But, such a remedy is readily available to everyone. It costs relatively little. It isn’t particularly complicated to follow. And yet, so few of us choose to take it. Certainly, the advice could hardly be described as exciting or (for most of us) fun, but surely it’s not that difficult to follow, is it? So, why are we so reluctant to do what is so obviously good for us?

One train of thought is that while we understand intellectual arguments perfectly well in our heads, our “gut,” which largely drives our behavior, just doesn’t get it. Our gut instinct is great for getting us out of immediate trouble — the fight or flight mechanism. But it is not so good at assessing long-term risk, and modifying behavior accordingly. It is for this reason that we tend to ignore hard data that should clearly direct our behavior in one way, while we react to risks that are intellectually indefensible.

The media is full of stories that terrify us — air crashes, child abductions and knife crime. Yet, the risk of suffering from any of these is, mercifully, actually quite small. If we really examined the data, we would see that, the risk of death from driving 1,150 km (the distance of the average nonstop flight in the US) is about 65 times that from flying the same difference. Still, but we don’t think twice about jumping in the car. On average, 36,000 Americans are killed each year by flu and its related complications. But unless this happens to be “swine flu” or “bird flu,” we don’t take too much notice. And, obesity is thought to be responsible for the deaths of around 100,000 people per year in the States.

Which brings us back to healthy living… The evidence demonstrating the benefit of a health lifestyle is overwhelming. The risk of developing a chronic disease through obesity is much greater than many of the dangers we routinely panic about. We all know what we should do, we know how we should do it, now it is just a matter of persuading our gut to listen to our head.

References

Ford, E., Bergmann, M., Kroger, J., Schienkiewitz, A., Weikert, C., & Boeing, H. (2009). Healthy Living Is the Best Revenge: Findings From the European Prospective Investigation Into Cancer and Nutrition-Potsdam Study Archives of Internal Medicine, 169 (15), 1355-1362 DOI: 10.1001/archinternmed.2009.237

Gardner D. Risk. The science and politics of fear. (London: Virgin Publishing, 2008).

Several studies have found that patients discharged from intensive care units (ICU) at night or on weekends fare worse than those discharged during daytime hours. Many clinicians view off-hours discharges as “premature,” citing an insufficient number of ICU beds as a culprit. Patient care may also be inconsistent during night and weekend hours do to decreased hospital staffing and cross-coverage of physicians. Whether the patients are discharged home, or discharged to a medical ward in the hospital, studies consistently show an increased risk of mortality in patients discharged from ICUs during night and weekend hours.

Discharge day of the week also affects patient outcomes. Friday is the most common day for hospital discharge, but these patients also have an increased risk of death or hospital readmission within 30 days, compared to patients discharged in the middle of the week. Patients may be discharged too soon due to patient and family wishes, or physician and staffing concerns. One study showed that 7.1% of patients discharged on Friday either died or were readmitted to the hospital within 30 days, compared to 5.4% of patients discharged on Wednesday. The risk was independent of patient or hospital variables such as gender, age, length of stay, or procedures performed during the stay. With an increased number of discharges taking place on Friday, patients may not receive adequate discharge instructions from hospital staff or may not be able to take advantage of social services that might be needed until Monday, contributing to poor patient outcomes.

Few studies have examined readmission rates among children. Studies have primarily focused on neonatal admissions as a factor of maternal care and discharge. However, one study found no increased risk of readmission for children discharged from the hospital based on day of discharge. Children discharged on Fridays had no significant risk of morbidity or mortality compared to children discharged in the middle of the week. (The rate of readmission for Friday discharges was 3.6%, versus 3.4% for Wednesday discharges.) This could be due to the fact that children are discharged home with adult caregivers. Children were more likely to be readmitted to the hospital based on patient complexity, disease severity, and previous hospital admissions. Males were less likely to be readmitted than females, as were children who had an operative procedure while admitted to the hospital.

An additional study recently examined the rate of hospital readmission of patients discharged from a hospitalist-based service versus a resident-staffed teaching service. The rate of readmission within 30 days from the resident’s service was significantly higher than from the hospitalist’s service. The length of hospital stay was longer under the hospitalist’s care, and patients were more often discharged home with detailed self-care instructions.

Time and place of hospital interventions may be critical in predicting patient outcomes. While time, day, or location of discharge may not be the only factor in determining patient recovery or prognosis, physicians should be aware of the consequences of hospital discharge when attempting to move patients out of hospital beds. Many hospitals are understaffed and in need of more bed space, but discharging patients before they are stable and without proper after-care instructions is a dangerous practice.

References

Beck CE, Khambalia A, Parkin PC, Raina P, Macarthur C. Day of discharge and hospital readmission rates within 30 days in children: A population-based study. Paediatr Child Health. Sep 2006;11(7):409-412.

Melissa J. Frei-Jones, Joshua J. Field, Michael R. DeBaun (2008). Risk factors for hospital readmission within 30 days: A new quality measure for children with sickle cell disease Pediatric Blood & Cancer DOI: 10.1002/pbc.21854

K LAUPLAND, R SHAHPORI, A KIRKPATRICK, H STELFOX (2008). Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings? Journal of Critical Care, 23 (3), 317-324 DOI: 10.1016/j.jcrc.2007.09.001

Palacio C, Alexandraki I, House J, Mooradian AD. A Comparative Study of Unscheduled Hospital Readmissions in a Resident-staffed Teaching Service and a Hospitalist-Based Service. South Med J. Jan 9 2009.

Tobin AE, Santamaria JD. After-hours discharges from intensive care are associated with increased mortality. Med J Aust. Apr 3 2006;184(7):334-337.

van Walraven C, Bell CM. Risk of death or readmission among people discharged from hospital on Fridays. Cmaj. Jun 25 2002;166(13):1672-1673.

