects for physical strength and robustness, the investigators gave them a standard dementia screening test, the mini-mental exam and a series of cognitive tests.

The investigators asked how many subjects scored high, had scores indicating dementia and were in between. The entire curve was shifted upward among the people born in 1915, they discovered.

Dr. Anderson, of the National Institute on Aging, said the news was good.

“With these two studies, we are beginning to see that more and more of us will have a chance to reach old age cognitively intact, postponing dementia or avoiding it altogether,” he said. “That is a happy prospect.”

This article has been revised to reflect the following correction:

Correction: July 16, 2013

An earlier version of this article misspelled the name of the medical center where Dr. Marcel Olde Rikkert works. It is the Radboud University Nijmegen Medical Center in the Netherlands, not Nigmegen.

Published in the NYTimes.

Jul 15, 8:28 PM EDT

STUDY: LATER RETIREMENT MAY HELP PREVENT DEMENTIA

BY MARILYNN MARCHIONE
AP CHIEF MEDICAL WRITER

BOSTON (AP) -- New research boosts the "use it or lose it" theory about brainpower and staying mentally sharp. People who delay retirement have less risk of developing Alzheimer's disease or other types of dementia, a study of nearly half a million people in France found.

It's by far the largest study to look at this, and researchers say the conclusion makes sense. Working tends to keep people physically active, socially connected and mentally challenged - all things known to help prevent mental decline.

"For each additional year of work, the risk of getting dementia is reduced by 3.2 percent," said Carole Dufouil, a scientist at INSERM, the French government's health research agency.


Read more:
http://hosted.ap.org/dynamic/stories...07-15-20-28-50

Kobi, I tend to agree with you. There was another article posted at the same site that talked about retirees can stay active physically and mentally. Many are doing it through volunteer work, social activism, part-time employment, etc.

Reading many of your posts, I don't think you have to worry about dementia. You still got it. :glasses:

Some casual humor mixed with valid science on orgasms
 

11 Reasons You Should Be Having More Orgasms

The Huffington Post | By Renee Jacques

Posted: 11/05/2013 1:54 pm EST | Updated: 11/05/2013 3:05 pm EST

Orgasm Health Benefits

Clearly, we don't need to convince you to have sex. It's hard-wired into our brains to propagate the species. And anyway, it feels pretty awesome. But here's more good news: Having an orgasm could help improve your health.

One of the main reasons orgasm feels so good is because your brain releases the pleasure hormone oxytocin when you climax. Oxytocin is also called the "love hormone" because of its important role in facilitating social bonding between humans. Most of the following points revolve around the release of oxytocin. Read on to discover eleven ways achieving an orgasm can make your life so much better...

1. Orgasms relieve stress.

In sexologist Beverly Whipple's book, "The Orgasms Answer Guide," she cites a study done by Carol Rinkleib Ellison in 2000, in which Ellison interviewed 2,632 women between the ages of 23 and 90 and found that 39 percent of those who masturbate reported that they do it in order to relax. Whipple says this is all because of oxytocin. When someone orgasms, she explains in her book, "the hormone oxytocin is released from nerve cells in the hypothalamus (a region of the brain) into the bloodstream."

"Orgasm relives tension as oxytocin stimulates feelings of warmth and relaxation," Ellison herself wrote in an informational report compiled by Planned Parenthood.

Additionally, research gathered in a study by scientists at Groningen University in the Netherlands found that when women experience an orgasm, the amygdala, the part of the brain associated with fear and anxiety, shows little to no activity.

2. An orgasm could make your significant other less likely to cheat.

Researchers in Germany decided to conduct an experiment in 2012 testing the power of oxytocin. They believed that high doses of the "love hormone" would cause men to consider going outside of their relationships, so they gave oxycotin to a group of (heterosexual) men and introduced them to a very attractive woman. The subjects were asked to determine when the attractive woman was at an "ideal distance" or an "uncomfortable distance."

Those who took oxycotin and were in monogamous relationships ended up distancing themselves about four to six inches farther than those who took oxytocin and were single. The researchers hypothesized that instead of oxytocin causing coupled men to cheat, it instead compelled them to hold on tighter to the bond they have already formed with their girlfriends.

3. The female orgasm could make men focus better.

There is so much power in the orgasm that an organization in San Francisco, called One Taste, is devoted to the practice of "orgasmic meditation," in which two partners focus on achieving the female orgasm. Recently, actress and former Playmate, Karen Lorre, revealed to HuffPost Live that she has 11 orgasms a day due to One Taste's new meditation practices. Even men have claimed that they receive health benefits by just pleasuring a woman. In a New York Times article on One Taste, a man confessed that "fixing his attention on a tiny spot of a woman's body improves his concentration at work."

