Is Bottled Tea Another Junk Drink?

A study revealed that bottled tea contains very low levels of antioxidants and polyphenols compared to brewed tea, a presentation at the 240^th National Meeting of the American Chemical Society revealed. In fact, the researchers found that in order to get the same benefits found in a single cup of brewed tea, in some cases the consumer would have to drink 20 bottles of bottled tea.

Shiming Li, Ph.D. who reported on research carried out by Professor Chi-Tang Ho, explained:

Consumers understand very well the concept of the health benefits from drinking tea or consuming other tea products. However, there is a huge gap between the perception that tea consumption is healthy and the actual amount of the healthful nutrients - polyphenols - found in bottled tea beverages. Our analysis of tea beverages found that the polyphenol content is extremely low.

Bottled tea is not only poor in levels of health-improving ingredients for which tea is famous, but it often contains high quantities of sugar and some other substances - substances the health-conscious consumer may be trying to avoid, Li pointed out.

Li and team measured polyphenol levels in six brands of tea bought from supermarkets. Half of them contained "virtually no antioxidants" while the rest had small quantities of polyphenols which would most likely carry little health benefit, especially when the high sugar content was taken into consideration.

What are polyphenols? A chemical which is known to protect against some health problems, as well as some of the effects of aging. A polyphenol, a type of antioxidant, protect cells and chemicals in our bodies from the damage caused by free radicals. Polyphenols can block the actions of some enzymes that help cancer growth. All brewed tea contain polyphenols. Put simply, polyphenols may protect against cancer, anti-inflammatory conditions and diabetes.

Li said:

Someone would have to drink bottle after bottle of these teas in some cases to receive health benefits," he said. "I was surprised at the low polyphenol content. I didn't expect it to be at such a low level.

The six teas contained:

• 81, 43, 40, 4 and 3 milligrams of polyphenols per 16-ounce bottle
Compared to


• 50 to 150 milligrams found in 1 average cup of home-brewed black or green tea, and costs only a few cents

Tea is the second most widely consumed drink worldwide, after water. Since 1990 tea sales in the USA have increased fourfold to approximately $7 billion per year, mainly as a result of published scientific studies which have revealed the polyphenol/antioxidant content of tea - and their ability to reduce cancer, heart disease and other illness risks.

Although bottled-tea makers do list polyphenol content on their labels, the amounts may not be right because there are no industry or government standards/guidelines for measuring or listing the polyphenolic compounds in a given product.

A regular tea bag may contain up to 175 milligrams of polyphenols, says Li. However, the polyphenol content drops when the bag is immersed into hot water. As manufacturers of bottled-tea change their processes, polyphenol levels may also vary.

Li said:

"Polyphenols are bitter and astringent, but to target as many consumers as they can, manufacturers want to keep the bitterness and astringency at a minimum. The simplest way is to add less tea, which makes the tea polyphenol content low, but tastes smoother and sweeter.

Li used high-performance liquid chromatography (HPLC) to make the first measurements of polyphenols in bottled tea beverages. He hopes this study will encourage similar use of HPLC by bottled-tea makers and others to provide consumers with better nutritional information.

Source: The American Chemical Society

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What Is Testicular Torsion? What Causes Testicular Torsion?

Testicular torsion occurs when a testicle rotates on the spermatic cord, which provides blood flow to the testicle. As a result, the flow of blood is stopped causing sudden, often severe pain and swelling. Prolonged testicular torsion will result in the death of the testicle and surrounding tissues.

Generally, testicular torsion requires emergency surgery. If treated within a few hours, the testicle can usually be saved. However, waiting longer for treatment can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.

Testicular torsion is most common in males 10 to 25 years old, but it can occur at any age. About 65 percent of cases occur in adolescents between 12 to 18 years of age. It occurs in about 1 of 4,000 males before the age of 25.

According to Medilexicon's medical dictionary:

Testicular Torsion is Torsion occurring during fetal development can lead to what is known as neonatal torsion or vanishing testis. This is one of the causes of an infant being born with one testicle (monorchism).

What are the signs and symptoms of testicular torsion?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms of testicular torsion include:

• Sudden or severe pain in one testicle
• Swelling of the scrotum, which is a loose bag of skin under the penis that contains the testicles
• Nausea
• Vomiting
• Abdominal pain
• A testicle can be positioned higher than normal or at an odd angle
• Tenderness of less than 6 hrs of duration
• Sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own. This is known as intermittent torsion and detorsion.

Seek emergency care for sudden or severe testicle pain. Signs and symptoms may be caused by another condition. However, prompt treatment can prevent severe damage or loss of the testicle if it is testicular torsion.

If there is sudden testicle pain that goes away without treatment, seek prompt medical help. This occurs when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Even though the testicle untwisted on its own, there is still need to see a doctor. Surgery may be required to prevent the problem from happening again.

What are the risk factors of testicular torsion?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

• Age. Testicular torsion is most common in males between 10 and 25 years old.
• Previous testicular torsion. A person that had testicular torsion that went away without treatment is likely to have it again in either testicle unless surgery is performed to correct the underlying problem.
• Climate. Torsions are sometimes called "winter syndrome". This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.
• Bell clapper deformity. In this deformity the testicle is only attached to the spermatic cord, like a bell clapper. A bell clapper deformity is a predisposing factor for testicular torsion in non-neonates. Currently there is no recommended clinical examination for a bell clapper deformity.

What are the causes of testicular torsion?

Testicular torsion occurs when the testicle rotates on the cord that runs upward from the testicle into the abdomen (spermatic cord). This rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

Males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles.

In men and boys who are at risk of testicular torsion, the condition often occurs with no apparent trigger. Signs and symptoms of testicular torsion may start with the following:

• An injury to the scrotum
• Physical activity
• Sleep

What are the complications of testicular torsion?

The following complications can be caused by testicular torsion:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage or death of the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.

How is testicular torsion diagnosed?

Testicular torsion will likely occur as an emergency situation, leaving little time for the patient to prepare. During medical examination, a number of questions will be asked to verify whether the signs and symptoms are caused by testicular torsion or something else. The scrotum, testicles, abdomen and groin will be examined.

The doctor may also test the patient's reflexes by lightly rubbing or pinching the inside of the thigh on the affected side. Normally this causes the testicle to contract. This reflex probably will not occur if there is testicular torsion.

Dizziness and nausea are often present when there is an absence of blood supply to the testicle, as well as a tremendous amount of pain. If the diagnosis is questionable, a urologist should be consulted immediately, because testicular viability may be compromised.

Often, doctors diagnose testicular torsion with just a physical exam. Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for the symptoms. These include:

• Urine tests or blood tests. This is to check whether the signs and symptoms are caused by an infection.
• Scrotal ultrasound. This uses high-frequency sound waves to create images of the testicle and check for blood flow. Decreased blood flow to the testicle is a sign of testicular torsion.
• Nuclear scan of the testicles. This involves injecting tiny amounts of radioactive material into the bloodstream. It is then possible to detect areas in the testicles that receive less blood flow, indicating torsion.
• Surgery. Sometimes surgery is necessary to identify whether symptoms are caused by testicular torsion or another condition. If there has been pain for several hours and the physical exam suggests testicular torsion, surgery may be performed without any additional testing. This is done in an attempt to save the testicle, because doing further testing might cause too much of a delay if there is no blood flowing to the testicle.

If suspicion is high, immediate untwisting is advised in order to prevent infarction and subsequent testicular loss with or without sterility.

If physical examination suggests a compromised blood supply and the patient has had such symptoms for a significant period, medical personnel may choose to bring the patient directly to surgery without an ultrasound, since the time required for ultrasound testing could affect testicular viability.

Surgical exploration may be necessary if diagnosis cannot be made using other methods. If there is the slightest hint of a torsion of the testicle, then doctors will perform surgery; even if the testicle turns out not to have twisted, they will still protect it by attaching the testicle to the scrotum wall.

What are the treatment options for testicular torsion?

Surgery is required to treat testicular torsion.

Manual detorsion: In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum. However, surgery is still needed to prevent torsion from occurring again. If testicular torsion occurs before birth, surgery may not be possible.

Surgery for testicular torsion is usually done during general anesthesia. The surgery is uncomplicated and generally does not require a stay in the hospital. It is a simple and minimally invasive surgery.

During surgery, the doctor will:

• Make a cut in the scrotum which is a loose bag of skin under the penis that contains the testicles
• Untwist the spermatic cord, if necessary
• Stitch one or usually both testicles to the inside of the scrotum to prevent rotation

The surgeon may suture both testicles to prevent torsion from occurring on the other side. With prompt diagnosis and treatment the testicle can be saved in a high number of cases. Testicular torsion is a surgical emergency that needs immediate surgical intervention. The sooner the testicle is untwisted, the greater the chance of successful treatment:

• Within six hours, the testicle can be saved about 90 percent of the time
• After 12 hours, chances of saving the testicle fall to about 50 percent
• After 24 hours, the testicle can be saved only about 10 percent of the time. Once the testicle is dead it must be removed to prevent gangrenous infection.

