Wednesday, August 8, 2012

Brain Coach Answers: How can I improve my short term memory? Is there a daily exercise I can do to improve it?

Q: How can I improve my mem­ory? Is there a daily exer­cise I can do to improve it?

A: The most impor­tant com­po­nent of mem­ory is atten­tion. By choos­ing to attend to some­thing and focus on it, you cre­ate a per­sonal inter­ac­tion with it, which gives it per­sonal mean­ing, mak­ing it eas­ier to remem­ber.

Elab­o­ra­tion and rep­e­ti­tion are the most com­mon ways of cre­at­ing that per­sonal inter­ac­tion. Elab­o­ra­tion involves cre­at­ing a rich con­text for the expe­ri­ence by adding together visual, audi­tory, and other infor­ma­tion about the fact. By weav­ing a web of infor­ma­tion around that fact, you cre­ate mul­ti­ple access points to that piece of infor­ma­tion. On the other hand, rep­e­ti­tion drills in the same path­way over and over until it is a well-worn path that you can eas­ily find.

One com­mon tech­nique used by stu­dents, is actu­ally, not that help­ful. Mnemonic tech­niques of using the first let­ter of each word in a series won’t help you remem­ber the actual words. It will help you remem­ber the order of words you already know. The phrase My Very Ener­getic Mother Just Screamed Utter Non­sense can help you remem­ber the order the plan­ets in our solar sys­tem, but it won’t help you recall the indi­vid­ual planet names: Mer­cury, Venus, Earth, Mars, Jupiter, Sat­urn, Uranus, Nep­tune.

These tech­niques do help you improve your mem­ory on a behav­ioral level, but not on a fun­da­men­tal brain struc­ture level. The main rea­son it gets harder for you to learn and remem­ber new things as you age is that your brain’s pro­cess­ing speed slows down as you get older. It becomes harder to do more than one thing at the same time, so it’s eas­ier to get con­fused. Your brain may also become less flex­i­ble, so it’s harder to change learn­ing strate­gies in mid-stream. All these things mean it becomes harder to focus. So far, there’s noth­ing you can do to change your brain’s pro­cess­ing speed, but there are tech­niques you can use to increase your learn­ing per­for­mance, even if your pro­cess­ing speed has slowed.


Alert­ness, focus, con­cen­tra­tion, moti­va­tion, and height­ened aware­ness are largely a mat­ter of atti­tude. Focus takes effort. In fact, most mem­ory com­plaints have noth­ing to do with the actual abil­ity of the brain to remem­ber things. They come from a fail­ure to focus prop­erly on the task at hand.

If you want to learn or remem­ber some­thing, con­cen­trate on just that one thing. Tune out every­thing else. The harder the task, the more impor­tant it is to tune out dis­trac­tions. (If some­one tells you they can do their home­work bet­ter with the TV or radio on, don’t believe it. Any speech or speech-like sounds auto­mat­i­cally use up part of your brain’s atten­tion capac­ity, whether you are aware of it or not.) In other words, it can be hard to do more than one thing at once, and it nat­u­rally gets harder as you get older. The solu­tion is to make more of an effort not to let your­self get dis­tracted until you’ve fin­ished what you have to do.


When you learn some­thing new, take breaks so that the facts won’t inter­fere with one another as you study them. If you’ve ever been to a movie dou­ble fea­ture, you know that you’ll have a hard time remem­ber­ing the plot and details of the first movie imme­di­ately after see­ing the sec­ond. Inter­fer­ence also works the other way. Some­times when your friend gets a new tele­phone num­ber, the old one will still be so famil­iar to you that it’s hard to remem­ber the new one.


Your brain remem­bers things by their mean­ing. If you spend a lit­tle effort extra up front to cre­ate mean­ing, you’ll need less effort later to recall it. When you read or hear a word you don’t already know — for exam­ple, “phocine” — your brain has to work harder. First, you have to remem­ber how to spell it long enough to look it up in a dic­tio­nary. There, you’ll see it means “seal-like” and it’s pro­nounced “fo-sine.” Now pic­ture a seal in your mind and repeat the word aloud. Even say “Fo! Fo! Fo!” aloud like a seal bark­ing. The sound of the word, its spelling, the image of a seal, and the bark­ing all work together to form mem­ory links. The more links the bet­ter to help you trig­ger the word later on, when you want to use it to describe, say, a sun­bather in a black one-piece.