4. Orgasms could help with insomnia.

Would you rather take a sleeping pill or have a mind-blowing orgasm to help you catch some Zzs? We think we know the answer. In her book, Whipple cites another study done by Ellison in which she reported that 32 percent of 1,866 U.S. women said they masturbate in order to facilitate falling asleep.

Why? No one knows for sure, though some researchers and sex therapists theorize that the release of other neurochemicals, like endorphins, can have a sedative effect, reported Self.

5. A man's orgasm could (maybe) make a woman less depressed.

A controversial study of college students in relationships at the State University of New York in Albany showed that women who had sex without condoms had fewer signs of depression than women who used condoms or refrained from sex, even when researchers controlled for relationship status and other personal factors.

What does this mean? Semen, resulting from the male orgasm, could be an effective antidepressant for women. That said, unprotected sex is NOT something we'd recommend -- after all, an STD or unplanned pregnancy can surely also contribute to depression, along with other medical and social risks.

The lead psychologist of the study, Gordon Gallup, told New Scientist that he believes the reason semen has the potential to lift a woman's mood is because of the several mood-altering hormones found in it. Gallup said that most of these hormones were found in the women's blood shortly after ejaculation.

6. Orgasms help alleviate pain.

“There is some evidence that orgasms can relieve all kinds of pain -- including pain from arthritis, pain after surgery and even pain during childbirth,” Lisa Stern, a nurse practitioner who works with Planned Parenthood, told Woman's Day. That's thanks to pain-relieving oxytocin and endorphins, reported MSNBC contributor Brian Alexander. Alexander cited research from Beverly Whipple, who found that women's pain tolerance and pain detection increased by 74.6 percent and 106.7 percent respectively, when those women masturbated to orgasm.

7. They could help men get over their colds faster.

A study at a German university studied 11 men who were asked to masturbate until completion. Blood was drawn continuously throughout the process, and it was discovered that sexual arousal and orgasm increased the number of "killer" cells called leukocytes. This means that when men are sick, an orgasm could initiate components of their immune system that could help them get over that bug sooner.

8. Steady orgasms could help you live longer.

In 1997, a group of researchers in Wales decided to look into the relationship between orgasms and mortality. They studied the sexual frequency of 918 men between the ages of 45 and 59. They evaluated those who died from coronary heart disease and discovered that those who had two or more orgasms a week died at a rate half of those who had orgasms less than once a month. The researchers concluded that "sexual activity seems to have a protective effect on men's health."

While women's orgasms have not been studied as extensively, Howard S. Friedman, PhD, and author of "The Longevity Project: Surprising Discoveries for Health and Long Life," decided to look into research conducted on couples. He cited a marital satisfaction study conducted by Stanford psychologist Lewis Terman in 1941, looking at the sex lives of 1,500 Californian couples. Terman recorded the frequency of orgasms these women had. Twenty years later, Friedman and his colleagues studied the death certificates of each of the women in Terman's study. What they discovered was that the women who reported a frequency of orgasm during intercourse tended to live longer than those who reported being less sexually fulfilled.

9. Orgasms will also stimulate your brain.

Orgasms sure get your blood flowing, and that doesn't exclude blood flow to your brain. In August, Rutgers researchers Barry Komisaruk and Nan Wise, asked female subjects to masturbate while lying in a MRI machine that measured blood flow to the brain. When the females orgasmed, it increased blood flow to all parts of the brain while allowing nutrients and oxygenation to all parts of the brain.


10. Orgasms could keep you looking young.

Forget Botox, just have an orgasm. Dr. David Weeks, a British consultant clinical psychologist and former head of old age psychology at the Royal Edinburgh Hospital, spent 10 years quizzing thousands of men and women of differing ages about their sex lives. He discovered that those between the ages of 40 and 50 who reported having sex 50 percent more than other respondents looked younger. While this study does not explicitly state the specifics as to why orgasms could make you look younger, Weeks says this could be because intercourse releases the human growth hormone, which makes skin look more elastic.

11. They just get better as you age.

There's no reason to stop having sex when you get older. In fact, you are more likely to enjoy it even more as you enter old age. A study in The American Journal of Medicine found that sexual satisfaction in women increases with age. Researchers from the University of California studied 806 women living in a planned community home.

The study measured the sexual activity of these women who had a median age of 67 and were all postmenopausal. The findings reported that sexually satisfaction actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always.