C GOLDFRAD, K ROWAN (2000). Consequences of discharges from intensive care at night The Lancet, 355 (9210), 1138-1142 DOI: 10.1016/S0140-6736(00)02062-6

This Swedish study evaluated more than 9 million Swedes from the population register from 1973 to 2004, and compared it to the public hospital discharge register showing all public psychiatric admissions in Sweden. The population encompassed more than 2 million nuclear families. The researchers assessed the data for the risk of schizophrenia, bipolar disorder, and their comorbidity in biological and adoptive parents and offspring, as well as siblings and half-siblings. Overall, the results indicated that individuals with a first-degree relative with one of these disorders were at an increased risk for developing either disorder.

Full siblings of first-degree relatives with either schizophrenia or bipolar disorder were 9 times more likely than the general population to develop schizophrenia and 8 times more likely to develop bipolar disorder during their lifetime. Half siblings also had an increased risk compared to the general population, but not as high as full siblings. Maternal half siblings were 3.6 times more likely to develop schizophrenia and 4.5 times more likely to develop bipolar disorder compared to the general population. Paternal half siblings had an even lower risk, at 2.7 times higher risk of schizophrenia and 2.4 times higher risk of bipolar disorder.

Interestingly, an increased risk of psychiatric illness exists in children – both adopted and biological – of parents with either bipolar disorder or schizophrenia. This led the researchers to conclude that, while there is a strong genetic component to these illnesses, environment also plays a factor. The portion of schizophrenia that is inherited genetically is 64%, and the portion of bipolar disorder that is inherited genetically is 59%. Approximately 63% of the causes of the cormorbidity of the two disorders is inherited genetically.

This is not the first study to show common causes and genetic links between bipolar disorder and schizophrenia. A large Danish register-based cohort study, similar to the current Swedish study, found similar results. People with first-degree relatives with schizoaffective disorder, schizophrenia, and bipolar disorder showed a significantly increased risk for developing any of the same diseases. A relative with bipolar disorder was the strongest risk factor for developing bipolar disorder, and a minor risk factor for developing schizophrenia, and a relative with schizophrenia was the strongest risk factor for developing schizophrenia, and a minor risk factor for developing bipolar disorder.

Several studies have proven that the same brain abnormalities exist in bipolar disorder and schizophrenia. Specifically, reductions in the white matter of the brain of patients with schizophrenia and bipolar disorder point towards shared mechanisms in the disease causes and pathology. Also, bipolar disorder and schizophrenia share several variations of genetic loci. Each illness also has its own unique genetic variations.

Schizophrenia affects approximately 1% of the adult population in the United States. Its symptoms include distorted thought and hallucinations, delusions, and disorganized speech and thinking, leading significant social dysfunction. Bipolar disorder affects more than 2% of the adult population in the United States and is a mood disorder that includes episodes of extreme elevated mood and depressive episodes or symptoms. Few risk factors other than family history have been identified for either disease.

The results of the current Swedish study is helping to redefine the signs, symptoms, and underlying structure of psychiatric illness. More accurate identification, diagnosis, and treatment begin with more knowledge of the causes and common disease pathways. Other researchers and authors have already challenged the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, as well as the World Health Organization’s International Classification of Disease. The new diagnostic criteria must account for the measurement and review of psychopathology to more effectively monitor current and future treatments.

References

J. Peter H. Burbach, Bert van der Zwaag (2009). Contact in the genetics of autism and schizophrenia Trends in Neurosciences, 32 (2), 69-72 DOI: 10.1016/j.tins.2008.11.002

T. M. Laursen (2005). Family History of Psychiatric Illness as a Risk Factor for Schizoaffective Disorder: A Danish Register-Based Cohort Study Archives of General Psychiatry, 62 (8), 841-848 DOI: 10.1001/archpsyc.62.8.841

Laursen TM, Munk-Olsen T, Nordentoft M, Bo Mortensen P. A comparison of selected risk factors for unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia from a danish population-based cohort. J Clin Psychiatry. Nov 2007;68(11):1673-1681.

P LICHTENSTEIN, B YIP, C BJORK, Y PAWITAN, T CANNON, P SULLIVAN, C HULTMAN (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study The Lancet, 373 (9659), 234-239 DOI: 10.1016/S0140-6736(09)60072-6

A MCINTOSH, S MANIEGA, G LYMER, J MCKIRDY, J HALL, J SUSSMANN, M BASTIN, J CLAYDEN, E JOHNSTONE, S LAWRIE (2008). White Matter Tractography in Bipolar Disorder and Schizophrenia Biological Psychiatry, 64 (12), 1088-1092 DOI: 10.1016/j.biopsych.2008.07.026

Jessika E Sussmann, G Katherine S Lymer, James McKirdy, T William J Moorhead, Susana Muñoz Maniega, Dominic Job, Jeremy Hall, Mark E Bastin, Eve C Johnstone, Stephen M Lawrie, Andrew M McIntosh (2009). White matter abnormalities in bipolar disorder and schizophrenia detected using diffusion tensor magnetic resonance imaging Bipolar Disorders, 11 (1), 11-18 DOI: 10.1111/j.1399-5618.2008.00646.x

There have been very few advances in the drug treatment options available for acute pain in the last decade, and opioids or narcotics, such as morphine, oxycodone, and hydrocodone, and non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, are the mainstays of acute pain management. Now, however, a new option is on the horizon. In November of 2008, the FDA approved a new pain reliever for the management of acute pain. Tapentadol is an immediate-release oral tablet for the treatment of moderate to severe acute pain. It is available in doses of 50 mg, 75 mg, and 100 mg. Studies are currently underway to evaluate a controlled-release formulation of tapentadol.

