September 24, 2008, 6:56 PM CT

American kids most medicated

American children are approximately three times more likely to be prescribed psychotropic medicine than children in Europe. A new study published recently in BioMed Central's open access journal Child and Adolescent Psychiatry and Mental Health claims that the differences may be accounted for by regulatory practices and cultural beliefs about the role of medicine in emotional and behavioural problems.

Julie Zito led a team of scientists from the USA, Gera number of and the Netherlands who investigated prescription levels in the three countries. She said, "Antidepressant and stimulant prevalence were three or more times greater in the US than in the Netherlands and Gera number of, while antipsychotic prevalence was 1.5 to 2.2 times greater".

The use of antidepressants, like Prozac, and stimulants, like Ritalin, in children has been the subject of a great deal of controversy and this study quantifies the differences in practice between the US and Western Europe. The authors claim that the differences may be partly due to different diagnostic classification systems, "The US trend of increasing bipolar diagnosis in children and adolescents does not reflect European practice". The authors also mention government cost restrictions in Europe, the larger number of child psychiatry experts per capita in the US and the use of two or more different psychotropic drugs in a single year in US children as possible explanations......... Posted by: JoAnn      Read more         Source

September 24, 2008, 6:21 PM CT

Balancing the brain

Neuroresearchers at Children's Hospital Boston have identified the first known "master switch" in brain cells to orchestrate the formation and maintenance of inhibitory synapses, essential for proper brain function. The factor, called Npas4, regulates more than 200 genes that act in various ways to calm down over-excited cells, restoring a balance that is thought to go askew in some neurologic disorders. The findings are reported in the September 24 advance online edition of the journal Nature

Synapses, the connections between brain cells, can be excitatory or inhibitory in nature. At birth, the rapidly developing brain teems with excitatory synapses, which tend to make nerve cells "fire" and stimulate their neighbors. But if the excitation isn't eventually balanced, it can lead to epilepsy, and diseases like autism and schizophrenia have been linked to an imbalance of excitation and inhibition. The creation of inhibitory connections is also necessary to launch critical periods -- windows of rapid learning during early childhood and adolescence, when the brain is very "plastic" and able to rewire itself.

Npas4 is a transcription factor, a switch that activates or represses other genes. The researchers, led by Michael Greenberg, PhD, director of the Neurobiology Program at Children's, demonstrated that the activity of as a number of as 270 genes changes when Npas4 activity is blocked in a cell, and that Npas4 activation is linked to an increased number of inhibitory synapses on the cell's surface......... Posted by: Daniel      Read more         Source

September 22, 2008, 10:38 PM CT

Pollution, everyday allergens, may be sources of laryngitis

Everyday exposure to environmental tobacco smoke, allergens, and air pollution may be the root of chronic cases of laryngitis, says new research presented at the 2008 American Academy of Otolaryngology Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in Chicago, IL.

Laryngitis symptoms include hoarseness of the voice, cough, and chronic clearing of the throat. Scientists and physicians generally attribute laryngitis to a viral infection and overuse of the voice. Other factors, including consistent exposure to second-hand smoke, have also been cited as a trigger.

Scientists have now found through animal models that exposure to different environmental pollutants, including dust mites and everyday air pollution, can cause what they term as "environmental laryngitis".

The findings are significant, given recent reports on diminishing air quality and increased unhealthy levels of ozone and particle pollution, particularly in countries like China, which could lead to more cases of laryngitis and chronic laryngitis......... Posted by: JoAnn      Read more         Source

September 22, 2008, 10:31 PM CT

1-week radiation effective breast cancer treatment

Boston Accelerated partial breast irradiation (APBI) using a type of radiation seed implants called balloon brachytherapy, a newer type of radiation therapy that offers more convenience to early-stage patients with breast cancer by shortening radiation treatment from the standard six to seven weeks of therapy to only one week, is as effective in keeping breast cancer from coming back as the standard external beam radiation therapy, as per a research studypresented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

"Not only does it make radiation therapy much more convenient, it may actually increase the rate of breast conservation, since some women choose mastectomy because they live too far from a radiation center and cannot afford the time and expense of six to seven weeks of living or traveling to the center," Peter Beitsch, M.D., lead author of the study and a surgical oncologist at Medical City Dallas Hospital in Dallas, said. "Also, there are a number of women who for a host of reasons don't receive the necessary postoperative radiation and the shortened course should hopefully allow more women to receive the treatment that they need."