So, never stop having orgasms!

http://www.huffingtonpost.com/2013/1...ef=mostpopular

Dog and human brain link revealed, pet dogs took part in the MRI scanning study

Last updated Feb 20, 2014, 4:52 PM PST

By Rebecca Morelle

Science reporter, BBC World Service

Devoted dog owners often claim that their pets understand them. A new study suggests they could be right.

By placing dogs in an MRI scanner, researchers from Hungary found that the canine brain reacts to voices in the same way that the human brain does.

Emotionally charged sounds, such as crying or laughter, also prompted similar responses, perhaps explaining why dogs are attuned to human emotions.

The work is published in the journal Current Biology.

Lead author Attila Andics, from the Hungarian Academy of Science's Eotvos Lorand University in Budapest, said: "We think dogs and humans have a very similar mechanism to process emotional information."

Eleven pet dogs took part in the study; training them took some time.

"We used positive reinforcement strategies - lots of praise," said Dr Andics.

"There were 12 sessions of preparatory training, then seven sessions in the scanner room, then these dogs were able to lie motionless for as long as eight minutes. Once they were trained, they were so happy, I wouldn't have believed it if I didn't see it."


The canine brain reacted to voices in the same way that the human brain does
For comparison, the team looked at the brains of 22 human volunteers in the same MRI scanners.

The scientists played the people and pooches 200 different sounds, ranging from environmental noises, such as car sounds and whistles, to human sounds (but not words) and dog vocalisations.

The researchers found that a similar region - the temporal pole, which is the most anterior part of the temporal lobe - was activated when both the animals and people heard human voices.

"We do know there are voice areas in humans, areas that respond more strongly to human sounds that any other types of sounds," Dr Andics explained.

"The location (of the activity) in the dog brain is very similar to where we found it in the human brain. The fact that we found these areas exist at all in the dog brain at all is a surprise - it is the first time we have seen this in a non-primate."


The team used a variety of techniques to train the dogs
Emotional sounds, such as crying and laughter also had a similar pattern of activity, with an area near the primary auditory cortex lighting up in dogs and humans.

Likewise, emotionally charged dog vocalisations - such as whimpering or angry barking - also caused a similar reaction in all volunteers,

Dr Andics said: "We know very well that dogs are very good at tuning into the feelings of their owners, and we know a good dog owner can detect emotional changes in his dog - but we now begin to understand why this can be."

However, while the dogs responded to the human voice, their reactions were far stronger when it came to canine sounds.

They also seemed less able to distinguish between environmental sounds and vocal noises compared with humans.

About half of the whole auditory cortex lit up in dogs when listening to these noises, compared with 3% of the same area in humans.

Commenting on the research, Prof Sophie Scott, from the Institute of Cognitive Neuroscience at University College London, said: "Finding something like this in a primate brain isn't too surprising - but it is quite something to demonstrate it in dogs.

"Dogs are a very interesting animal to look at - we have selected for a lot of traits in dogs that have made them very amenable to humans. Some studies have show they understand a lot of words and they understand intentionality - pointing."

But she added: "It would be interesting to see the animal's response to words rather than just sounds. When we cry and laugh, they are much more like animal calls and this might be causing this response.

"A step further would be if they had gone in and shown sensitivity to words in the language their owners speech."

Dr Andics said this would be the focus of his next set of experiments.


BBC © 2014

How do we really make decisions?
 

Last updated Feb 23, 2014, 6:28 PM PST

By Toby Macdonald

With every decision you take, every judgement you make, there is a battle in your mind - a battle between intuition and logic.

And the intuitive part of your mind is a lot more powerful than you may think.

Most of us like to think that we are capable of making rational decisions. We may at times rely on our gut instinct, but if necessary we can call on our powers of reason to arrive at a logical decision.

We like to think that our beliefs, judgements and opinions are based on solid reasoning. But we may have to think again.

Prof Daniel Kahneman, from Princeton University, started a revolution in our understanding of the human mind. It's a revolution that led to him winning a Nobel Prize.

His insight into the way our minds work springs from the mistakes that we make. Not random mistakes, but systematic errors that we all make, all the time, without realising.

Prof Kahneman and his late colleague Amos Tversky, who worked at the Hebrew University of Jerusalem and Stanford University, realised that we actually have two systems of thinking. There's the deliberate, logical part of your mind that is capable of analysing a problem and coming up with a rational answer.

This is the part of your mind that you are aware of. It's expert at solving problems, but it is slow, requires a great deal of energy, and is extremely lazy. Even the act of walking is enough to occupy most of your attentive mind.