Tapentadol is unlike most other pain relievers, as it has 2 modes of action: it activates the opioid receptors in the brain, spinal cord, and gastrointestinal tract, and also inhibits the reuptake of norepinephrine in the brain. Tramadol is the other so-called “multimodal analgesic” that functions similarly: it also activates opioid receptors, and inhibits the reuptake of both norepinephrine and serotonin in the brain. This dual mechanism of action leads to fewer gastrointestinal side effects than traditional pain relievers, and offers a decreased likelihood of tolerance to the drug.

Tapentadol, like all opioid-based therapies, has some risk of dependence, abuse, and addiction. It is safe and effective when used and monitored appropriately in patients, but will require monitoring by health care professionals to determine the appropriate dose and length of therapy. Like all opioids, caution is advised when taking tapentadol with alcohol, illicit drugs, and other opioid medications.
FDA approval of tapentadol follows clinical trials involving more than 2000 patients. Many studies have evaluated tapentadol versus traditional pain relievers following orthopedic and dental surgeries. Overall, tapentadol was as effective, or more effective, than current therapies, and patients experienced few side effects. The most common side effects were those expected with opioid-based treatment: nausea, dizziness, vomiting, sleepiness, and headaches.

Tapentadol is manufactured by Johnson & Johnson; a brand name has not been determined. Before tapentadol is available for use, it must be reviewed by the United States Drug Enforcement Agency to determine its classification as a controlled substance.

References

FDA Approves New Drug to Alleviate Moderate to Severe Pain; FDA News, 2008.

Regina Kleinert, Claudia Lange, Achim Steup, Peter Black, Jutta Goldberg, Paul Desjardins (2008). Single Dose Analgesic Efficacy of Tapentadol in Postsurgical Dental Pain: The Results of a Randomized, Double-Blind, Placebo-Controlled Study Anesthesia & Analgesia, 107 (6), 2048-2055 DOI: 10.1213/ane.0b013e31818881ca

Jens-Ulrich Stegmann, Horst Weber, Achim Steup, Akiko Okamoto, David Upmalis, Stephen Daniels (2008). The efficacy and tolerability of multiple-dose tapentadol immediate release for the relief of acute pain following orthopedic (bunionectomy) surgery Current Medical Research and Opinion, 24 (11), 3185-3196 DOI: 10.1185/03007990802448056

A new study published in JAMA reports that treating depression through behavior modification — particularly physical activity — may reduce the incidence of cardiovascular events. The prospective Heart and Soul Study was conducted in San Francisco from 2000 to 2008, and followed more than 1000 outpatients with diagnosed coronary heart disease. Depressive symptoms were assessed using the Patient Health Questionnaire, and 199 patients were determined to show depressive symptoms at baseline.

During the nearly 5 years of follow-up, 341 cardiovascular events occurred across both depressed and non-depressed patients, including heart attack, stroke, transient ischemic attack, hospitalization for heart failure, and death. Depression was associated with a 50% higher risk of cardiovascular events. The annual rate of these events was 10% in the group with depressive symptoms, versus 6.7% in the non-depressed group. After adjusting for severity of cardiovascular disease as well as comorbid conditions, depressive symptoms were associated with a 31% higher rate of cardiovascular events. Physical inactivity was associated with a 44% increased risk of cardiovascular events in people with depressive symptoms, though this association was not significant. The researchers postulate that patients with depressed symptoms are less likely to be compliant with medication regimens, or adhere to diet and exercise guidelines, explaining some of the increased risk.

While the association between physical activity and decreased cardiovascular risk was not statistically significant in this study, researchers theorize that cardiovascular risk could be attenuated by behavioral modification, including exercise. A combination of antidepressant medication and regular exercise may reduce the risk of cardiovascular events in patients with depression. Currently, a follow-up clinical trial is underway to evaluate the effects of antidepressants versus exercise on depression and cardiovascular risk factors.

While this latest study did not reveal significant findings in the relationship between exercise, depression, and cardiovascular disease, many studies show that cardiovascular risk is higher in depressed patients, as well as those with other mental health disorders. However, the appropriate identification and treatment of depression is challenging for health care providers due to the range of presentations and causes of stress. Mental health needs to be treated the same as traditional cardiovascular risk factors like smoking, obesity, and high blood pressure. Treatment through medication, psychotherapy, or behavior modification may have significant benefit in reducing the morbidity and mortality of cardiovascular disease.

References

Arslan A, Uzun M. Does the lower nitric oxide level cause cardiovascular changes in major depressed women? Eur Rev Med Pharmacol Sci. Sep-Oct 2008;12(5):309-313.

J DENOLLET, K MAAS, A KNOTTNERUS, J KEYZER, V POP (2008). Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women Journal of Clinical Epidemiology DOI: 10.1016/j.jclinepi.2008.08.006

H Lester, A Howe (2008). Depression in primary care: three key challenges Postgraduate Medical Journal, 84 (996), 545-548 DOI: 10.1136/pgmj.2008.068387

Sowden GL, Huffman JC. The impact of mental illness on cardiac outcomes: A review for the cardiologist. Int J Cardiol. Nov 10 2008.