After surgery, for several weeks, the patient needs to avoid:

• strenuous activity
• sexual activity

Testicular torsion in newborns and infants

In some cases, surgery is needed to diagnose and correct testicular torsion. This can prevent future problems with fertility or male hormone production. The doctor and parents decide whether a newborn or infant should have surgery.

After birth. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend later, nonemergency surgery.

Before birth. If signs and symptoms of testicular torsion occur after birth, the doctor may recommend emergency surgery.

Prevention

Having testicles that can rotate or move back and forth freely in the scrotum is an inherited trait. Some males have this attribute and others do not.
The only way to prevent testicular torsion for a man with this trait is through surgery to attach both testicles to the inside of the scrotum so that they cannot rotate freely.

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What Is Social Anxiety Disorder? What Causes Social Anxiety Disorder?

Social anxiety disorder or social anxiety is an excessive emotional discomfort, anxiety, fear or worry about social situations. The individual is exceptionally worried about social situations, being evaluated or scrutinized by other people - there is a heightened fear of interactions with others. Social anxiety disorder is sometimes referred to as social phobia. A phobia is an irrational fear of certain situations, objects or environments.

A person with social anxiety disorder typically is excessively fearful of embarrassment in social situations - this fear can sometimes have a debilitating effect on personal and professional relationships.

An individual with social anxiety disorder may have signs and symptoms of blushing, trembling, accelerated heartbeat, muscle tension, nausea, sweating, abdominal discomfort and lightheadedness.

Social anxiety often occurs early in childhood as a normal part of social development and may go unnoticed until the person is older. The triggers and frequency of social anxiety vary considerably, depending on the individual.

Most of us may feel nervous in certain social situations, such as giving a presentation, going out on a date, or taking part in a competition (such as a quiz). This is normal and in most cases is not social anxiety disorder. Social anxiety disorder is when everyday social interactions cause excessive fear, self-consciousness and embarrassment. Such trivial tasks as filling a form with people around, or eating in public places or with friends may become considerable ordeals for somebody with social anxiety disorder.

According to Medilexicon's medical dictionary:

Social phobia is "a persistent pattern of significant fear of a social or performance situation, manifesting in anxiety or panic on exposure to the situation or in anticipation of it, which the person realizes is unreasonable or excessive and interferes significantly with the person's functioning; 2. a DSM diagnosis that is established when specified criteria are met." (DSM = Abbreviation for the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.)

What are the signs and symptoms of social anxiety disorder?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Social anxiety disorder is a chronic mental health condition in which the sufferer has an irrational fear or anxiety of situations or activities, believing he/she will be observed and judged by others. There is considerable fear of humiliation or embarrassment. There may be physical, emotional and behavioral signs and symptoms.

Behavioral and emotional signs and symptoms:

• Anxiety reaches such a point that daily tasks, including school life, work and other activities become affected
• Avoiding situations where the sufferer feels he/she may be the center of attention
• Children with possible social anxiety disorder tend to be worried about being embarrassed in front of peers, but not generally in front of adults
• Considerable fear of being in situations with strangers (people the sufferer does not know)
• Dread over how they will be presented to others
• Excessive fear of being teased or criticized
• Excessive fear that other people may notice that the sufferer looks anxious
• Excessive worry about being anxious, which makes the anxiety worse
• Excessive worry about embarrassment and humiliation
• Fear of meeting people in authority
• Having severe anxiety or panic attacks when in the feared situation
• Refraining from doing certain things or talking to people because of a fear of humiliation or embarrassment
• The individual worries excessively about being in situations where he/she may be judged
• When in a situation that causes anxiety the sufferer's mind may go blank

Physical signs and symptoms:

• A feeling that the heart is either pounding too hard or fluttering (palpitations)
• Abdominal pain and/or stomach upset
• Avoiding eye contact
• Blushing
• Children with social phobia may weep, have tantrums, cling to parents, or shut themselves out
• Clammy hands
• Cold hands
• Confusion
• Crying
• Diarrhea
• Difficulty talking; this may include a shaky voice
• Dry mouth
• Dry throat
• Excessive sweating
• Muscle tension
• Nausea
• Shaking
• Trembling
• Walk disturbance - the individual is so worried about how they walk that they lose balance when passing a group of people

An individual with social anxiety disorder may also:

• Be over-sensitive to criticism
• Have low self-esteem
• Have poor social skills
• Not be assertive
• Talk negatively about himself/herself - thoughts are often self-defeating and inaccurate

Individuals with social anxiety disorder sometimes underachieve at school or at work in order to avoiding the attention of being promoted or having to participate in group tasks. In severe or chronic (long-term) cases of social anxiety the person may develop other psychological conditions, such as depression.

A person with social anxiety disorder may find the following situations extremely difficult to face:

• Being introduced to people they don't know
• Talking to people they don't know
• Going into a room where the people are already settled
• Looking at people straight in the eye (eye contact)
• Ordering a meal in a restaurant
• Starting a conversation
• Using a public telephone
• Using a public toilet
• Writing in front of other people
• Doing anything where other people may be looking on

People with social anxiety disorder usually know that their anxiety is irrational. However, in many cases the anxiety persists and does not get better without appropriate treatment.

What are the risk factors for social anxiety disorder?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

According to The Mayo Clinic, USA, approximately 3% to 13% of people in Western countries experience social anxiety disorder at some time in their lives. The disorder typically starts in the early to midteens, but can sometimes start much earlier or later.

The following factors may increase the risk of developing social anxiety disorder:

• Gender - social anxiety disorder is significantly more common among females than males.
  
• Genetics - if a person's parents or a sibling has the condition his/her risk of developing it is higher, compared to other people.
  
• Nurture - some people believe that social anxiety disorder may develop in people who have witnessed anxious behavior in others. Some experts believe there may be a link between the disorder and over-protective parenting.
  
• Some life experiences - children who have experienced bullying, ridicule, humiliation or rejection are said to be more susceptible to social anxiety, compared to other people. Sexual abuse, a family conflict or some other negative experience may also be factors.
  
• The individual's personality - children who are withdrawn, restrained, shy or timid when confronted with a new situation are thought to be more prone to developing social anxiety disorder.
  
• A demanding ordeal - some people may experience social anxiety for the first time when they have to make an important presentation. Actors may experience stage-fright or some kind of social phobia when they are on stage.

What are the causes of social anxiety disorder?

Experts say that social anxiety disorder has both environmental and genetic causes.

• Genetic causes - as the condition is more common in families (appears to run in families). There is ongoing research which attempts to find out how much of this is genetic versus acquired learning (if family members are anxious, the offspring will learn that behavior).
  
• Chemicals in the body - scientists are currently undergoing research into what natural body chemicals might be playing a part in the development of social anxiety disorder. Serotonin, a brain chemical, may play a key role when its brain levels are not right or if the patient is extremely sensitive, some scientists suggest.
  
• Brain structure - some experts believe the amygdala (part of the brain) may play a role in fear response, resulting in an excessive reaction in patients with an overactive amygdala.
  
• Weather and/or demographics - Mediterranean countries have lower rates of social anxiety disorder compared to Scandinavian countries. This could be due to warmer weather as well as a higher population density in the Mediterranean countries. Warmer weather may reduce avoidance and increase interpersonal contact. Others suggest that the factors may be cultural.

Diagnosing social anxiety disorder

A doctor, often a GP (general practitioner, primary care physician) may carry out a physical as well as a psychological evaluation. The physical exam helps the doctor rule out any physical causes for the patient's symptoms. There is no current laboratory test that can diagnose social anxiety disorder.

A GP will probably refer the patient to a mental health provider, usually a psychiatrist or psychologist. The mental health provider will ask the patient to describe his/her symptoms, when they occur, how often, and how long they have been occurring. The health care professional may ask the patient to complete a questionnaire.

In the USA a patient must meet the DSM criteria (DSM = Abbreviation for the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.) In the USA this manual is used by doctors and other mental health providers, as well as insurance companies when determining whether to reimburse the patient's treatment. The criteria include:

• The patient avoids situations which may produce anxiety
• The patient has a persistent fear of social situations in which they believe they will be scrutinized, or act in a way that's embarrassing or humiliating.
• The patient recognizes that his/her anxiety level is excessive or out of proportion for the situation
• The patient's daily living is affected by his/her anxiety
• The social situations cause a lot of anxiety

What are the treatment options for social anxiety disorder?

In a significant number of patients, social anxiety disorder continues for life, usually fluctuating in its severity. Available treatments can help people control their symptoms considerably, as well as gaining confidence.

Psychotherapy together with medications are considered by most experts as the most effective treatments.

Psychotherapy

Psychotherapy is treatment by psychological means. Psychotherapy may utilize persuasion, suggestion, reassurance, insight (perceptiveness, self-awareness), and instruction so that the person can see himself/herself and their problems in a more realistic way and wish to overcome and/or cope with them effectively. There are many types of psychotherapy, including cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.

Cognitive behavioral therapy (CBT) has been shown to improve symptoms enormously. CBT helps the patient realize that it is their own thoughts, rather that the situations or other people, that determine how they react or behave. The way a person thinks may positively affect their behavior, even if the situation or people don't. In this type of psychotherapy the patient learns how to recognize and change negative thoughts about themselves.