Daniel Kahneman's insights into the mind spring from the systematic errors we make all the time
If you are asked to solve a tricky problem while walking, you will most likely stop because your attentive mind cannot attend to both tasks at the same time. If you want to test your own ability to pay attention, try the invisible gorilla test devised by Chris Chabris, from Union College, New York, and Daniel Simons from the University of Illinois.

But then there is another system in your mind that is intuitive, fast and automatic. This fast way of thinking is incredibly powerful, but totally hidden. It is so powerful, it is actually responsible for most of the things that you say, do, think and believe.

And yet you have no idea this is happening. This system is your hidden auto-pilot, and it has a mind of its own. It is sometimes known as the stranger within.

Most of the time, our fast, intuitive mind is in control, efficiently taking charge of all the thousands of decisions we make each day. The problem comes when we allow our fast, intuitive system to make decisions that we really should pass over to our slow, logical system. This is where the mistakes creep in.

Our thinking is riddled with systematic mistakes known to psychologists as cognitive biases. And they affect everything we do. They make us spend impulsively, be overly influenced by what other people think. They affect our beliefs, our opinions, and our decisions, and we have no idea it is happening.

It may seem hard to believe, but that's because your logical, slow mind is a master at inventing a cover story. Most of the beliefs or opinions you have come from an automatic response. But then your logical mind invents a reason why you think or believe something.

Dr Laurie Santos studies monkeys to learn how deep seated our biases really are
According to Daniel Kahneman, "if we think that we have reasons for what we believe, that is often a mistake. Our beliefs and our wishes and our hopes are not always anchored in reasons".

Since Kahneman and Tversky first investigated this radical picture of the mind, the list of identified cognitive biases has mushroomed. The "present bias" causes us to pay attention to what is happening now, but not to worry about the future. If I offer you half a box of chocolates in a year's time, or a whole box in a year and a day, you'll probably choose to wait the extra day.

But if I offer you half a box of chocolates right now, or a whole box of chocolates tomorrow, you will most likely take half a box of chocolates now. It's the same difference, but waiting an extra day in a year's time seems insignificant. Waiting a day now seems impossible when faced with the immediate promise of chocolate.

According to Prof Dan Ariely, from Duke University in North Carolina, this is one of the most important biases: "That's the bias that causes things like overeating and smoking and texting and driving and having unprotected sex," he explains.

Confirmation bias is the tendency to look for information that confirms what we already know. It's why we tend to buy a newspaper that agrees with our views. There's the hindsight bias, the halo effect, the spotlight effect, loss aversion and the negativity bias.

This is the bias that means that negative events are far more easily remembered than positive ones. It means that for every argument you have in a relationship, you need to have five positive memories just to maintain an even keel.

We feel the pain of financial loss much more than the pleasure of a gain
The area of our lives where these cognitive biases cause most grief is anything to do with money. It was for his work in this area that Prof Kahneman was awarded the Nobel Prize - not for psychology (no such prize exists) but for economics. His insights led to a whole new branch of economics - behavioural economics.

Kahneman realised that we respond very differently to losses than to gains. We feel the pain of a loss much more than we feel the pleasure of a gain. He even worked out by how much. If you lose £10 today, you will feel the pain of the loss. But if you find some money tomorrow, you will have to find more than £20 to make up for the loss of £10. This is loss aversion, and its cumulative effect can be catastrophic.

One difficulty with the traditional economic view is that it tends to assume that we all make rational decisions. The reality seems to be very different. Behavioural economists are trying to form an economic system based on the reality of how we actually make decisions.

Dan Ariely argues that the implications of ignoring this research are catastrophic: "I'm quite certain if the regulators listened to behavioural economists early on we would have designed a very different financial system, and we wouldn't have had the incredible increase in the housing market and we wouldn't have this financial catastrophe," he says.

These biases affect us all, whether we are choosing a cup of coffee, buying a car, running an investment bank or gathering military intelligence.

Humans aren't the only species that shows loss aversion.

So what are we to do? Dr Laurie Santos, a psychologist at Yale University, has been investigating how deep seated these biases really are. Until we know the evolutionary origins of these two systems of thinking, we won't know if we can change them.

Dr Santos taught a troop of monkeys to use money. It's called monkeynomics, and she wanted to find out whether monkeys would make the same stupid mistakes as humans. She taught the monkeys to use tokens to buy treats, and found that monkeys also show loss aversion - making the same mistakes as humans.