M. A. Whooley (2006). Depression and Cardiovascular Disease: Healing the Broken-Hearted JAMA: The Journal of the American Medical Association, 295 (24), 2874-2881 DOI: 10.1001/jama.295.24.2874

M. A. Whooley, P. de Jonge, E. Vittinghoff, C. Otte, R. Moos, R. M. Carney, S. Ali, S. Dowray, B. Na, M. D. Feldman, N. B. Schiller, W. S. Browner (2008). Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease JAMA: The Journal of the American Medical Association, 300 (20), 2379-2388 DOI: 10.1001/jama.2008.711

Recently, an article was published about this topic by a group of researchers from the National Institutes of Health (NIH) and it caught my attention. According to a series of over 40,0000 interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), almost half of college-aged individuals had a psychiatric disorder in the past year. What was very interesting about this survey was that college students had a greater risk of alcohol use disorder compared to non-college students in the same age group.

Does this mean that you’re likely to run into life-long alcohol problems by going to college? Well, not necessarily. Let’s see why. If you read the study that was published in the Archives of General Psychiatry, you’ll find that when the authors adjusted that risk by taking into account factors such as background sociodemographics, the risk for alcohol misuse between the college and non-college groups was roughly the same. However, college students were significantly less likely to have a diagnosis of drug use disorder or nicotine dependence. We all know that college students are surrounded by enormous peer pressure and parties. In fact, fatalities from alcohol intoxication are not too uncommon. Why aren’t college students seeking help if they have alcohol use disorders? Many of them probably fail to recognize the severity of the problem.

So what’s the bottom line? The conclusion of this paper reads:

Psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population.

Most people probably already know this, so what did this paper tell us? We all know that many college students misuse alcohol and drugs. This often leads to life-long dependence problems and other serious mental health disorders. These researchers noted that many college students are not seeking professional help for their mental health problems. Treatment rates for alcohol misuse remain low and this underscores the need for public health initiatives aimed at both college students and their non-college-attending peers. People need to be reminded that no one is immune from the dangers of drugs, tobacco, or alcohol. The social stigmas associated with substance use may prevent people from seeking professional help, so this remains yet another barrier for people.

Alcohol misuse remains a significant public health problem in this country. There is tremendous need for interventions aimed at reducing alcohol abuse, especially in the college-aged population. The authors of this paper note that skills-based interventions, motivational interviewing, and personalized normative feedback are all effective ways to reduce drinking in college students.

Reference

C. Blanco, M. Okuda, C. Wright, D. S. Hasin, B. F. Grant, S.-M. Liu, M. Olfson (2008). Mental Health of College Students and Their Non-College-Attending Peers: Results From the National Epidemiologic Study on Alcohol and Related Conditions Archives of General Psychiatry, 65 (12), 1429-1437 DOI: 10.1001/archpsyc.65.12.1429

In addition to high cholesterol, elevated levels of C-reactive protein (CRP) — a measure of inflammation — are predictive of cardiovascular events. Since statins are known to lower CRP levels, in addition to cholesterol levels, the JUPITER trial evaluated the daily use of rosuvastatin in patients with elevated CRP, but normal to low LDL cholesterol levels. The primary endpoints assessed in the study included heart attack, stroke, heart-related deaths or hospitalizations, the need for artery-opening procedures, unstable angina, and death. The patient population included 17,802 people in the United States and 25 other countries. One-quarter of the patients were black or Hispanic, and 40% were women — a demographic significantly underrepresented in most statin trials. Men in the study were aged 50 or older, and women were aged 60 or older. None had a history of heart disease or diabetes.

The study was a double blind, placebo-controlled trial in which patients were randomly assigned to take a daily placebo or 20 mg rosuvastatin. The study, funded by the AstraZeneca, the manufacturer of Crestor, was supposed to last 5 years, but was stopped after a median length of less than 2 years when an independent review panel found that the patients in the rosuvastatin group were faring significantly better than those in the placebo group.

Overall, rosuvastatin reduced the risk of any cardiovascular event by 44%. The risk of heart attack was reduced by 54%, stroke by 48%, and the need for an artery-opening procedure by 46%. In more absolute terms, there were 136 cardiovascular events each year per 10,000 people taking placebo, and only 77 events for those taking rosuvastatin. Remarkably, every subgroup benefited from rosuvastatin.

The study is astonishing, but not without concern. Most importantly, people taking rosuvastatin had a significantly increased risk of high blood sugar levels and new-onset diabetes. Further, while no significant differences were seen in the adverse event profiles of rosuvastatin versus placebo in JUPITER, it is not known what the long-term effects of some of these statins, which can cause rare, but serious side effects, may be. Lastly, the cost of rosuvastatin is prohibitive. Rosuvastatin is currently only available as a brand-name drug at a cost of approximately $3.45 daily. Several other statins are now available as generic alternatives and are available for less than $1 daily.

Expanding the results of JUPITER to the entire adult population in the United States would call for approximately 4% of them to be treated with daily rosuvastatin. At the current market price, it would cost $9 billion annually, and prevent 30,000 cardiovascular events. More simply, 120 people would need to be treated for 2 years to prevent 1 event.

The JUPITER trial did offer confirmation that CRP levels can be used to predict risk of cardiovascular events, but simply calling for every person with elevated CRP to start drug therapy may not be indicated. Prevention is certainly an important concept in health care today, but prevention should more likely include things like a sensible diet, exercising regularly, and not smoking. Popping pills to mitigate every risk factor would merely increase drug interactions, adverse drug events, and health care costs. Practitioners and patients must balance the benefits of any treatment or prevention practice with its long-term risks and costs.