This type of therapy has two main parts:

• a cognitive part designed to limit distorted thinking.
  
• a behavioral part designed to change the way people react to the objects or situations that trigger anxiety.

The patient may also receive exposure therapy where they gradually work up to facing situations they fear - the aim is to improve the patient's skills at coping with the anxiety-inducing situations and to develop confidence to face them. With cognitive delivered exposure (CDE), the patient safely confronts the situations or places that cause problems, often in the company of the therapist.

Medications

SSRIs (selective serotonin reuptake inhibitors) are the most common medications prescribed for patients with social anxiety disorder - they are thought to be the safest as well as most effective treatment for persistent symptoms. Examples may include Paroxetine (Paxil, Paxil CR), Sertraline (Zoloft), Fluvoxamine (Luvox, Luvox CR), or Fluoxetine (Prozac, Sarafem). Side effects may include:

• Headaches
• Insomnia
• Nausea
• Sexual dysfunction

The patient may be prescribed an SNRI (serotonin and norepinephrine reuptake inhibitors), such as venlafaxine (Effexor, Effexor XR).

Patients usually start on a small dose, which is gradually increased. According to The Mayo Clinic, it may take up to three months for any changes in symptoms to be noticeable.

Benzodiazepines - these anti-anxiety medications help reduce anxiety levels. Examples include alprazolam (Xanax) and clonazepam (Klonopin). Because they may cause dependence, treatment courses are usually short. Side effects may include:

• Confusion
• Drowsiness
• Light-headedness
• Loss of balance
• Memory loss

Beta-blockers - this type of medication helps block the stimulating effects of adrenaline (epinephrine). They are usually prescribed for specific situations, such as having to make a presentation. They are not used for general treatment.

What are the possible complications of social anxiety disorder?

In many cases, untreated social anxiety disorder can persist throughout the patient's life. The person's life may be dominated by his/her anxieties, which interfere with daily life, school work, professional work, relationships and general happiness.

In severe cases the individual may quit work, drop out of school and become isolated.

There is also a risk of alcohol and/or substance abuse, depression, and even suicide.

Many people, including some experts, argue that social anxiety is caused by inherent problems with society, including a competitive culture, power imbalances, lack of care and poor social education in families. They say the clinical boundaries of social anxiety disorder have been stretched too far - in other words, too many people are being diagnosed as having a medical problem when they don't.

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Memory Problems Or Mild Cognitive Impairment More Common In Men

Mild cognitive impairment, which may include problems with memory or thinking beyond that explained by the normal aging rate, is more common among men than women, say researchers in an article published in the medical journal Neurology, September 7 issue. People with mild cognitive impairment, or MCI can function in everyday activities, but they may have problems with memory, such as remembering people's names, losing the flow of a conversation, and not remembering where they left things.

In this latest study, researchers found that men are 1.5 times more likely to have mild cognitive impairment than women. MCI frequently leads to Alzheimer's disease.

Study author Ronald Petersen, MD, PhD, with the Mayo Clinic in Rochester, Minnesota, said:

This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men. If these results are confirmed in other studies, it may suggest that factors related to gender play a role in the disease. For example, men may experience cognitive decline earlier in life but more gradually, whereas women may transition from normal memory directly to dementia at a later age but more quickly.

Petersen and team interviewed 2,050 people aged between 70 and 89 years, in Olmstead Country, Minnesota, about their memory and their medical history. Their memory and thinking skills were also tested.

They found that:

• Almost 14% of the individuals they tested and interviewed had mild cognitive impairment
• Approximately 10% had dementia
• 76% had normal memory and thinking skills, according to the tests and interviews
• 19% of the men had mild cognitive impairment
• 14% of the women had mild cognitive impairment

Petersen said:

Our results, showing combined rates of MCI and dementia at 22% highlight the public health impact these conditions have and the importance of finding treatments for them.

Mild cognitive impairment rates were higher among individuals who were never married, and/or people who had a low level of education, the researchers wrote.

In a Mayo Clinic press release, Peterson is quoted as saying:

The finding that the frequency of mild cognitive impairment is greater in men was unexpected, since the frequency of Alzheimer's disease is actually greater in women. It warrants further study. If we consider the 16% prevalence of mild cognitive impairment in individuals without dementia, then add the 10-11% of individuals who already have dementia or Alzheimer's disease, we're looking at 25 percent or more of the population aged 70 or older who have dementia or are at risk of developing dementia in the near future. With the aging of America, these numbers are staggering and the impact on the health care economy, as well as on individuals and their families, is quite impressive. The need for early diagnosis and therapeutic intervention is increasingly important.

What is dementia? - dementia is the progressive deterioration in cognitive function - the ability to process thought (intelligence). Progressive means the symptoms will gradually get worse. The deterioration is more than might be expected from normal aging and is due to damage or disease. Damage could be due to a stroke, while an example of a dementia-causing-disease might be Alzheimer's.

Dementia is a set of signs and symptoms - dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. Dementia, unlike Alzheimer's, is not a disease in itself. When dementia appears the higher mental functions of the patient are involved initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him.

Dementia is significantly more common among elderly people. However, it can affect adults of any age.

What is mild cognitive impairment? - this is an intermediate stage between normal cognitive decline that occurs with age, and the more pronounced decline that occurs with dementia. The individual may have problems with memory, language, judgment and thinking beyond what might be expected for their age. Put simply, dementia is a sort of halfway house between normal cognitive decline due to aging and dementia. People with mild cognitive decline have a higher risk subsequently developing dementia, including Alzheimer's disease.

Sources: The Mayo Clinic, The American Academy of Neurology.

"Prevalence of mild cognitive impairment is higher in men"
The Mayo Clinic Study of Aging

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Retinal Implant 'Enables Blind People To See'

Researchers in Germany have developed a retinal implant that has allowed three blind people to see shapes and objects within days of the implant being installed. Impressively, one blind person was able to identify and find objects placed on a table in front of him, as well as walking around a room independently and approaching people, reading a clock face and differentiating seven shades of grey. The research is published in Proceedings of the Royal Society B.

The device, which has been developed by the company Retinal Implant AG together with the Institute for Ophthalmic Research at the University of Tuebingen, represents an unprecedented advance in electronic visual prostheses and could eventually revolutionise the lives of up 200,000 people worldwide who suffer from blindness as a result of retinitis pigmentosa, a degenerative eye disease.

In this disease light receptors in the eye cease to function. Writing in Proceedings of the Royal Society B, Prof. Dr. Eberhart Zrenner (founding Director of Retinal Implant AG and Director and Chairman of the University of Tuebingen Eye Hospital) states that "The results of this pilot study provide strong evidence that the visual functions of patients blinded by a hereditary retinal dystrophy can, in principle, be restored to a degree sufficient for use in daily life."

The device - known as a subretinal implant - sits underneath the retina, directly replacing light receptors lost in retinal degeneration. As such, it uses the eyes' natural image processing capabilities beyond the light detection stage to produce a visual perception in the patient that is stable and follows their eye movements. Other types of retinal implants - known as epiretinal implants - sit outside the retina and because they bypass the intact light-sensitive structures in the eyes they require the user to wear an external camera and processor unit.

The subretinal implant described in this paper achieves unprecedented clarity because it has a great deal more light receptors than other similar devices. As Prof. Dr. Zrenner states, "The present study...presents proof-of-concept that such devices can restore useful vision in blind human subjects, even though the ultimate goal of broad clinical application will take time to develop."

Source:
Royal Society
Retina Implant AG

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Multivitamin Use Linked To Increased Breast Cancer Risk

Researchers in Sweden who studied data on over 35,000 middle aged and older women followed for 10 years found a link between taking multivitamins and increased risk of breast cancer and said this was of concern to public health and should be investigated further.

You can read about the study, conducted at the Karolinska Institutet in Stockholm, Sweden, online in the 24 March issue of the American Journal of Clinical Nutrition.

Many women use multivitamins in the belief that they will protect them from chronic diseases like cancer and heart disease, wrote the authors in their background information.

In fact, in February 2009, the Archives of Internal Medicine published details of a large US study of over 160,000 postmenopausal women that found no convincing evidence that long term use of multivitamins changed their risk of developing common cancers, cardiovascular disease or dying prematurely.

But, as the authors of this Swedish study pointed out, the effect of multivitamins on breast cancer only is unclear.

For the prospective study, lead and corresponding author Dr Susanna C Larsson, of the Division of Nutritional Epidemiology, National Institute of Environmental Medicine at the Karolinska Institutet, and colleagues, looked at data from 35,329 women in the Swedish Mammography Cohort, who filled in questionnaires about their use of multivitamins and breast cancer risk factors. The women were cancer free and aged between 49 and 83 when they filled in the questionnaires in 1997.

The results showed that:

• 974 women were diagnosed with incident breast cancer over a mean follow up of 9.5 years.


• 293 of the diagnoses were among 9,017 women who reported using multivitamins.