Her conclusion is that these biases are so deep rooted in our evolutionary past, they may be impossible to change.

"What we learn from the monkeys is that if this bias is really that old, if we really have had this strategy for the last 35 million years, simply deciding to overcome it is just not going to work. We need other ways to make ourselves avoid some of these pitfalls," she explained.

We may not be able to change ourselves, but by being aware of our cognitive limitations, we may be able to design the environment around us in a way that allows for our likely mistakes.

Dan Ariely sums it up: "We are limited, we are not perfect, we are irrational in all kinds of ways. But we can build a world that is compatible with this that gets us to make better decisions rather than worse decisions. That's my hope."

HORIZON: How You Really Make Decisions is on Monday 24 February, 9pm, BBC2

BBC © 2014

Three-person baby details announced
 

Last updated Feb 27, 2014, 3:03 AM PST

By James Gallagher

Health and science reporter, BBC News

How the creation of babies using sperm and eggs from three people will be regulated in the UK has been announced.

The draft rules will be reviewed as part of a public consultation and could come into force by the end of 2014.

Doctors say three-person IVF could eliminate debilitating and potentially fatal diseases that are passed from mother to child.

Opponents say it is unethical and could set the UK on a "slippery slope" to designer babies.

Using the parents' sperm and eggs plus an additional egg from a donor woman should prevent mitochondrial disease.

Mitochondria are the tiny, biological "power stations" that provide energy to nearly every cell of the body.

One in every 6,500 babies has severe mitochondrial disease leaving them lacking energy, resulting in muscle weakness, blindness, heart failure and even death.

As mitochondria are passed down from mother to child, using an extra egg from a donor woman could give the child healthy mitochondria.

However, it would also result in babies having DNA from two parents and a tiny amount from the donor as mitochondria have their own DNA.

Scientists have devised two techniques that allow them to take the genetic information from the mother and place it into the egg of a donor with healthy mitochondria.

The Department of Health has already backed the technique and says this consultation is not about whether it should be allowed, but how it is implemented.

The regulatory body, the Human Fertilisation and Embryology Authority, will have to decide in each cases that there is a "significant risk" of disability or serious illness.

It is anticipated that only the most severely affected women - perhaps 10 cases per year - would go ahead.

The regulations suggest treating the donor woman in the same manner as an organ donor.

Any resulting children will not be able to discover the identity of the donor, which is the case with other sperm and egg donors.

Prof Doug Turnbull, who has pioneered research in mitochondrial donation at Newcastle University, said: "I am delighted that the government has published the draft regulations.

"This is very good news for patients with mitochondrial DNA disease and an important step in the prevention of transmission of serious mitochondrial disease."

The chief medical officer for England, Prof Dame Sally Davies, said: "Allowing mitochondrial donation would give women who carry severe mitochondrial disease the opportunity to have children without passing on devastating genetic disorders.

"It would also keep the UK at the forefront of scientific development in this area.

"I want to encourage contributions to this consultation so that we have as many views as possible before introducing our final regulations."

Dr David King, the director of Human Genetics Alert, said this was a decision of "major historical significance" which had not been debated adequately.

"If passed, this will be the first time any government has legalised inheritable human genome modification, something that is banned in all other European countries.

"The techniques have not passed the necessary safety tests so it is unnecessary and premature to rush ahead with legalisation.

"The techniques are unethical according to basic medical ethics, since their only advantage over standard and safe egg donation is that the mother is genetically related to her child.

"This cannot justify the unknown risks to the child or the social consequences of allowing human genome modification."

BBC © 2014

http://www.bbc.com/news/health-26367220

Immune upgrade gives 'HIV shielding'
 

Last updated Mar 6, 2014, 3:55 AM PST

By James Gallagher

Health and science reporter, BBC News

HIV budding out of a T-cell, part of the immune system.

Doctors have used gene therapy to upgrade the immune system of 12 patients with HIV to help shield them from the virus's onslaught.

It raises the prospect of patients no longer needing to take daily medication to control their infection.

The patients' white blood cells were taken out of the body, given HIV resistance and then injected back in.

The small study, published in the New England Journal of Medicine, suggested the technique was safe.

Some people are born with a very rare mutation that protects them from HIV.

It changes the structure of their T-cells, a part of the immune system, so that the virus cannot get inside and multiply.

The first person to recover from HIV, Timothy Ray Brown, had his immune system wiped out during leukaemia treatment and then replaced with a bone marrow transplant from someone with the mutation.

Now researchers at the University of Pennsylvania are adapting patients' own immune systems to give them that same defence.