References

M. A. Hlatky (2008). Expanding the Orbit of Primary Prevention — Moving beyond JUPITER New England Journal of Medicine DOI: 10.1056/NEJMe0808320

P. M Ridker, E. Danielson, F. A.H. Fonseca, J. Genest, A. M. Gotto, J. J.P. Kastelein, W. Koenig, P. Libby, A. J. Lorenzatti, J. G. MacFadyen, B. G. Nordestgaard, J. Shepherd, J. T. Willerson, R. J. Glynn (2008). Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein New England Journal of Medicine DOI: 10.1056/NEJMoa0807646

The easiest method of screening is, of course, self-examination. This is easy and can be performed in the privacy of one’s home. Many reliable medical websites provide information on the step-by-step process of the breast self-examination. A new tool called Cue is being released this month — this is a small device that may be placed in the shower. It is a small disc like instrument that reminds women of the best time in the month for breast exams, and also provides reminders when it is time for a mammogram.

The CDC recommends that women above 40 years of age schedule a mammogram every two years in addition to regular self-exams. A newer method of screening is the breast ultrasound, using the reflective properties of sonic waves to detect lumps and areas of calcification. When used as an adjunct to mammograms, more diagnoses of Cancer can be made. MRI is the most sensitive at detecting such potentially cancerous masses at much earlier stages of the disease. However, a MRI is recommended for women who are at a high risk (due to genetic, familial and environmental factors) of developing cancer. If lumps or masses are detected, a biopsy usually follows to check if the lump is malignant or benign.

Apart from these specific screening tools, a healthy daily lifestyle may also help decrease the risk of cancer. Foods high in beta-carotene and fiber such as carrots, legumes, squash, and whole grains may have anti-oxidant properties, lowering cancer risk. Foods high in saturated fats such as red meats, margarine, whole fat creams and cheeses may increase risk of all forms of cancer. Getting regular exercise and avoiding smoking and excessive alcohol consumption also contributes towards decreasing the risk of cancer.

Talking to friends and family to spread awareness is more important now than ever. Print, internet and broadcast media are doing an excellent job of promoting an understanding of this condition. Little steps can go a long way, and spreading awareness and encouraging everyone to do the same will help early detection and potentially save lives.

Reference

C. K. Kuhl (2005). Mammography, Breast Ultrasound, and Magnetic Resonance Imaging for Surveillance of Women at High Familial Risk for Breast Cancer Journal of Clinical Oncology, 23 (33), 8469-8476 DOI: 10.1200/JCO.2004.00.4960

So why do experts think that cell phones might cause cancer? First, cell phones are instruments that receive and emit radiofrequency (RF) waves. These are low frequency radiations that could potentially penetrate body tissues and cause increase in cellular temperature. Second, traditional cell phone use forces us to hold the instrument in such close proximity to the head; it concentrates the radiation into the brain. It is not known for sure if these radiations cause mutations in DNA or ions in the body fluid. But at the same time, the long-term effects of the radiation on the body have not been studied.

In the 1980’s, there was a tremendous increase in the number of cell phone users. This trend continued over the next decade and into the next millennium. The number of cellular phone subscribers has more than doubled in the last 8 years (from 110 million in 2000 to 255 million in 2008). Cell phones are used so frequently and for such prolonged time periods that it is highly important to conduct studies that throw some light on the cumulative effect of radiation exposure. Another important area to focus on is children’s cell phones and their effects. Since the child’s nervous system is still growing and developing, the cells are more susceptible to changes in structure. This increases their risk of cancer.

Some of the other factors that determine cancer risk are size of the cellular phone, strength of connecting signal, proximity to the ear, and frequency of use. Some people are already genetically predisposed to getting cancer; and it is especially necessary for them to be extra cautious. The vice-president of the American Cancer Society advises using headsets while talking over cell phones, using text messaging and using the speaker phone tool to greatly decrease risk. The general consensus is also that extensive research that needs to be done on the long-term effects.

In today’s wireless world, human beings are islands in a sea of radiation from every possible type of electronic device — from laptop machines to the complex gaming systems and phones that let you do a million things other than just talk! In an environment such as this, do we really have to actually talk over the cell phone to tap into the radiations? Aren’t we already exposed to them radiations just by being outdoors, or near a satellite dish receiver or a digital recorder? We can eat foods that are rich in antioxidants; we can refrain from smoking and drinking. But what can we do about the millions of E-toxins flying around us in the form of lethal radiations?

Reference

Cellular Telephone Use and Cancer Risk. National Cancer Institute Factsheet.

The number of people who suffer from sleep-deprivation are substantial. Data from the National Sleep Foundation’s 2007 Sleep Study shows that 67% of women experience sleep problems more than once a week. And beyond the statistics, it is obvious that sleep-issues plague many. Just take a look at the covers of magazines or check out your local paper; you don’t have to look far to find a story about how to sleep better.

Ironically, medical professionals routinely assert that getting a proper night’s rest is vital, is necessary, to being healthy and feeling good. Adequate, quality sleep is touted to help a number of medical problems from clinical depression to the common cold. And anyone who has worked or works with children knows first-hand how important a good-night’s sleep is for promoting a balanced mood and emotional resilience. Point is, sleep is one of the most important things we can do to keep our bodies and minds healthy. At least that’s what the medical professionals tell us.

This is precisely why it has always amazed me that this same profession has routinely ignored their own advice. The recent BMJ article, Efforts to reduce US trainees’ hours were ineffective, study says, is recent evidence that interns and doctors are still expected to work ridiculously long hours in hospitals.

The consequences of tired doctors on-call are obvious and so to remedy this problem the US Accreditation Council for Graduate Medical Education enforced new limits of no more than 30 consecutive hours for residents whose long shifts were more likely to cause mistakes or patient risks. Interns participating in this particular study kept journals noting the basics such as hours spent working or sleeping. They also noted things such as car crashes or possible risky medical situations such as errors they made.