• Use of multivitamins was linked to a statistically significant 19 per cent increased risk of breast cancer (after adjusting for lifestyle and risk factors like weight, diet, smoking, exercise, and family history of breast cancer, the relative risk of women who reported using multivitamins was 1.19, with confidence interval ranging from 1.04 to 1.37).


• Hormone receptor status did not change the strength of this link significantly.

The authors concluded that:

"These results suggest that multivitamin use is associated with an increased risk of breast cancer. This observed association is of concern and merits further investigation."

Readers concerned about these findings should note that they don't prove that multivitamins caused the women's breast cancer: a prospective study, which this was, can only show whether there is a link or not and try and rule out possible influencers.

As Larsson pointed out in an email to Reuters Health, it is possible that something they did not measure is responsible for the link. Also, even if the link was causal, these findings show that for any one woman, using multivitamins has a small effect on her risk of breast cancer, she noted.

However, given the widespread use of multivitamins, there is an important public health message in this study, said the authors.

Speculating on what the biological reasons might be, the researchers mentioned various previous studies that taken as a whole reveal a conflicting picture. For example, some studies on folic acid suggested it increases breast cancer risk while others suggested it has no effect and may even decrease it.

In the meantime, Larsson recommends women eat a healthy and varied diet instead of using pills to get the nutrients they need.

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Opioid Use Linked To More Fractures And Even Death Among Elderly Patients

Elderly patients with arthritis who regularly take opioids for pain experience more undesirable and sometimes dangerous side effects than those on other painkillers, such as Coxibs and NSAIDs (non-steroidal anti-inflammatory drugs), researchers from Brigham and Women's Hospital, Boston, reveal in Archives of Internal Medicine.

Opioids are a class of drugs commonly prescribed for their painkilling (analgesic) properties. They include substances such as codeine, oxycodone, methadone, or morphine. They may be more easily recognized by the brand names, such as OxyContin, Kadian, Demerol, Percocet, Avinza, Percodan, Darvon, , Vicodin, and Lomotil.

The authors wrote:

"In the United States, one in five adults received a prescription for an analgesic in 2006, accounting for 230 million prescription purchases; however, the comparative safety of these drugs is unclear. Although the cardiovascular safety of nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) and selective cyclooxygenase-2 inhibitors (coxibs) has been called into question, there is little comparable information about the third major analgesic group, opioids."

Daniel H. Solomon, M.D., M.P.H., at Brigham and Women's Hospital, Boston and team set out to compare the safety of opioids, Coxibs and NSAIDs among 12,840 Medicare beneficiaries. They had all been given one or more of these painkillers between 1999 and 2005. By gathering data from an extensive claims database, the researchers worked out how many of them developed heart attacks, stroke, heart failure, gastrointestinal tract bleeding, bowel obstruction, liver toxicity, acute kidney injuries, and bone fractures.

They found that patients on opioids had a higher risk of experiencing adverse events compared to those on NSAIDs or Coxibs. Those on NSAIDs had the lowest risk.

The authors reported 101 fractures per 1,000 patients among those on opioids annually, compared to just 19 for those on Coxibs.

Cardiac risk was lower for those on NSAIDs compared to coxib or opioids users.

Opioid usage was linked to a higher risk of death or hospitalization than NSAID usage. Coxib users had the same risk as NSAID users.

21 per 1,000 NSAID users annually experience gastrointestinal tract bleeding, compared to 12 per 1,000 among coxib users.

The authors wrote:

"Analgesics are used daily by millions of people; however, current data do not allow patients or physicians to determine which type of agent is safest. We compared nsNSAIDs, coxibs and opioids across a wide range of specific safety events and several composite safety events. Although nsNSAIDs pose certain risks, these analyses support the safety of these agents compared with other analgesics. The recent concerns raised about opioid use in non-malignant pain syndromes appear warranted on the basis of these data."

In another article in the same journal (same issue), Dr. Solomon and team gathered data just on Medicare beneficiaries who took opioids for non-malignant pain for the period 1996-2005.

6,275 patients on five types of opioids - tramadol, propoxyphene, codeine, hydrocodone, and oxycodone - were compared for adverse events rates after 30 and 180 days.

Gastrointestinal adverse events risks were similar across all groups throughout the study period, the authors report. Cardiovascular events risk was similar across all groups after 30 days, but at 180 days those on codeine had significantly higher cardiovascular events risk.

When using hydrocodone as a reference point, tramadol users had a 79% lower risk of fracture and those on propoxyphene had a 46% lower risk.

The risk of death was 2.4 times higher among oxycodone users when compared to hydrocodone, and two times higher among codeine users.

The authors wrote:

"This study's findings do not agree with a commonly held belief that all opioids are associated with similar risk. The risks were not explained by the dosage being prescribed and did not vary across a range of sensitivity analyses. The risks were substantial and translated into numbers needed to treat that would be considered clinically significant. Our findings regarding cardiovascular risk were surprising and require validation in other data sets."

The authors stress that an experimental design is required to prove a cause-and-effect relationship between opioids and adverse events, rather than an observational one.."but these results should prompt caution and further study."

During a follow-up of a clinical trial, researchers found that approximately 189 days after patients had stopped taking Rofecoxib, their risk of cardiovascular events increased significantly. This was reported in a separate research letter published in the same journal.

"The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults"

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PMO Compounds Show Promise Against Deadly Ebola, Marburg Viruses

US scientists have discovered two compounds from a family known as antisense phosphorodiamidate morpholino oligomers, or PMOs, can protect monkeys infected with Ebola and Marburg viruses from going on to develop lethal hemorrhagic fever, which has a 90 per cent fatality rate in humans; and they are now proceeding with clinical trials.

The "proof of concept" study that led to these findings was a collaboration between the US Army Medical Research Institute of Infectious Diseases (USAMRIID) based at Fort Detrick, Maryland, and AVI BioPharma, a Washington-based biotechnology firm, and was published in the 22 August advanced online issue of Nature Medicine.

There are currently no vaccines or effective treatments for the Ebola and Marburg filoviruses, which are commonly transmitted through blood and bodily fluids. However, infection can also occur via the aerosol route, which is why they are a cause of grave concern as potential weapons in biological warfare or terrorism.

When scientists research these viruses they have to work in special maximum containment labs and follow Biosafety level 4 procedures where they have to wear positive-pressure biohazard suits and breathe filtered air.

In their paper, first author Travis K. Warren of USAMRIID and colleagues describe how one PMO compound AVI-6002, from a group they called PMOplus (short for positively charged phosphorodiamidate morpholino oligomers), protected 60 per cent of monkeys infected with the Ebola virus and another called AVI-6003 protected 100 per cent of monkeys infected with Marburg.

Moreover, they showed that the PMOplus compounds protected the monkeys even when they were given one hour after exposure to the viruses, suggesting they could be used to treat people who accidentally become infected in labs and hospitals.

Warren said in a statement that the compounds block critical genetic viral sequences, halting virus replication long enough to give the host immune system time to mount a defence and eliminate it from the body.

To begin with, Warren and colleagues tested various PMO compounds on mice and guinea pigs infected with Ebola, until they found one called AVI-6002 that resulted in a survival rate of 90 per cent and over in animals treated either before or just after exposure.

They then proceeded to prove the concept in a series of studies on monkeys. First they exposed 9 monkeys to Ebola virus and gave 8 of them AVI-6002 within half to one hour later. 5 of the 8 survived. In a second set of experiments, 3 of 5 monkeys in each group survived when given a dose of 40 mg of AVI-6002 per kg of body weight.

Warren and colleagues then turned to the Marburg virus (more specifically the Lake Victoria Marburg virus, MARV): as before, they screened potential candidate compounds in mice and guinea pigs, until they found AVI-6003, which was more than 90 per cent effective at preventing Marburg infection in both animals.

In a further set of experiments on cynomolgus monkeys (crab eating macaques), they showed that AVI-6003 was 100 per cent effective, if given 30 to 60 minutes after infection with a dose of 40 mg per kg body weight.

They concluded that:

"PMOplus may be useful for treating these [Ebola and Marburg] and other highly pathogenic viruses in humans."

The reason the USAMRIID and AVI BioPharma team set out to investigate these compounds in the first place was because in February 2004, a USAMRIID scientist accidentally stuck her thumb with a needle while treating Ebola-infected mice.

The researcher went into quarantine following recommendation by USAMRIID medical experts that she be isolated for 21 days to check if she had been infected.

The unfortunate incident coincided with a visit by Dr. Patrick Iversen from AVI BioPharma, and the company immediately volunteered to try and find compounds to treat her if she should need it.

The team at AVI worked four days solid to develop human-grade anti-Ebola compounds, and in the meantime a team of experts from AVI and USAMRIID put together a request to seek emergency approval from the US Food and Drug Administration (FDA) to use the experimental drugs if necessary.

Five days after the exposure the compounds were in the hands of the USAMRIID medical team.

However, the scientist was luckily not infected and the drugs did not have to be used. But the two organizations decided to press ahead and test them on animals, and that is how these studies got off the ground.