Millions of T-cells were taken from the blood and grown in the laboratory until the doctors had billions of cells to play with.

The team then edited the DNA inside the T-cells to give them the shielding mutation - known as CCR5-delta-32.

About 10 billion cells were then infused back in, although only around 20% were successfully modified.

When patients were taken off their medication for four weeks, the number of unprotected T-cells still in the body fell dramatically, whereas the modified T-cells seemed to be protected and could still be found in the blood several months later.

Replacement therapy?
The trial was designed to test only the safety and feasibility of the method, not whether it could replace drug treatment in the long term.


Prof Bruce Levine, the director of the Clinical Cell and Vaccine Production Facility at the University of Pennsylvania, told the BBC: "This is a first - gene editing has not to date been used in a human trial [for HIV].

"We've been able to use this technology in HIV and show it is safe and feasible, so it is an evolution in the treatment of HIV from daily antiretroviral therapy."

He says the aim is to develop a therapy that gets people away from expensive daily medication.

"What if we can now take the leap to an upfront treatment that can last for years?"

Such a treatment will be expensive so any benefit will depend on how long people could be freed from drugs and how long that protection would last.

Prof Levine argues this could be several years, which might save money in the long term.

Commenting on the findings, Prof Sharon Lewin from Monash University in Australia, told BBC News: "The idea of modifying a T-cell to make it resistant and showing it is feasible and they survive - that's exciting in itself.

"What most people are aiming for in HIV is a way you take treatment for a short period of time and that keeps the virus under control."

She said drug treatment would not be replaced by this, especially in the early stages of the infection.

But it might lead to people eventually replacing drugs with an immune upgrade, but "it's still a long way off".

Two people in England have developed tuberculosis after contact with a domestic cat, Public Health England has announced.
 

March 27, 2014

The two human cases are linked to nine cases of Mycobacterium bovis infection in cats in Berkshire and Hampshire last year.

Both people were responding to treatment, PHE said.

It said the risk of cat-to-human transmission of M. bovis remained "very low"

Dr Dilys Morgan, Public Health England: These are the first documented cases of cat-to-human transmission...”

M. bovis is the bacterium that causes tuberculosis in cattle, known as bovine TB, and other species.

Transmission of M. bovis from infected animals to humans can occur by breathing in or ingesting bacteria shed by the animal or through contamination of unprotected cuts in the skin while handling infected animals or their carcasses.

Screening tests
The nine cases of M. bovis infection in cats in Berkshire and Hampshire were investigated by PHE and the Animal Health and Veterinary Laboratories Agency (AHVLA) during 2013.

The findings of the investigation are published in the Veterinary Record on Thursday

What is tuberculosis?

Tuberculosis (TB) is an infectious disease caused by a germ which usually affects the lungs.

Symptoms can take several months to appear and include

•Fever and night sweats

•Persistent cough

•Losing weight

•Blood in your phlegm or spit

Almost all forms of TB are treatable and curable, but delays in detection and treatment can be damaging.

TB caused by M. bovis is diagnosed in less than 40 people in the UK each year. The majority of these cases are in people over 65 years old.

Overall, human TB caused by M. bovis accounts for less than 1% of the 9,000 TB cases diagnosed in the UK every year.

Those working closely with livestock and/or regularly drinking unpasteurised (raw) milk have a greater risk of exposure.

Public Health England
Screening was offered to people who had had contact with the infected cats. Following further tests, a total of two cases of active TB were identified.

Molecular analysis showed that M. bovis taken from the infected cats matched the strain of TB found in the human cases, indicating that the bacterium was transmitted from an infected cat.

Two cases of latent TB were also identified, meaning they had been exposed to TB at some point, but they did not have the active disease.

PHE said it was not possible to confirm whether these were caused by M. bovis or something else.

No further cases of TB in cats have been reported in Berkshire or Hampshire since March 2013.

'Uncommon in cats'
Dr Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at PHE, said: "It's important to remember that this was a very unusual cluster of TB in domestic cats.

"M. bovis is still uncommon in cats - it mainly affects livestock animals.

"These are the first documented cases of cat-to-human transmission, and so although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed M. bovis infection should be assessed and receive public health advice."

Out of the nine cats infected, six died and three are currently undergoing treatment.

Prof Noel Smith, head of the bovine TB genotyping group at the AHVLA, said testing of nearby herds had revealed a small number of infected cattle with the same strain of M. bovis as the cats.

However, he said direct contact between the cats and these cattle was unlikely.

"The most likely source of infection is infected wildlife, but cat-to-cat transmission cannot be ruled out."