Unfortunately, the study was unable to prove that a more rational system that allowed interns to get the rest they needed prevented most of the mistakes that lack-of-sleep were previously blamed for! The reason? Interns, regardless of the new limits, were still required to work ridiculously long-hours so the results could not be measured.

Now I know that it takes a lot to make it through medical school and through the rotations that are mandatory before becoming a certified MD. But come on, doctors are not superhuman. They are not immune to the effects, sometimes deadly effects, of sleep-deprivation. The human body requires sleep, as the medical profession is so fond of telling us. Why is it then that those whose business is the human body aren’t allowed to take care of their own?

Reference

J. H. Tanne (2008). Efforts to reduce US trainees’ hours were ineffective, study says BMJ, 337 (aug05 2) DOI: 10.1136/bmj.a1140

While the standard drug treatment options available have a successful record for returning patients to a normal, functioning social and work life, there is little evidence that antidepressants decrease the risk of suicide in severely depressed patients. Evidence suggests that, not only are antidepressants not successful in reducing the risk of suicide, but they may actually increase it. There have been many indications recently that several antidepressants increase the risk of suicide in adolescents, prompting black-box warnings on the drug labeling. Another small study found that patients hospitalized for depressive symptoms, including suicide attempts, were more likely to have been treated with a benzodiazepine or antidepressant prior to the suicide attempt. These patients were also less likely to have received an antipsychotic medication, antiepileptic mood stabilizer, or lithium than patients who did not attempt suicide.

A recent study published in the Journal of Clinical Psychiatry reported that adding the atypical antipsychotic drug risperidone to standard antidepressant drug therapy significantly reduced the risk of suicide. The 8-week, double-blind, placebo-controlled study examined 24 adult patients with a diagnosis of major depressive disorder. The patients received either low-dose risperidone or placebo in addition to their established antidepressant therapy and were evaluated periodically on their depressive symptoms, suicidal ideations, and impulsiveness. The results showed that risperidone significantly reduced the risk of suicide, as well as impulsiveness, compared to placebo. The effects were seen as early as 2 weeks into treatment, and lasted for the length of the study. The patients taking risperidone reported no significant adverse effects. This study included a small sample of patients, and was a short duration, but the results are promising that antipsychotics are effective in treating depression with suicidal ideations.

This is not the first time that antipsychotics have been used for severe and difficult-to-treat mood and anxiety disorders. Atypical antipsychotics — as opposed to typical antipsychotics like Haloperidol — are often used to treat acute manic phases of bipolar disorder, as well as to prevent relapse following successful treatment of mania. Further, small numbers of patients experiencing psychotic depression have been treated successfully with an atypical antipsychotic only. However, these agents tend to be expensive, and can cause metabolic side effects, including weight gain, increased cholesterol, and diabetes mellitus, and are not considered first-line agents.

Larger studies are needed to confirm the effects of antipsychotics on decreasing suicide risk, but the results of the latest work are promising and offer insights into potential treatment strategies for high-risk populations suffering from major depressive disorder.

References

B GAUDIANO, D YOUNG, I CHELMINSKI, M ZIMMERMAN (2008). Depressive symptom profiles and severity patterns in outpatients with psychotic vs nonpsychotic major depression? Comprehensive Psychiatry, 49 (5), 421-429 DOI: 10.1016/j.comppsych.2008.02.007

M RAJA, A AZZONI, A KOUKOPOULOS (2008). Psychopharmacological treatment before suicide attempt among patients admitted to a Psychiatric Intensive Care Unit Journal of Affective Disorders DOI: 10.1016/j.jad.2008.04.024

Reeves H, Batra S, May RS, Zhang R, Dahl DC, Li X (2008). Efficacy of Risperidone Augmentation to Antidepressants in the Management of Suicidality in Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Pilot Study J Clin Psychiatry. e1-e9.

From pneumonia to the shingles to the flu, I wasn’t one to win the perfect attendance awards handed out at the end of the year. In contrast, my best friend M, seldom missed school. When she came down with something, strep throat was the usual culprit, she was whisked off to the doctor, started on a round of antibiotics, and then returned to school later that day or the next at the latest. Even today, when M or her children get sick she follows her usual protocol, a quick visit to the doctor, the appropriate medicine and all is well.

The difference in our getting-well-routines no doubt had something to do with the fact that M’s mother worked outside the home whereas my mother was a stay-at-home mom. Of course, I now understand how difficult it is to take off days, not to mention weeks, at a time to take care of a sick child. My mother had the luxury of letting my body heal itself, when it would comply, because she wasn’t having to use up precious sick days.

Because of my childhood I’ve always hesitated to use medicine. Not always a blessing, this has caused me some problems when medicine has truly been the best course of action for one ailment or another. But besides from my belief that in many cases the body can heal itself is my weariness at the possible negative effects of taking this or that drug. Once again I blame my childhood because I was known for having reactions to numerous drugs: hives, bruises, etc.

So when articles such as, Antibiotics account for 19% of emergency department visits in US for adverse events and Antibiotics may be linked to risk of cancer, are released my anxiety increases dramatically. Whereas many people would shrug off articles like these, I examine the facts trying to make heads or tails of the significance of the findings.

And in these cases, both articles provide good information about antibiotic usage. The first article discusses the fact that about 19% of ER visits are related to adverse events related to antibiotics. Many of these cases, about 80%, have to do with allergic reactions while some are caused by overdoses or errors.

In the second article, researchers have found some evidence that antibiotics may increase the risk of certain types of cancer. The results are far from concrete though and researchers note that:

… the observational design of the study means that they cannot say whether antibiotic use causes cancer or whether other factors, such as infectious agents or behavioral factors, explain the findings.