A number of women with breast cancer are able to undergo breast conserving treatment to keep their breast after therapy. Typically, this means they first have surgery to remove the cancer (a lumpectomy) followed by a course of radiation treatment to kill any cancer cells that may remain. The standard radiation treatment therapy takes a few minutes, every day, Monday through Friday, for six to seven weeks......... Posted by: Janet      Read more         Source

September 22, 2008, 10:29 PM CT

Acupuncture reduces side effects of breast cancer treatment

Boston Acupuncture is as effective and longer-lasting in managing the common debilitating side effects of hot flashes, night sweats, and excessive sweating (vasomotor symptoms) linked to breast cancer therapy and has no therapy side effects in comparison to conventional drug treatment, as per a first-of-its-kind study presented September 24, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

Findings also show there were additional benefits to acupuncture therapy for patients with breast cancer, such as an increased sense of well being, more energy, and in some cases, a higher sex drive, that were not experienced in those patients who underwent drug therapy for their hot flashes.

"Our study shows that physicians and patients have an additional treatment for something that affects the majority of breast cancer survivors and actually has benefits, as opposed to more side effects. The effect is more durable than a drug usually used to treat these vasomotor symptoms and, ultimately, is more cost-effective for insurance companies," Eleanor Walker, M.D., lead author of the study and a radiation oncologist at the Henry Ford Hospital Department of Radiation Oncology in Detroit, said.

The reduction in hot flashes lasted longer for those patients with breast cancer after completing their acupuncture therapy, in comparison to patients after stopping their drug treatment plan......... Posted by: Janet      Read more         Source

September 22, 2008, 10:28 PM CT

Radiation plus hormone therapy in prostate cancer

Boston For men with locally advanced prostate cancer the addition of radiation therapy to anti-androgen hormone treatment reduces the risk of dying of prostate cancer by 50 percent in comparison to those who have anti-androgen hormone therapy alone, as per a randomized study presented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

"This randomized trial is the first to show that men with locally advanced prostate cancer will survive substantially longer when radiation is added to their therapy plan," Anders Widmark, M.D., lead author of the study and a professor in radiation oncology at Umea University in Umea, Sweden, said. "I would encourage men with locally advanced prostate cancer to talk to their doctor to see if they would be a good candidate for radiation treatment in addition to hormone therapy".

Locally advanced prostate cancer is cancer that has grown close to the border or outside the prostate gland and into neighboring tissue, but has not spread into the lymph nodes or to other organs. In this study, anti-androgen hormone treatment is used to treat prostate cancer by blocking the stimulating effect of testosterone on the prostate cancer cells, to shrink the prostate cancer and slow down the growth of prostate cancer. External beam radiation treatment (also called radiotherapy) involves a series of daily therapys to acurately deliver radiation to the prostate......... Posted by: Mark      Read more         Source

September 22, 2008, 10:26 PM CT

Women and South Asians with angina

Women and South Asian people with typical pain were more likely than those with atypical pain to receive a diagnosis of angina pectoris and to have increased mortality rates or acute coronary complications, a study by UK scientists found. Despite this, in women and South Asians, both those with typical and atypical pain had lower rates of angiography and coronary interventions compared with men and white people respectively.

In this study of 7784 South Asian and white people in the United Kingdom, it was also observed that more women than men and more South Asians compared with white people reported atypical chest pain and were less likely to receive a diagnosis of angina.

"Women and South Asian people with typical chest pain were at increased risk of adverse coronary outcomes compared with those who presented with atypical pain," state Dr. Justin Zaman of University College London and UK-based colleagues.

Differences in the description of symptoms did not account for the lower rates of intervention. "Further study should examine why South Asians and white women with potentially the same adverse prognosis as men received poorer care," state the researchers.