Cattle herds with confirmed cases of bovine TB in the area have all been placed under movement restrictions to prevent the spread of disease.

http://www.bbc.com/news/health-26766006

Doctors implant lab-grown vagina

Last updated Apr 10, 2014, 5:45 PM PST

By James Gallagher

Health and science reporter, BBC News

Experts said the study, published in the Lancet, was the latest example of the power of regenerative medicine.

In each woman the vagina did not form properly while they were still inside their mother's womb, a condition known as vaginal aplasia.

Current treatments can involve surgically creating a cavity, which is then lined with skin grafts or parts of the intestine.

The scaffold is made of a biodegradable material

Doctors at Wake Forest Baptist Medical Centre in North Carolina used pioneering technology to build vaginas for the four women who were all in their teenage years at the time.

Scans of the pelvic region were used to design a tube-like 3D-scaffold for each patient.

A small tissue biopsy was taken from the poorly developed vulva and grown to create a large batch of cells in the laboratory.

Muscle cells were attached to the outside of the scaffold and vaginal-lining cells to the inside.

The vaginas were carefully grown in a bioreactor until they were suitable to be surgically implanted into the patients.

One of the women with an implanted vagina, who wished to keep her name anonymous, said: "I believe in the beginning when you find out you feel different.

"I mean while you are living the process, you are seeing the possibilities you have and all the changes you'll go through.

"Truly I feel very fortunate because I have a normal life, completely normal."

'An important thing'

All the women reported normal sexual function.

Vaginal aplasia can lead to other abnormalities in the reproductive organs, but in two of the women the vagina was connected to the uterus.

There have been no pregnancies, but for those women it is theoretically possible.

The scaffold is placed in an incubator

Dr Anthony Atala, director of the Institute for Regenerative Medicine at Wake Forest, told the BBC News website: "Really for the first time we've created a whole organ that was never there to start with, it was a challenge."

He said a functioning vagina was a "very important thing" for these women's lives and witnessing the difference it made to them "was very rewarding to see".

This is the first time the results have been reported. However, the first implants took place eight years ago.

'Most important questions'

Meanwhile, researchers at the University of Basel in Switzerland have used similar techniques to reconstruct the noses of patients after skin cancer.

The other side of the scaffold is coated with smooth muscle cells before it is incubated a second time

It could replace the need to take cartilage from the ribs or ears in order to rebuild the damage caused by cutting the cancer away.

Prof Martin Birchall, who has worked on lab-grown windpipes, commented: "These authors have not only successfully treated several patients with a difficult clinical problem, but addressed some of the most important questions facing translation of tissue engineering technologies.

The steps between first-in-human experiences such as those reported here and their use in routine clinical care remain many, including larger trials with long-term follow-up, the development of clinical grade processing, scale-out, and commercialisation."

BBC © 2014

‘Smart pills’ with chips, cameras and robotic parts raise legal, ethical questions
 

REDWOOD CITY, Calif. — Each morning around 6, Mary Ellen Snodgrass swallows a computer chip. It’s embedded in one of her pills and roughly the size of a grain of sand. When it hits her stomach, it transmits a signal to her tablet computer indicating that she has successfully taken her heart and thyroid medications.

“See,” said Snodgrass, checking her online profile page. With a few swipes she brings up an hourly timeline of her day with images of white pills marking the times she ingested a chip. “I can see it go in. The pill just jumped onto the screen.”

Snodgrass — a 91-year-old retired schoolteacher who has been trying out the smart pills at the behest of her son, an employee at the company that makes the technology — is at the forefront of what many predict will be a revolution in medicine powered by miniature chips, sensors, cameras and robots with the ability to access, analyze and manipulate your body from the inside.

As the size and cost of chip technology has fallen dramatically over the past few years, dozens of companies and academic research teams are rushing to make ingestible or implantable chips that will help patients track the condition of their bodies in real time and in a level of detail that they have never seen before.

Several have been approved by the Food and Drug Administration, including a transponder containing a person’s medical history that is injected under the skin, a camera pill that can search the colon for tumors, and the technology, made by Proteus Digital Health, that Snodgrass is using. That system is being used to make sure older people take their pills; it involves navigating a tablet and wearing a patch, which some patients might find challenging.

Scientists are working on more advanced prototypes. Nanosensors, for example, would live in the bloodstream and send messages to smartphones whenever they saw signs of an infection, an impending heart attack or another issue — essentially serving as early-warning beacons for disease. Armies of tiny robots with legs, propellers, cameras and wireless guidance systems are being developed to diagnose diseases, administer drugs in a targeted manner and even perform surgery.