USAMRIID commander Colonel John P Skvorak told the press that:

"This report of successful early post-exposure treatment of filovirus hemorrhagic fever is significant on its own."

"But the drug characteristics of these PMOs also support investigation of potentially broader therapeutic applications," he added.

The researchers have submitted investigational new drug applications (IND) for AVI-6002 and AVI-6003 to the US Food and Drug Administration (FDA) and are proceeding with clinical trials.

"Advanced antisense therapies for postexposure protection against lethal filovirus infections."

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Homeopathic Teething Tablets Contain Inconsistent And Potentially Dangerous Levels Of Belladonna

Hyland's Teething Tablets, a homeopathic product aimed at relieving symptoms linked to teething contain inconsistent quantities of belladonna, which can be harmful to humans in high doses, the FDA (Food and Drug Administration) reports. The makers are issuing a recall. People who have bought this product are warned not to use them, and to get rid of them.

During the manufacturing process, small quantities of belladonna are added to Hyland's Teething Tablets. However, large doses of belladonna can be toxic and cause serious harm. Hence, any tablet or medication containing belladonna needs to be very carefully controlled to make sure the doses are accurate.

FDA laboratories found that Hyland's Teething Tablets do not contain consistent belladonna doses.

The FDA informs that there have been reports of adverse events in children which are linked to belladonna toxicity. Some reports received also describe incidences of children consuming too many tablets because the container caps are not child resistant.

Signs and symptoms related to belladonna toxicity include:

• agitation
• breathing difficulties
• constipation
• flushing of the skin
• listlessness, lethargy, fatigue
• muscle weakness
• problems urinating
• seizures
• sleeping too much

Parents, guardians and caregivers who have children with these signs and symptoms should see a doctor immediately, the FDA advises, especially if they have been taking Hyland's Teething Tablets.

The FDA adds that parts of the manufacturing operation in the Standard Homeopathic Company have been found to be "substandard". A manufacturing inspection is currently underway.

Health care professionals and lay people who witness side effects after Hyland's Teething Tablet use are encourage to report details online at www.fda.gov/MedWatch/report.htm, or call the following telephone number and request a reporting form, 1-800-332-1088.

According to the Standard Homeopathic Company, the makers of Hyland's Teething Tablets:

Belladonna is included in the Tablets to ease the redness, inflammation and discomfort of the child's gum that often occurs during the teething process.

.. Hyland's Teething Tablets contain homeopathically prepared forms of Calcarea Phosphorica, Chamomilla, Coffea Cruda, and Belladonna. These ingredients are all prepared in accordance with the Homeopathic Pharmacopoeia of the United States (HPUS).

HPUS has been recognized by the FDA since 1938 as the official compendium for homeopathic medicine in the U.S.

Source: FDA, Standard Homeopathic Company

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Genetically Modified Salmon As Safe To Eat As Normal Atlantic Salmon

U.S. regulators say that genetically engineered salmon as safe to eat as wild Atlantic salmon, after completing a preliminary analysis. Aqua Bounty Technologies Inc., have genetically modified their salmon so that they eat all year round and grow twice as fast as salmon typically would in their natural environments.

Genetically modified (engineered) salmon is an Atlantic salmon. It has been modified by adding a growth hormone regulating gene from another fish - the Pacific Chinook salmon - as well as an on-switch gene from an Ocean Pout (Zoarces americanus, an eel-type fish) to the Atlantic Salmon's 40,000 genes. The genetically engineered Atlantic salmon eats all year round and gets bigger much more rapidly. Normal Atlantic salmon only feed during the spring and summer.

The aim of the genetic modifications is to speed up the fish's growth, without affecting its eventual size or other characteristics. Normal Atlantic salmon take about three years to reach market size, while the genetically modified one takes from 16 to 18 months.

There is a 10-year ongoing review of an application to allow genetically modified salmon into the U.S. food supply - if approved, it will be the first modified animal to be approved to be sold for human consumption.

Aqua Bounty Technologies Inc. has named their modified salmon AquAdvantage Salmon.

A Veterinary Medicine Advisory Committee, which advises the FDA, is holding a three-day meeting, starting on September 19^th, 2010, at the Rockville Hilton, 1750 Rockville Pike, Rockville, Maryland, to decide whether to approve the fish for the U.S. food supply market. Although the Committee's decision/recommendation is not binding, the FDA tends to go along with what they say.

In a press release, Aqua Bounty Technologies informs that:

In addition, the FDA will hold a public hearing on the application of its food labeling requirements and how they might apply to AquAdvantage® Salmon on 21^st September at the same location (Rockville Hilton, 1750 Rockville Pike, Rockville, Maryland).

Today's news refers to documents released before the meeting by the FDA saying the genetically modified salmon is as safe to eat as normal Atlantic salmon, and that the modified fish were "highly unlikely to produce significant effects on the environment".

Dr. Ronald Stotish, President and CEO of AquaBounty, commented:

This is welcome and exciting news for the Company as we near the end of the detailed and necessary process to receive regulatory approval for our AquAdvantage Salmon. The meeting will provide an opportunity for the public to understand how the application of our technology will enable the safe and sustainable production of high quality fish. We believe the economic and environmental benefits of our salmon will very effectively help to meet the demand for food from the growing world population.

According to the Institute of Social and Economic Research, University of Alaska, Anchorage, during the years 2000-2004, Americans consumed:

• 284 metric tons of salmon per year
• One third of Salmon consumed consisted of Pacific salmon, and two thirds was Atlantic Salmon
• One third was domestic production and two thirds was imported
• 60% was fresh salmon, 20% was frozen salmon, and 20% was canned salmon
• 45% of pacific salmon was canned
• Almost no Atlantic salmon was canned
• 34% of Pacific salmon was frozen
• 13% of Atlantic salmon was frozen
• 21% of Pacific salmon was fresh
• 87% of Atlantic salmon was fresh

Americans consumed 130,000 metric tons of salmon in 1989, compared to 284,000 in 2004. This increase was mostly due to the growth in imported farmed salmon.

Sources: Institute of Social and Economic Research (University of Alaska), FDA (Food and Drug Administration), Aqua Bounty Technologies Inc., Wikipedia.

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What Are Proteins? What Is A Protein? How Much Protein Do I Need?

Proteins are large molecules consisting of amino acids which our bodies and the cells in our bodies need to function properly. Our body structures, functions, the regulation of the body's cells, tissues and organs cannot exist without proteins. Our muscles, skin, bones and many other parts of the body contain significant amounts of protein. Protein accounts for 20% of total body weight.

Enzymes, hormones and antibodies are proteins. Proteins also work as neurotransmitters and carriers of oxygen in the blood (hemoglobin).

Imagine proteins as machines; machines which make all living things, from viruses, bacteria, butterflies, jellyfish, plants and humans function. The human body is made up of approximately 100 trillion cells - each one has a specific function. Each cell has thousands of different proteins, which together make the cell do its job - the proteins are tiny machines within the cell. Amino acids and proteins - protein is made up of amino acids; amino acids are the building blocks of protein, there are 20 of them. Imagine there are 20 different types of bricks, and a much larger number of different types of houses which we could name according to the way we combined the bricks (their sequence). The bricks are the amino acids and the houses are the proteins.

The 20 different amino acids are:

• Alanine
• Arginine
• Asparagines
• Aspartic acid
• Cysteine
• Glutamic acid
• Glutamine
• Glycine, histidine
• Isoleucine
• Leucine
• Lysine
• Methionine
• Phenylalanine
• Proline
• Serine
• Threonine
• Tryptophan
• Tyrosine
• Valine

These 20 amino acids can be arranged in millions of different ways to create millions of different proteins, each one with a specific function in the body. Amino acids are organic molecules - they are made out of carbon, hydrogen, oxygen, nitrogen and sometimes sulphur.

There are three types of nutrients that are essential as energy sources for the human body:

• Proteins
• Carbohydrates
• Fats

One gram of protein or carbohydrate contains 4 calories, while one gram of fat has 9 calories.

Jons Jacob Berzelius (1779-1848), a Swedish doctor and chemist, introduced the word protein into science. Dutch chemist Gerhardus Johannes Mulder had already described proteins beforehand, but had not introduced the word as we know it today.

The Greek word protos means "first" and the Greek word proteios means "the first quality". As European scientists believed it was essential to life (a primary/first quality for life, a raw/primary material), they created a new word from the original Greek one.

According to Medilexicon's medical dictionary:

Proteins are Macromolecules consisting of long sequences of α-amino acids [H₂N-CHR-COOH] in peptide (amide) linkage (elimination of H2O between the α-NH2 and α-COOH of successive residues). Protein is three fourths of the dry weight of most cell matter and is involved in structures, hormones, enzymes, muscle contraction, immunologic response, and essential life functions. The amino acids involved are generally the 20 α-amino acids (glycine, l-alanine) recognized by the genetic code. Crosslinks yielding globular forms of protein are often effected through the -SH groups of two l-cysteinyl residues, as well as by noncovalent forces (hydrogen bonds, lipophilic attractions, etc.).