In a related commentary, Dr. Deborah Diercks from the University of California and coauthor Dr. Chadwick Miller of Wake Forest University ask whether misdiagnoses occur because of the way patients report symptoms or physician misinterpretation or bias. They point out that "patients with atypical chest pain are still at significant risk for cardiac disease.and patients with typical symptoms, regardless of ethnic background or sex, should receive further cardiac evaluation to minimize the impact of cardiac disease"......... Posted by: Daniel      Read more         Source

September 22, 2008, 10:24 PM CT

Statins increase risk of postoperative delirium

The use of statins is linked to a 28% increased risk of postoperative delirium in elderly patients, found University of Toronto professor Dr. Donald Redelmeier and his colleagues in a retrospective cohort analysis involving more than 280 000 patients.

Ontario's Institute for Clinical Evaluative Sciences (ICES) looked at elderly patients who underwent elective surgery in Ontario and who had received 2 or more prescriptions for statins in the year before surgery, including at least one prescription in the 90 days preceding surgery. A number of patients took multiple medications, underwent abdominal, musculoskeletal or urogenital surgery which had a mean duration of about 115 minutes.

Delirium, in addition to causing anxiety in patients and families, contributes to longer hospital stays, a prolonged need for intensive care, and can disrupt and delay care.

They observed that 1 in 14 elderly patients were taking statins before surgery and 1 in 90 experienced delirium. Longer surgeries and age over 70 years increased the risk of delirium.

"Our results suggest that this association was more than a coincidence, especially among patients who received higher doses of statins and had longer duration noncardiac surgeries," state Dr. Redelmeier and his colleagues. "The association between statins and risk of delirium was distinct and was not observed with other lipid-lowering medications, cardiovascular medications or common drugs that reflect underlying chronic diseases but have no major effects on the cardiovascular system"......... Posted by: JoAnn      Read more         Source

September 22, 2008, 10:22 PM CT

Half of trials supporting FDA applications go unpublished

Over half of all supporting trials for FDA-approved drugs remained unpublished 5 years after approval, says new research published in this week's PLoS Medicine The most important trials determining efficacy, and those with statistically significant results and larger sample sizes, are more likely would be published.

Ida Sim and his colleagues from the University of California San Francisco searched the medical literature to determine the publication status of all 909 clinical trials that supported the 90 new drug approval applications approved by the US Food and Drug Administration (FDA) between 1998 and 2000. Eventhough 76% of the pivotal trials (typically large Phase II or III trials designed to provide evidence on the overall risks and benefits of a drug) had been published in medical journalscommonly within 3 years of FDA approvalonly 43% of all of the submitted trials had been published.

The scientists also found evidence of selective reporting of the results from these trials. For example, Sim and his colleagues report that a pivotal trial in which a new drug works better than an old drug is more likely would be published than a trial in which the new drug does no better. This is a form of publication bias that may lead to an inappropriately favorable record in the medical literature of a drug's true risk-benefit profile relative to other standard therapies, and can lead to preferential prescribing of newer and more-expensive therapys, say the authors......... Posted by: Scott      Read more         Source

September 22, 2008, 10:20 PM CT

Physicians may miss opportunities to respond with empathy

In a small study of 20 audiorecorded interactions, physicians seldom responded empathetically to concerns raised by lung cancer patients, as per a report in the September 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Empathy is an important element of effective communication between patients and physicians and is linked to improved patient satisfaction and compliance with recommended therapy," the authors write as background information in the article. "Patients who are more satisfied with the communication in their medical encounters have improved understanding of their condition, with less anxiety and improved mental functioning." However, responding to patients' emotional needs can be challenging for physicians; they may begin medical school with empathy for their patients but gradually learn detachment, perhaps in order to cope with time constraints or sadness.

Diane S. Morse, M.D., of the University of Rochester Medical Center, Rochester, N.Y, and his colleagues conducted an analysis of 20 recorded and transcribed consultations between patients with lung cancer (average age 65, all male) and nine physicians (three oncologists and six thoracic surgeons). Each visit contained an average of 326 statements, and those made by patients were coded into three themes: statements about the impact of lung cancer, statements about diagnosis or therapy and statements about health system issues affecting care......... Posted by: Scott      Read more         Source