Say you’re on vaca­tion in Maui, stay­ing at a beach­front hotel in room #386. How do you remem­ber that? Method num­ber one: Pause for a minute to take a men­tal snap­shot of your room door viewed from an out­side van­tage point. Then, when you return to that same van­tage point, you’ll know which door is yours. Method num­ber two: Stop and think for a minute. You’re on the third floor, which is the top floor of the hotel, so the num­ber 3 is easy. Now for the 8 and the 6. The expres­sion “to eighty-six” comes to mind — as in to get rid of, do away with, or throw out. As in what your boss will do to you if you decide to spend an extra week in Maui. Done.
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Brain Training Games: Context, Trends, Questions

A spate of recent news cov­er­age on brain fit­ness and “brain train­ing” reflects a grow­ing inter­est in nat­ural, non-drug-based inter­ven­tions to keep our brains sharp as we age. This inter­est is very timely, given the aging pop­u­la­tion, increas­ing Alzheimer’s rates, and soar­ing health care costs that place more empha­sis than ever on pre­ven­tion and chang­ing lifestyle.

This past Tues­day, the MIT Club of North­ern Cal­i­for­nia, the Amer­i­can Soci­ety on Aging, and Smart­Sil­vers spon­sored an event on The Emerg­ing Brain Fit­ness Soft­ware Mar­ket: Build­ing Bet­ter Brains to explore the real­i­ties and myths of this grow­ing field. The panel was mod­er­ated by Zack Lynch, Exec­u­tive Direc­tor of the Neu­rotech­nol­ogy Indus­try Orga­ni­za­tion, and com­posed of a ven­ture cap­i­tal­ist and 3 CEOs of pro­gram devel­op­ers in the field. Before the panel, I had the chance to present an overview of the state of the Brain Fit­ness Soft­ware Mar­ket based on our upcom­ing report to be released on March 4th.

Why are we talk­ing about this field at all? Well, for one, an increas­ing num­ber of com­pa­nies are achiev­ing sig­nif­i­cant com­mer­cial suc­cess in pack­ag­ing “brain exer­cise”. An exam­ple is the line of Nin­tendo games, such as Brain Age and Brain Train­ing, that have shipped over 15 mil­lion units world­wide despite lim­ited sci­en­tific sup­port, since 2005. What is less vis­i­ble is that a num­ber of com­pa­nies and sci­en­tists are part­ner­ing to bring prod­ucts to mar­ket with a more solid clin­i­cal val­i­da­tion. We esti­mate the US mar­ket was $225m in 2007 (grow­ing from $100 in 2005). Wheras K12 Edu­ca­tion used to be the major seg­ment, adult con­sumers are respon­si­ble for most of that growth: we esti­mate the con­sumer seg­ment grew from a few mil­lion in 2005 to $80 m in 2007.

Who is buy­ing these prod­ucts? Yes, of course, many adults over 50 who want to pro­tect their mem­ory are among the pio­neers. 78 mil­lion baby boomers are eager to try new approaches. A grow­ing num­ber of retire­ment com­mu­ni­ties and nurs­ing homes are offer­ing pro­grams to their res­i­dents to expand their usual fit­ness and social activ­i­ties. And we can’t for­get about K12 edu­ca­tion: cer­tain brain fit­ness soft­ware pack­ages have shown they can help kids who have dyslexia and related difficulties.

Is there sci­ence behind these claims? Do these prod­ucts work? It depends on how we define “work”. If “work­ing” means quan­tifi­able short-term improve­ments after a num­ber of weeks of sys­tem­atic “brain train­ing” to improve spe­cific cog­ni­tive skills, then the answer is that a num­ber of pro­grams do seem to work. If , on the other hand, “work­ing” means mea­sur­able long-term ben­e­fits, such as bet­ter over­all brain health as we age, or lower inci­dence of Alzheimer’s symp­toms, the answer is that cir­cum­stan­tial evi­dence sug­gests they may, but it is still too early to tell.

Are there any pub­lic pol­icy impli­ca­tions? We cer­tainly believe that there are. The Cen­ter for Dis­ease Con­trol recently part­nered with the Alzheimer’s Asso­ci­a­tion to develop a com­pre­hen­sive Cog­ni­tive Health roadmap to bet­ter guide research efforts and improve pub­lic edu­ca­tion on the lifestyle habits that every proud owner of a brain could ben­e­fit from fol­low­ing. Given the high rates of trau­matic brain injuries and stress dis­or­ders found in a large num­ber of the men and women com­ing home from the Iraq war, the mil­i­tary is invest­ing heav­ily in research to help iden­tify prob­lems to develop tools to solve them, and we expect that research will trans­late into wider health appli­ca­tions. No pres­i­den­tial can­di­date, to our knowl­edge, has directly addressed his or her pri­or­i­ties in the cog­ni­tive health realm but, given the grow­ing impor­tance and eco­nomic impact of brain-related dis­or­ders, we expect that to hap­pen soon.