The function of proteins

In virtually every biological process proteins are playing a role. The main functions of proteins in the human body are to:

• Build, strengthen and repair/replace things, such as tissue. Examples include keratin (strengthens protective coverings, such as hair), collagen and elastin (both provide support for connective tissue).
• Make antibodies for our immune system
• Make hormones, which help cells send messages and coordinate bodily activities
• Muscle contractions - actin and myosin, two types of proteins, are involved in muscle contraction and movement.
• Make enzymes. An enzyme facilitates a biochemical reaction.
• Carry things - hemoglobin, a protein, transports oxygen through the blood.
• Mediate cell response - rhodopsin is a protein in the eye which is used for vision
• Storing things - ferritin is a protein which stores iron in the liver

Dietary requirements of protein

Nobody seems to agree on how much protein we can eat; experts from industry, government agencies, diet companies and nutritional organizations have a varying list of assertions.

An individual's daily protein requirement depends on several factors, including:

• Age - a growing child's needs will not be the same as an individual aged 80 years
• Sex - males generally require more protein than (non-pregnant or non-breastfeeding) females
• Weight - an individual who weighs 200lbs will require more protein compared to somebody who weighs 120lbs. In fact, recent studies indicate that weight matters more than age when determining dietary protein requirements.
• Muscular exertion - an individual who earns his living delivering pianos will require more protein than a computer programmer of the same age and height
• Muscle mass - a muscle-bound weight trainer will need more dietary protein than a marathon runner
• Health - a person who is convalescing after an illness or medical procedure may need more dietary protein than other people

The Institute of Medicine, part of the National Academy of Sciences, USA, which created the DRI (Dietary Reference Intake), a system of nutrition, recommends the following for dietary protein intake:

Percentage of energy that should come from protein:
(Source: DRI page7)

• Children aged 1 to 3 years - 5% to 20%
• Children aged 4 to 18 years - 10% to 30%
• Adults - 10% to 35%

According to the US Department of Agriculture, our protein intake should be:

• Infants - 10 grams per day
• Teenage boys - up to 52 grams per day
• Teenage girls - up to 46 grams per day
• Adult men- approximately 56 grams per day
• Adult women - approximately 46 grams per day
• Pregnant or lactating (breastfeeding) women - about 71 grams per day

Protein deficiency

In some developing countries protein deficiency is s major cause of illness and premature death. Protein deficiency can lead to mental retardation and reduced IQ.

In most parts of the world where protein deficiency is common, total food energy consumption is also too low - i.e. people are not getting enough food in general. Protein deficiency can lead to:

• Growth problems
• Wasting and shrinkage of muscle tissue
• Apathy
• Diarrhea
• Fatty liver
• Swollen belly
• Swollen legs
• Anemia
• Weaker immune system, leading to a higher susceptibility to infections and diseases

In several countries where protein deficiency is a serious problem, the leaves and other parts of the Moringa tree can help provide dietary protein.

In developed countries, especially Western Europe where the dietary requirements of poorer people are very carefully monitored and resolved, protein deficiency is quite rare. In developed nations, protein deficiency is more likely to occur among people on crash diets, or among very elderly individuals who do not eat properly. Some studies indicate that protein deficiency and general malnutrition is probably worse than people realize, especially in the USA among poor people, convalescing patients, and the elderly. The difference in the nutritional content of a Japanese/Finnish state school lunch, compared to one in the USA would shock most Finnish or Japanese nutritionists.

Sources of dietary protein

• Meat
• Poultry
• Fish and fish eggs
• Insects
• Dairy products
• Seeds and nuts
• Soy products
• Quorn - a fungus extract, popular in the UK/Ireland. Egg-white is used as a binder, so it is not a vegan source.
• Eggs
• Grains, vegetables and legumes also have protein (less per kilo of total weight)

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What Is Lactose Intolerance (Lactase Deficiency)? What Causes Lactose Intolerance?

People with lactose intolerance or lactase deficiency cannot metabolize lactose properly; they lack lactase, an enzyme required in the digestive system to break down lactose. Patients typically experience a bloating, flatulence, and diarrhea after drinking milk. Lactose is a sugar that is found most notably in milk.

At least three-quarters of adults show decreased lactase activity as they get older. Lactose intolerance is less common in northern than southern Europe; it is more common in Africa and Asia than in Europe.

According to Medilexicon's medical dictionary:

Lactose intolerance is a disorder characterized by abdominal cramps and diarrhea after consumption of food that contains lactose (milk, ice cream); believed to reflect a deficiency of intestinal lactase; may appear first in young adults who had tolerated milk well as infants.

Symptoms can range from some mild discomfort to severe, depending on how much lactase they produce and the extent of their consumption of milk and other dairy products.

What is Lactose?

Lactose, which has a formula C₁₂H₂₂O₁₁, is a sugar that is found in the milk of mammals; it makes up around 2% to 8% of milk. It was discovered by Fabriccio Bartoletti in 1619, and later identified as a sugar by carl Wilhelm Scheele in 1780.

The human body uses the enzyme lactase to break down lactose into galactose and glucose - which is then absorbed into the bloodstream.

What are the signs and symptoms of lactose intolerance?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Typically, a person with lactose intolerance will experience symptoms after consuming milk or some dairy product that contains lactose. Symptoms may include:

• flatulence - a buildup of excessive gas in the intestinal tract; this can lead to farting and burping.
• Diarrhea - an hour or two after consuming lactose the individual can suddenly become desperate to go to the toilet.
• Bloated feeling
• Stomachache and abdominal pains
• Tummy rumbles
• Nausea
• Dehydration - if symptoms are severe

What are the causes of lactose intolerance?

Lactose is a type of sugar found in milk. Lactase is a protein, an enzyme that is produced in the small intestine - it breaks down lactose. Individuals with lactose intolerance do not produce enough lactase.

People with adequate amounts of lactase can break down lactose into glucose and galactose (a type of sugar) which are then absorbed into the bloodstream. In people with low levels of lactase, the lactose is not broken down and does not absorb into the bloodstream, instead it moves into the large intestine (colon). Bacteria in the colon react to the lactose, triggering symptoms.

Four main types of lactose deficiency

Primary lactase deficiency - genetically inherited. It is the most common type and usually develops when the patient is under 20 years of age. As soon as the individual's diet includes less milk, lactase production drops. In most cases, this occurs when the baby is weaned from milk to solids. Although lactase levels may drop at such an early age, it may be a few years before lactose intolerance symptoms develop.

Secondary lactase deficiency - there is a problem with the small intestine that results in inadequate amounts of lactase production. Possible causes are intestinal surgery, Crohn's disease, ulcerative colitis, chemotherapy, celiac disease and gastroenteritis. If the underlying condition is chronic (long-term), the resultant lactose intolerance tends to be long-term too.

Congenital lactase deficiency - the person is born with a genetic mutation which means they produce very little lactase (or none at all). The condition is inherited from the patient's parents.

Familial lactase deficiency - lactase production is fine, but it does not do the job. It does not break down the lactase into glucose and galactose so that it can be absorbed into the bloodstream. This condition is also inherited from the parents.

What are the risk factors of lactose intolerance?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Age- older people are more likely to have lactose intolerance than babies or young children.

Ancestry - northern Europeans are less likely to suffer from lactose intolerance than southern Europeans. People from all non-European (non-Caucasian) ancestries are more likely to develop lactose intolerance compared to people from southern Europe.

Radiation therapy (radiotherapy) - people who have received radiotherapy in their abdomen have a higher risk of subsequently developing lactose intolerance.

Being born prematurely - children who were born at full term will never have lactose intolerance symptoms until they are 3 years of age or more. Premature babies may have symptoms earlier.

How is lactose intolerance diagnosed?

Most people will visit their GP (general practitioner, primary care physician first) if they have lactose intolerance type symptoms. Ideally, before the visit, keeping a food diary and writing down when symptoms appear and how severe they are may help the doctor reach a diagnosis.

The doctor may advise the patient to try a lactose free diet for a couple of weeks, to see if symptoms improve. If they do, the individual most likely suffers from lactose intolerance.

Hydrogen breath test - the patient fasts overnight and then has a lactose solution the following morning. Hydrogen concentrations in exhaled air are measured. If levels are very high, the patient probably has lactose intolerance.

Lactose tolerance test - the patient consumes a lactose solution before a blood sample is taken to measure glucose levels. If glucose levels have not risen, it means the lactose has not been broken down into glucose and galactose, which in normal cases would have gone into the bloodstream. A milk tolerance test is the same, just that the patient's drink is milk instead of a lactose solution.

Stool sample - lactose tolerance tests and hydrogen breathe tests are not suitable for babies and very young children. So the doctor may have a stool sample tested. If levels of acetate and other fatty acids are high, the child is probably lactose intolerant.

Underlying disease/condition - if the doctor suspects there may be an underlying cause, such as celiac disease, a small bowel biopsy may be ordered; a tissue sample of the small intestinal lining is taken. This is a surgical procedure.

What are the treatment options for lactose intolerance?