But while the technology may be within reach, the idea of putting little machines into the human body makes some uncomfortable, and there are numerous uncharted scientific, legal and ethical questions that need to be thought through.

What kind of warnings should users receive about the risks of implanting chip technology inside a body, for instance? How will patients be assured that the technology won’t be used to compel them to take medications they don’t really want to take? Could law enforcement obtain data that would reveal which individuals abuse drugs or sell them on the black market? Could what started as a voluntary experiment be turned into a compulsory government identification program that could erode civil liberties?

In 2002, when silicon chips containing their medical records were injected into some Alzheimer’s patients, it was deeply unsettling to privacy advocates. Several states subsequently passed legislation outlawing the forced implantations, and the technology never took off.

Marc Rotenberg, executive director of the Washington-based Electronic Privacy Information Center, said he worries about the coercive use of the chips — whether they are implanted for a few months or permanently, or are swallowed and last in the body only about a day.

“There’s something very troubling about a chip being placed in a person that they can’t remove,” he said.

Proponents of the technology, however, say the devices could save countless lives and billions of dollars in unnecessary medical bills.

Eric Topol is the director of the Scripps Translational Science Institute in La Jolla, Calif., and has written a book about the digital revolution in health care. He said he believes the science is moving so quickly that many of these gadgets will be ready for commercial use within the next five years.

“The way a car works is that it has sensors and it tells you what’s wrong. Why not put the same type of technology in the body? It could warn you weeks or months or even years before something happens,” Topol said.

Refining the technology

The ingestible chip that Snodgrass is using — it was the first smart pill to be approved by the Food and Drug Administration and the European Union, in 2012 and 2010, respectively — is still being tested by a handful of doctors and hospitals, as the company continues to refine its software. Proteus officials say they hope to make it more widely available within the next year.

Britain’s National Health Service has begun using the technology with heart patients to figure out whether it can increase compliance with prescribed medication. Swiss pharmaceutical giant Novartis has said it would seek FDA clearance to use the Proteus chips in the medications it makes for transplant patients to minimize the chance of organ rejection.

In the United States, the focus has been the elderly.

Made entirely of edible ingredients, the one-square-millimeter chip has copper on one side and magnesium on the other, and it is activated when it comes into contact with stomach acids. It’s used in conjunction with a patch, which is shaped like a large Band-Aid and worn on the torso. For five minutes after being swallowed, the chip sends out a unique 16-digit code that is picked up by the patch, which in turn beams the information to a nearby smartphone or tablet — where it can be shared via the Internet with family members, doctors and the company.

The patch contains additional sensors that tracks things such as temperature, heart rate, movement (whether someone is standing, sitting or lying flat) and sleep.

George Savage, a co-founder and chief medical officer of Proteus, said studies show that 50 percent of patients do not take their medications as prescribed and that allowing doctors to see whether patients actually take the drugs — and their reactions to the medicine — could help them figure out better treatments.

“It may be wasteful for an oncologist to see a particular patient every few months. Maybe all they need is a nurse if everything is going well,” Savage said. “Or, maybe if they are not taking their medications, they need a psychologist or social worker instead.”

On a recent weekday, Snodgrass’ son, Doug Webb, a 62-year-old electrical engineer, brought up a Web page with his mother’s name and a slew of charts and numbers. Snodgrass is in good health for her age and pretty good about taking her medications, but she lives alone. Webb worries that she might accidentally skip some doses as she gets older.

“With all the traffic here, I can only make it down to see her once a week, so this is a way for me to check in on her more often,” Webb said.

His mother has been taking the smart pills since December, so Webb knows her schedule well. A few months ago, after Webb’s stepfather was diagnosed with stage 4 colon cancer, Webb could see the effects of that news in his mother’s data: She was sleeping irregularly and sometimes could not get in her daily walk around the golf course near her house because she didn’t want to leave his side. One day, she forgot to take her pills and didn’t realize it until Webb pointed out a gap in her data.

“Sometimes I see very strange numbers and I’ll call her up and say, ‘What’s going on?’ ” he said.

On this day, Webb could see that his mother has taken one set of pills shortly after 6 a.m. and another at 10 a.m. It looked like she had been reading in her chair in the morning as usual and had been pretty active the rest of the day, taking more than 5,000 steps. All in all, he thought, it looked like she had had a good day. But just to make sure, he made it a point to remind himself to call her during his commute home.

http://www.washingtonpost.com/nation...5c0_story.html