What are some trends that exec­u­tives and investors should be look­ing at to under­stand this grow­ing mar­ket?

Let me make a few predictions:

1) An increased empha­sis on Brain Main­te­nance, from retire­ment com­mu­ni­ties to gyms and health clubs. Will health clubs one day offer brain fit­ness pro­grams, and per­haps “brain coaches”? We think so.
2) Bet­ter and more widely avail­able assess­ments of cog­ni­tive func­tion will enable of all us to estab­lish an objec­tive base­line of how our minds are evolv­ing, iden­tify pri­or­i­ties for “work­outs” and lifestyle inter­ven­tions, and help us mea­sure progress. Science-fiction? Not really. there are already pretty good tests used in clin­i­cal and med­ical envi­ron­ments, the chal­lenge will be to refine and pack­age those assess­ments in a consumer-friendly way.
3) We will see more and bet­ter computer-based tools, each of which may be more appro­pri­ate to work on spe­cific pri­or­i­ties. Just as we find a vari­ety of machines in health clubs today, in the future we can expect dif­fer­ent pro­grams tai­lored to train spe­cific cog­ni­tive skills.
4) More non-computer based tools will also pro­vide much value. There is more and more research on how med­i­ta­tion and cog­ni­tive ther­apy, to men­tion 2 exam­ples, can be very effec­tive in lit­er­ally re-wiring parts of the brain.
5) Insur­ance Com­pa­nies will intro­duce incen­tives for mem­ber who want to fol­low brain fit­ness pro­grams. Per­haps even com­pa­nies will offer such pro­grams to employ­ees to attract and retain mature work­ers who want access to the best and the lat­est inno­va­tions to keep their minds sharp.

Now, this being a pretty new field, the panel dis­cussed sev­eral open ques­tions, that will only be clar­i­fied with time:

– What is the right busi­ness model? are we talk­ing about content-driven edu­tain­ment? or ther­a­peu­tic appli­ca­tions, per­haps with some reg­u­la­tions by the FDA? sell­ing soft­ware prod­ucts? online sub­scrip­tions?

– What is the killer appli­ca­tion? fun games with unproven brain ben­e­fits? pro­grams that improve the men­tal skills involved in spe­cific activ­i­ties, such as dri­ving? appli­ca­tions that help slow down the pro­gres­sion from Mild Cog­ni­tive Impair­ment to full-blown Alzheimer’s symp­toms?

– How will con­sumers and insti­tu­tions receive qual­ity infor­ma­tion and edu­ca­tion to nav­i­gate through the emerg­ing research and the over­whelm­ing num­ber of new pro­grams, sep­a­rat­ing real­ity from hype?

In sum­mary, what were the main take-aways from the event?

1. Research indi­cates that a num­ber of cog­ni­tive abil­i­ties (atten­tion, mem­ory…) can be assessed and trained

2. An emerg­ing mar­ket is start­ing to develop-growing from an esti­mated $100m in 2005 to $225m in 2007, in the US alone-, and is poised to keep grow­ing at sig­nif­i­cant rates.

3. Many com­pa­nies are cur­rently sell­ing prod­ucts direct to con­sumers (as well as through insti­tu­tions) with some­times unclear claims — this threat­ens to con­fuse con­sumers and present a major obsta­cle to the growth and cred­i­bil­ity of the sector.
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Brain Training Top 10 Future Trends

In an emerg­ing, dynamic, high growth mar­ket, like brain train­ing, it is dif­fi­cult to make pre­cise pro­jec­tions. But, we can observe a num­ber of trends that exec­u­tives, con­sumers, pub­lic pol­icy mak­ers, and the media should watch closely in the com­ing years, as brain  fit­ness and train­ing becomes main­stream, new tools appear, and an ecosys­tem grows around it.

1. We pre­dict an increased empha­sis on brain main­te­nance in loca­tions rang­ing from retire­ment com­mu­ni­ties to gyms. As a computer-savvy baby boomer pop­u­la­tion looks for ways to stay men­tally fit, brain fit­ness, or brain train­ing, is becom­ing part of their vocab­u­lary and concern.