There are many people who insist that lactose intolerance in people who are no longer being bottle fed or breast fed is not an undesirable condition, but a natural state of a human being. We are the only mammals that carry on drinking milk after babyhood.

People who live in countries where the non-baby human diet contains very little lactose, lactose intolerance does not require treatment - in fact, many lactose-intolerant people will be unaware of it.

If the patient has an underlying condition/disease, it is important that he/she has it under control - this means adhering/complying to their treatment plan.

The simplest way to avoid having the symptoms if you are lactose intolerant, is to avoid lactose. If symptoms are mild, it might be a question of trial an error until you find your lactose threshold.

Any product that contains lactose will have the ingredient listed on its label.

The US NIH (National Institutes of Health), wrote:

Dietary control of lactose intolerance depends on people learning through trial and error how much lactose they can handle.

Products containing lactose

Most milk and milk products have lactose in them. Many processed foods have milk and milk products added to them. If you are lactose intolerant, check the labels carefully in these types of foods:
(list source: National Institutes of Health, USA):

• bread and other baked goods
• candies
• instant potatoes, soups, and breakfast drinks
• liquid and powdered milk-based meal replacements
• margarine
• non-dairy liquid and powdered coffee creamers
• non-dairy whipped toppings
• potato chips, corn chips, and other processed snacks
• processed breakfast cereals
• processed breakfast foods such as doughnuts, frozen waffles and pancakes, toaster pastries, and sweet rolls
• processed meats, such as bacon, sausage, hot dogs, and lunch meats
• protein powders and bars
• salad dressings
• waffles, pancakes, biscuits, cookies, and mixes to make them

Any product with milk, lactose, whey, curds, milk by-products, dry milk solids or non-fat dry milk powder listed in their labeling (ingredients) will have lactose in them.

Some medications, such as birth control pills and stomach acid medications have lactose in them. Patients with severe lactose intolerance should tell their doctor or pharmacist.

What are the complications of lactose intolerance?

If a person comes from a dairy-friendly society and tries to avoid lactose-containing products, he/she will have to make sure their move does not result in malnutrition. Milk contains calcium, proteins, vitamins A, B12 and D - all important nutrients for good health.

If you are embarking on a change of diet, make sure you ask your doctor or a qualified dietician/nutritionist what you should do.

Calcium is found in seaweeds, nuts and seeds, blackstrap molasses, beans, oranges, figs, quinoa, amaranth, collard greens, okra, rutabaga, broccoli, dandelion leaves, kale, and fortified products such as orange juice and soy milk

Vitamin A can be found in carrots, broccoli, sweet potatoes, cod liver oil, liver, spinach, pumkin, cantaloupe melon, egg, apricot, papaya, mango, and peas.

Vitamin D levels can be enhanced by exposure to natural sunlight, consuming fatty fish, eggs, fish liver oils, and some fortified soy milks and other fortified products.

Lactose free milk - this does exist. If you suffer from severe symptoms, make sure the lactose levels are zero, and not just reduced.

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What Is An Anal Fissure? What Causes An Anal Fissure?

An anal fissure is an anal tear, crack or ulcer in the lining of the anal canal - a cut or tear in the anus that extends into the anal canal. It is a common cause of red blood in the stool (feces) and toilet paper. According to rectal (colorectal) doctors, approximately one tenth of all their patient visits are for anal fissures. Patients commonly feel pain during and after a bowel movement.

Although most anal fissures are less than one centimeter across, the anus is an extremely sensitive part of the body, pain symptoms tend to be worse than one would expect from such a small tear.

Anal fissures can affect people of any age or sex equally. It is the most common cause of rectal bleeding in babies and children. Some children may find the sight of bright red blood in stools and toilet paper distressing.

In most cases, anal fissures resolve without the need for medical treatment or surgery. Topical creams and/or suppositories and OTC painkillers may help with symptoms. Some people, however, may experience chronic (long-term) problems if the lesion fails to heal properly.

According to Medilexicon's medical dictionary:

An anal fissure is a crack or slit in the mucous membrane of the anus, very painful and difficult to heal.

An anal fissure that lasts less than six weeks is called an acute anal fissure. A chronic anal fissure has symptoms for longer than six weeks. A primary anal fissure has not identifiable cause, while a secondary anal fissure does have an identifiable cause.

What are the signs and symptoms of an anal fissure?

The patient feels and describes a symptom, while other people, including the physician or nurse detect a sign. For example, headache may be a symptom while dilated pupils may be a sign.The main signs and symptoms of an anal fissure include:

• Pain - especially when going to the toilet (passing stools). During the passing of a stool the pain is sharp, and then afterwards there may be a longer deep burning sensation.
  
  Fear of pain may put some patients off going to the toilet, increasing their risk of having constipation. Unfortunately, after delaying going, when the person does go there is likely to be more pain and tearing because the stools will be harder and larger.
  
  Some people may experience a sharp pain when they clean themselves with toilet paper.
• Blood - because the blood is fresh, it will be bright red and may be noticed on the stools or the toilet paper. Anal fissures in infants commonly bleed. Children may be alarmed at the sight of bright-red blood in their stools or toilet paper.
• Itching - in the anal area. The sensation may be intermittent or persistent.
• Dysuria - discomfort when urinating (less common). Some patients may urinate more frequently.
• Pus - a malodorous (bad smelling) discharge of pus may come from the anal fissure.

What are the causes of anal fissure?

• Constipation - large, hard feces (stools) are more likely to cause lesions in the anal area during a bowel movement than soft and smaller ones.
• Muscle spasms - experts believe that anal sphincter muscle spasms may increase the risk of developing an anal fissure. A spasm is a brief, automatic jerking muscle movement, when the muscle can suddenly tighten. Muscle spasms may also undermine the healing process.
• Pregnancy and childbirth - pregnant women have a higher risk of developing an anal fissure towards the end of their pregnancy. The lining of the anus may also tear during childbirth.
• STIs (sexually-transmitted infections) - also known as STDs (sexually transmitted diseases) are linked to a higher risk of having anal fissures. Examples include syphilis, HPS (human papilloma virus), herpes and Chlamydia.
• Underlying conditions - some underlying conditions, such as Crohn's disease, ulcerative colitis and other inflammatory bowel diseases may cause ulcers to form in the anal area.
• Anal sex - can sometimes cause anal fissures (rare).

How is an anal fissure diagnosed?

A doctor, often a GP (general practitioner, primary care physician) will usually be able to diagnose an anal fissure after a physical examination of the anal area. If nothing is visible, gentle pressure onto the anal area will usually result in pain if there is an anal fissure.

Rectal exam - this involves inserting a gloved finger or small instrument into the rectum. Usually, however, the GP will not do this because it may cause too much pain. A specialist may apply anesthesia to the area before a rectal exam.

If the GP suspects there may be something more serious, the patient will be referred to a specialist.

Sigmoidoscopy or colonoscopy: a rigid or flexible viewing tube is used to inspect inside the anus and rectum. This diagnostic test may be ordered if the doctor wants to rule out a more serious disease of the anus.

What are the treatment options for an anal fissure?

In most cases an anal fissure will resolve within a few weeks. The doctor may recommend some medications to relieve symptoms of pain, burning or discomfort.

If the patient is suffering from constipation, a laxative may be prescribed. The individual will also be encouraged to increase his/her dietary fiber intake, which will help soften the stools. The National Health Service (NHS), UK says that adults should aim for at least 18 grams of fiber each day.

There is a risk of stomach cramps, wind, bloating and diarrhea if the fiber intake increase is rapid and too high. The increase should be done gradually.

The patient should make sure he/she is drinking plenty of fluids, preferably water.

Pain - the doctor may recommend a topical anesthetic. Topical means it is applied directly onto the skin. For the prolonged burning sensation after going to the toilet, Tylenol (paracetamol) or ibuprofen may help (ask your doctor or pharmacist). Some patients find that a warm (not too hot) bath helps relax the muscles and ease pain.

GTN (glyceryl trinitrate) - this medication helps speed up lesion healing by dilating the blood vessels in the area. The doctor may prescribe this medication if healing is slower than expected.

Calcium channel blockers - a medication originally designed to bring down high blood pressure; it also relaxes the sphincter muscle, as well as increasing the supply to blood to the affected area (which speeds up healing).

A steroid cream/ointment - will reduce inflammation around the lesion, which may help with symptoms of itching and pain.

Botulinum toxin (Botox) - used successfully for many disorders with muscle spasms.

Surgery - if the fissure is chronic (long-term) and does not heal, surgery may be an option.

A portion of the anal sphincter muscle is surgically removed, resulting in fewer and less severe spasms - this procedure is known as Internal sphincterotomy. According to the National Health Service (NHS), UK, about 95% of patients who undergo this procedure have good results.

A fissurectomy is the surgical removal of the fissure - this procedure is rare and may be used in children.