The most useful information is related to the use of antibiotics for respiratory tract infections. John Bartlett, a specialist in infectious diseases at Johns Hopkins University, Baltimore notes that many respiratory tract infections are not due to bacterial infections and therefore are not going to respond to antibiotics. In those cases of course, using antibiotics would not be the smart choice.

Both studies seem to add fuel to the already current idea that prescribing antibiotics should not be done recklessly. But even though this overriding attitude has been standard for a few years now, many people still think of antibiotics as the answer to their aches and pains. And, like my friend M, there are reasons for this that are far-removed from any medical implications. Allowing your body to heal itself is not necessarily a quick process. And in today’s fast paced world, that is an unpopular notion.

References

R. Dobson (2008). Antibiotics may be linked to risk of cancer BMJ, 337 (aug21 3) DOI: 10.1136/bmj.a1381

B. Roehr (2008). Antibiotics account for 19% of emergency department visits in US for adverse events BMJ, 337 (aug15 2) DOI: 10.1136/bmj.a1324

Children today receive dozens of doses of vaccines to prevent at least 16 illnesses throughout their infancy, childhood, and adolescence. For almost every child, these vaccines are safe and effective, leaving behind no more than a sore arm or leg for a few hours. However, the number of parents refusing vaccines for their children is rising.

Most states allow parents to refuse vaccination for religious reasons, but many health departments allow refusal for vaguely defined philosophical reasons. Most of theses reasons never have to be documented or addressed, and the parents are only required to check a box on a form to allow them to refuse vaccination for their child. Less than 2% of parents refuse vaccinations for their children, according to the CDC, but the incidence varies by location.

Parents choose not to vaccinate their children for many reasons. Many religious objections are legitimate, but often, other reasons are misguided and result from a lack of correct information or an extreme belief in personal freedom. The safety fears are worsening, though all vaccines on the market today have an acceptable safety profile, free of major adverse side effects for the majority of patients. The link between vaccines and autism is highly controversial and has not been proved, but many parents are still fearful. These issues continue to be addressed by the CDC and vaccine manufacturers to guarantee the safest possible vaccination program for all children.

While the rights of parents to choose what is best for their child are important and should be protected, vaccines do not benefit just the child receiving the shot. Herd immunity results from vaccinated individuals protecting unvaccinated individuals. The more vaccinated people that are protected from contagious diseases, the less likely it is that the disease will spread through the population to unvaccinated people. Herd immunity is especially important when considering people who cannot be vaccinated. For instance, very young children who have not yet been vaccinated can have very severe and life-threatening reactions to vaccine-preventable diseases. The elderly may not have received vaccinations that are now routine, and they often have multiple medical conditions that make infectious diseases more serious than in young, healthy people. Immunocompromised individuals, such as those with autoimmune disorders or those undergoing chemotherapy regimens, are not able to receive some vaccines, and the risk of a serious episode of an infectious disease increases with their worsening immune function.

Universal vaccination does not only contribute to disease prevention, but it contributes to the overall health and productivity of society. Quality of life is improved for both children and their caregivers when they avoid episodes of infectious disease. Parents do not miss workdays to care for a sick child. Societies experience improved healthcare delivery and infrastructure from routine vaccination programs.

Many parents, themselves, never experienced the diseases against which today’s vaccines are designed to protect, and some seem more afraid of the vaccine than the disease it prevents. Countless lives have been saved through the development of safe, effective vaccines. Education and communication are vital to parents’ interactions with pediatricians, in order to properly assess each vaccine’s appropriateness for each child and to protect future generations from deadly preventable diseases.

References

Bonanni, P. (2007). Vaccination and risk groups: how can we really protect the weakest? Human Vaccines, 3(5), 217-219.

Calandrillo, S.P. (2004). Vanishing vaccinations: why are so many Americans opting out of vaccinating their children? University of Michigan Journal of Law Reform, 37(2), 353-440.

Ulmer, J.B., Liu, M.A. (2002). SCIENCE AND SOCIETY – VACCINES: Ethical issues for vaccines and immunization. Nature Reviews Immunology, 2(4), 291-296. DOI: 10.1038/nri780

The FDA’s assessment consisted of reviewing 199 placebo-controlled trials evaluating the safety and efficacy of various antiepileptic drugs (also known as anticonvulsants). The following drugs were included in the review: carbamazepine (Carbatrol, Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), tiagabine (Gabitril), topiramate (Topamax), valproate (Depakote, Depakene, Depacon), and zonisamide (Zonegran). Although only these drugs were included in the review, experts suggest that all anticonvulsant drugs carry the same risk. Antiepileptic drugs are not just used to treat epilepsy. They can be used to treat psychiatric disorders, including bipolar disorder, depression, and anxiety, as well as migraines and neuropathic pain.

Overall, the risk of suicide is double for patients receiving an antiepileptic drug, compared to patients receiving a placebo. Approximately 2 patients per 1000 exhibited suicidal thoughts or behaviors when treated with an antiepileptic drug. A total of 4 patients completed suicide among the treatment groups, while no suicides occurred in the placebo groups. The risk for suicidal thoughts and behaviors was higher in patients with epilepsy, versus psychiatric or other conditions, in the FDA’s evaluation.

All of the drugs evaluated in the study appear to have a similar risk of suicidal thoughts and behaviors. The risk was also consistent across all major demographic groups studied. Only patients aged 5 years or older were included in this analysis, with an average age of 42 years. Slightly more than half of the patients were female and more than three-quarters were white. The only subgroup of patients that showed a slightly higher risk of suicidal behavior was non-North American patients, versus patients who resided in North America. 61% of patients evaluated were from North American locations.