Preventing anal fissure

• Keep your stools soft - eat a well balanced diet with plenty of fiber. Make sure your fluid/liquid intake is adequate - remember that water is the best fluid.
• Don't delay going to the toilet - when you feel like going.. go! Don't put it off. If you do, the stools that eventually come through will be larger and harder.
• Babies - frequent diaper (UK: nappy) changes can reduce the risk of anal fissures developing in babies.
• Wiping - if you are susceptible, use moistened cloths or cotton pads to clean yourself after going to the toilet. Don't use rough and/or perfumed toilet paper.
• Exercise - regular exercise can reduce the risk of developing constipation, resulting in less risk of anal fissures. Make sure you are well hydrated during and after exercise (plenty of fluids).
• Straining - avoid straining and sitting in the toilet for a long time. If you like reading in the toilet and are susceptible to anal fissures, you may have to seriously consider not bringing any reading material with you to the toilet.

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19% Of Sexually Active Gay/Bisexual Men Are HIV Positive In Parts of US Cities

Almost one in every 5 sexually active gay/bisexual men, also known as MSM (men who have sex with men) is HIV positive, and 44% of them do not know they are infected, according to a CDC report - Morbidity and Mortality Weekly Report (MMWR) - published yesterday. According to the study involving 21 major cities in the United States, those most likely to be unaware of their HIV positive status are African-American and young individuals. To estimate and monitor risk behaviors, CDC's National HIV Behavioral Surveillance system (NHBS) collects data from metropolitan statistical areas (MSAs) using an anonymous cross-sectional interview of men at venues where MSM congregate, such as bars, clubs, and social organizations.

Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said:

This study's message is clear: HIV exacts a devastating toll on men who have sex with men in America's major cities, and yet far too many of those who are infected don't know it. We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among men who have sex with men.

These findings add weight to President Obama's recent drive for a National HIV/AIDS Strategy for the United States, which stressed that:

The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.

The President's strategy listed MSM as one of the few priority groups to focus HIV prevention endeavors. Lowering the number of HIV positive people who are unaware of their infection is one of its key targets, the CDC (Centers for Disease Control and Prevention) writes.

The study tested 8,153 sexually active gay/bisexual males in 21 cities for HIV who had taken part in the 2008 National HIV Behavioral Surveillance (NHBS) system. They calculated HIV awareness as well as prevalence among men who have sex with men.

NHBS tracks risk behaviors, access to medical and prevention services, and HIV testing among populations deemed to be of high risk in cities were the numbers of people living with AIDS is known to be high.

The report reveals that:

• 28% of African-American sexually active gay/bisexual men were infected
• 18% of Hispanic sexually active gay/bisexual men were infected (In the USA the term "Hispanic" tends to refer to people either from Latin America or with Latin American ancestry and not including Spain, while in the UK it means people from Spanish speaking countries, including Spain but not including Brazil)
• 16% of Caucasian sexually active gay/bisexual men were infected

There was a clear difference in HIV infection rates across socioeconomic groups. Rates were higher among people with lower income and academic levels, while awareness of their HIV status was higher as education and income increased. The report adds that previous studies had found similar statistics in heterosexual populations.

The authors also reveal that:

• 59% of African-American MSM who were HIV infected were unaware of their HIV status
• 46% of Hispanic MSM who were HIV infected were unaware of their HIV status
• 26% of Caucasian (white) MSM who were HIV infected were unaware of their HIV status
• MSM under the age of thirty were less likely to be HIV positive than older sexually active gay/bisexual men
• 63% of MSM under the age of 30 years who were HIV positive were unaware of their HIV status
• 30% of MSM over the age of 30 years who were HIV positive were unaware of their HIV status
• 71% of African-American MSM under the age of 30 years who were HIV positive were unaware of their HIV status
• 63% of Hispanic MSM under the age of 30 years who were HIV positive were unaware of their HIV status
• 40% of Caucasian MSM under the age of 30 years who were HIV positive were unaware of their HIV status

The following factors are most likely linked to low HIV status awareness among MSM, the authors write:

• Infections occurred recently
• They may have miscalculated their personal risk
• There were not enough opportunities to get tested
• A belief that the HIV threat is becoming less serious because of advances in treatment

Poverty, stigma, homophobia and limited health-care access will definitely make the Strategy more challenging, the report points out.

Jonathan Mermin, M.D., director of CDC's Division of HIV/AIDS Prevention, said:

For young men who have sex with men - including young men of color who are least likely to know they may be infected - the future is truly on the line. It is critical that we reach these young men early in their lives with HIV prevention and testing services and continue to make these vital services available as they become older.

The study authors believe that most new sexually transmitted infections occur among individuals who do not know they are infected, and that they take steps to protect their sexual partners as soon as they do know. Therefore, unawareness of HIV status is most likely a key factor in HIV transmission. Regular HIV testing among MSM, especially the younger ones is crucial.

The CDC recommends that MSM of all age and socioeconomic groups be tested at least once a year, and more frequently if they have multiple partners, anonymous partners, or use drugs during sex.

Less than half of the HIV positive MSM who did not know about their status had been tested during the previous 12 months.

Even though HIV prevention for sexually active gay/bisexual men is a priority, the CDC believes a lot more needs to be done to reduce the burden of HIV on MSM, as well as increasing access to prevention.

What is the difference between HIV and AIDS

AIDS stands for Acquired ImmunoDeficiency Syndrome.

• Acquired - means that the disease develops after birth, is not hereditary, from contact with a disease causing agent (in this case, HIV).
• Immunodeficiency - means that the disease is characterized by a weakening of the immune system.
• Syndrome - refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person's immune system.

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes.

In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

Put simply: HIV is the virus, while AIDS is the illness.

"Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men - 21 Cities, United States"
CDC MMWR September 24, 2010 / 59(37);1201-1207

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Majority Of Americans Will Have Diabetes Or Pre-Diabetes By 2020 - With Huge Financial Costs

Imagine a society where over half its people, i.e. the majority of them, are diabetic or prediabetic. There is a good chance this will happen in the USA by 2020. The estimated $3.35 trillion cost over the coming ten years is massive. A study by The Center for Health Reform & Modernization of UnitedHealth Group, an insurance company, reveals that if the current pattern continues, those figures will be a reality within the next ten years. The report offers some suggestions which may slow things down, and perhaps even turn them round.

By 2020, diabetes and prediabetes will use up approximately 10% of health care spending, the authors estimate. The current annual health care bill of $194 billion will shoot up to nearly $500 billion.

UnitedHealth says it produced the report for November's National Diabetes Awareness month. Suggestions within it could save as much as $250 billion over the coming decade. Included are potential savings to the government in Medicare, Medicaid, and other programs of $144 billion.

It is vital that lifestyle interventions that address obesity and prevent prediabetes from developing into full blown diabetes are put into action. Medication programs to ensure proper diabetes control are also important.

Simon Stevens, executive vice president, UnitedHealth Group, and chairman of the UnitedHealth Center for Health Reform & Modernization, said:

"Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it. What is now needed is concerted, national, multi-stakeholder action. Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models. Done right, the human and economic benefits for the nation could be substantial."

Average healthcare costs in the USA for people without diabetes stand at approximately $4,400, compared to $11,700 for those with the disease. For diabetes patients with complications, the average annual cost rises to $20,700. Add to this the impact on work productivity and employer costs and the numbers increase considerably.

Diabetes rates in the USA are growing at such a rate that it is now "one of the fastest-growing diseases in the nation." 27 million Americans are known to have diabetes, and a further 67 million are thought to be prediabetic.

Diabetes Type 2 can sometimes have no symptoms at all. The same is the case with prediabetes. The percentage of babies born after the year 2000 who will probably have diabetes some time during their lives is extremely worrying. Diabetes significantly increases the risk of blindness, nerve damage, limb amputation, kidney disease, cancer, and heart disease.

The authors of the report explain the link between obesity and diabetes type 2 risk. Over two-thirds of US adults and 17% of children are overweight/obese. The report stresses that overweight/obesity rates are still rising, and consequently so are/will diabetes and prediabetes risk. The majority of American overweight/obese adults either have diabetes type 2 or prediabetes. The authors quote studies which have shown a doubling of type 2 diabetes risk when a person puts on 11-16 pounds of body weight. Those who gain 17 to 24 pounds triple their risk.

Deneen Vojta, M.D., senior vice president of the UnitedHealth Center for Health Reform & Modernization, who helped develop UnitedHealth Group's Diabetes Prevention and Control Alliance, said:

"Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early and prevent this devastating disease before it's too late."

The report offers four solutions:

• Lifestyle intervention - public health initiatives and more extensive use of wellness programs could reduce diabetes/prediabetes human totals by up to ten million.
• Preventing prediabetes from becoming full blown diabetes - community-based intervention programs have been shown to reduce prediabetes rates, consequently lowering eventual diabetes rates.
• Medication and care compliance programs - to achieve better diabetes control. Well controlled diabetes significantly lowers the risk of complications. Another word for compliance is adherence (sticking to the treatment plan).
• Public-private partnerships for lifestyle intervention strategies - the authors explain that more extensive use of public-private partnerships to develop infrastructure would have a beneficial effect on prediabetes and diabetes rates.

"The United States of Diabetes: Challenges and Opportunities in the Decade Ahead" (PDF)

Source: UnitedHealth Center for Health Reform & Modernization (UnitedHealth Group)

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