The increased risk of suicide was seen as early as one week after starting treatment with an antiepileptic drug, and continued for at least 24 weeks. (Most of the trials included in the review did not extend past 24 weeks, so suicidal thoughts and behaviors after this time cannot be accurately assessed.)

Healthcare professionals are advised to use this information when prescribing antiepileptic drugs for any patients. The risks associated with the drugs should be balanced with the benefit obtained from the treatment.

Patients and families must also be aware of the risks associated with antiepileptic drugs and monitor patients for emerging or worsening depression, anxiety, hostility, or mania. Patients should not stop taking an antiepileptic drug without first discussing it with their healthcare providers.

The FDA is currently working with manufacturers of antiepileptic drugs to require additional safety information and warnings in the each of the drug’s labeling.

Reference

FDA. Statistical Review and Evaluation: Antiepileptic Drugs and Suicidality. 2008.

Women are three times more likely to develop an eating disorder than men. Recent reports indicate that the lifetime prevalence of anorexia is 0.6%, bulimia, 1%, and binge-eating disorders, 2.8%. While most of these cases do occur during adolescence, the face of the eating disorder patient is changing. Women are now experiencing disordered eating and body image issues much later in life — through early adulthood, pregnancy and motherhood, and midlife.

While all eating disorders pose serious mental and physical health risks to the patient, eating disorders throughout pregnancy and motherhood are particularly concerning, since the patterns of disordered eating may also pose health risks to the child. Some women with disordered eating may easily be able to cope with the weight gain and body changes associated with pregnancy, because they are able to put the health of the baby first. Others still may find ways to control their eating and weight gain, risking the health — and possibly life — of their unborn child. Disordered eating during pregnancy may lead to dehydration, cardiac abnormalities, diabetes, depression, and labor complications for the mother. Likewise, the baby may experience slowed development, premature birth, low birth weight, respiratory distress, and feeding difficulties.

Women who are able to maintain healthy eating patterns during pregnancy may still be at risk for disordered eating during the transition into new motherhood. A recent study found that some women with pre-existing eating disorders were “desperate,” according to the survey, to return to their controlled, disordered eating practices. These women chose not to breastfeed their infants, allowing them to return more quickly to restrictive eating and intense exercise routines. Still other women chose to breastfeed for entirely the same reasons; they viewed nursing as a faster way to lose weight and would permit themselves to eat treats that they would not otherwise allow.

Women with a history of eating disorders were also more likely to experience depression in the postpartum period, not just a recurrence of the eating disorder. Postpartum depression, as well as eating disorders, can lead to serious complications for mothers, children, and entire families. Maternal-child bonding is impaired and the child is at risk for insufficient care and feeding.

Even women who did not have symptoms of eating disorders prior to pregnancy may experience eating disorders in the postpartum period. New mothers often experience extremes of stress, emotion, and exhaustion. For many new mothers, this is the first time they have experienced any lack of control over their lives and their bodies and they may find themselves seeking to gain some control through management and manipulation of their eating habits and weight loss. The consequences of disordered eating habits can lead to obvious health problems: malnutrition, dehydration, heart failure, even death. Researchers are now finding that mothers with eating disorders may place their children at increased risk for developing an eating disorder, also.

On the other hand, one study found some women whose eating practices improved after becoming a mother. This was likely due to a decrease in impulsive and self-destructive attitudes seen as women mature and become mothers. However, these same mothers did not have a satisfactory body image, even though they did not exhibit symptoms associated with disordered eating. Still, researchers found that motherhood had an overall positive effect on disordered eating.

The stress of motherhood and the corresponding body changes lead to depressive symptoms for many women, including eating and body image disorders. Add to this the ever-present notion that women should have it all and be it all, and the rail-thin celebrity moms on every television show and magazine cover, and it is no wonder mothers are at risk for unhealthy eating behaviors and attitudes. Health care providers routinely screen for postpartum depression, but providers are critical to the evaluation of disordered eating practices. Unfortunately, there is little research to support standard treatment regimens in pregnant and postpartum women, once diagnosed. The best treatment likely remains a multidisciplinary approach, in which women can be open and honest about their fears, concerns, and anxieties about motherhood and family members and health care providers provide support, encouragement, and education for the new mom.

References

Adair, C.E., Marcoux, G.C., Cram, B.S., Ewashen, C.J., Chafe, J., Cassin, S.E., Pinzon, J., Gusella, J.L., Geller, J., Scattolon, Y., Fergusson, P., Styles, L., Brown, K.E. (2007). Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health and Quality of Life Outcomes, 5(1), 23. DOI: 10.1186/1477-7525-5-23

Astrachan-Fletcher, E., Veldhuis, C., Lively, N., Fowler, C., Marcks, B. (2008). The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. Journal of Women’s Health, 17(2), 227-239. DOI: 10.1089/jwh.2007.0550

Mazzeo, S.E., Slof-Op’t Landt, M.C., Jones, I., Mitchell, K., Kendler, K.S., Neale, M.C., Aggen, S.H., Bulik, C.M. (2006). Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. International Journal of Eating Disorders, 39(3), 202-211. DOI: 10.1002/eat.20243

Stapleton, H., Fielder, A., Kirkham, M. (2008). Breast or bottle? Eating disordered childbearing women and infant-feeding decisions. Maternal & Child Nutrition, 4(2), 106-120. DOI: 10.1111/j.1740-8709.2007.00121.x

von Soest, T., Wichstrøm, L. (2008). The impact of becoming a mother on eating problems. International Journal of Eating Disorders, 41(3), 215-223. DOI: 10.1002/eat.20493