2. Phys­i­cal and men­tal exer­cise will be bet­ter inte­grated. Phys­i­cal exer­cise has been shown to increase the rate of neu­ro­ge­n­e­sis, whereas men­tal exer­cise helps ensure the sur­vival of any newly cre­ated neu­rons. Today both activ­i­ties usu­ally take place in very dif­fer­ent set­tings: the for­mer, in health clubs, the later, in uni­ver­si­ties. We pre­dict that the bor­ders between them will become more dif­fuse. Expect new pro­grams such as brain fit­ness pod­casts that allow us to train work­ing mem­ory as we jog or exer­cise bikes with built-in brain games.

3. Watch for a broad gov­ern­ment ini­tia­tive, sim­i­lar to the one JFK led, to increase the pub­lic aware­ness of the need for brain fit­ness. It is becom­ing more widely under­stood by the med­ical and pol­icy com­mu­nity that a com­bi­na­tion of phys­i­cal exer­cise, nutri­tion, men­tal exer­cise and stress man­age­ment can help us main­tain our brain health as we age. As politi­cians and pol­icy mak­ers look for ways to delay the onset of Alzheimer-related symp­toms of our aging pop­u­la­tion, new ini­tia­tives may be launched.

4. Bet­ter and more widely avail­able assess­ments of cog­ni­tive func­tion will serve as objec­tive base­lines to mea­sure the impact of cog­ni­tive train­ing inter­ven­tions. There will also likely be bet­ter diag­nos­tic tests to iden­tify early Alzheimer’s symp­toms, for exam­ple. Reli­able diag­nos­tic assess­ments of cog­ni­tive abil­i­ties will help move this field for­ward just as jump­ing on a scale tells you if your phys­i­cal fit­ness and diet pro­gram is working.

5. Improved computer-based tools will come to mar­ket. The grow­ing pipeline of research stud­ies will enable the mar­ket lead­ers and new entrants to refine exist­ing tools and devise new ones. More clin­i­cal stud­ies will show the ben­e­fits of brain fit­ness pro­grams to address spe­cific clin­i­cal con­di­tions and learn­ing disabilities.

6. Low tech options will play an increas­ing role in the brain fit­ness field. Already, increas­ing research is show­ing the cog­ni­tive value and brain plas­tic­ity impact of inter­ven­tions such as med­i­ta­tion and cog­ni­tive ther­apy. More research and wider appli­ca­tions will help refine our under­stand­ing of when and how they can be most helpful.

7. Doc­tors and phar­ma­cists will help patients nav­i­gate through the over­whelm­ing range of avail­able prod­ucts and inter­pret the results of cog­ni­tive assess­ments. This will require sig­nif­i­cant pro­fes­sional devel­op­ment efforts, given that most doc­tors today were trained under a very dif­fer­ent under­stand­ing of the brain than the one we have today.

8. Insur­ance com­pa­nies will intro­duce incen­tives for mem­bers to encour­age healthy aging. Many insur­ance plans today include rewards for mem­bers who, for exam­ple, vol­un­tar­ily take health-related ques­tion­naires that enable them to iden­tify steps to take to improve health. Increas­ingly, brain-related lifestyle fac­tors will become part of these incen­tivized interventions.

9. Invest­ments in new cog­ni­tive inter­ven­tions for the U.S. mil­i­tary will be com­mer­cial­ized. As the mil­i­tary increas­ingly funds research to improve the diag­nos­tic and treat­ment of prob­lems such as PTSD and TBI, the result­ing prod­ucts will ulti­mately find com­mer­cial uses.

10. Brain train­ing will be added to cor­po­rate well­ness and lead­er­ship ini­tia­tives. Large employ­ers with exist­ing cor­po­rate well­ness and lead­er­ship pro­grams will intro­duce brain fit­ness spe­cific pro­grams aimed not only at improved health out­comes but also at increased pro­duc­tiv­ity and cog­ni­tive per­for­mance in the workplace.

These pre­dic­tions come from our ground­break­ing Mar­ket Report titled The State of the Brain Fit­ness Soft­ware Mar­ket 2008,
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The Ten Habits of Highly Effective Brains

Let’s review some good lifestyle options we can fol­low to main­tain, and improve, our vibrant brains.

1. Learn what is the “It” in “Use It or Lose It”. A basic under­stand­ing will serve you well to appre­ci­ate your brain’s beauty as a liv­ing and constantly-developing dense for­est with bil­lions of neu­rons and synapses.
2. Take care of your nutri­tion. Did you know that the brain only weighs 2% of body mass but con­sumes over 20% of the oxy­gen and nutri­ents we intake? As a gen­eral rule, you don’t need expen­sive ultra-sophisticated nutri­tional sup­ple­ments, just make sure you don’t stuff your­self with the “bad stuff”.
3. Remem­ber that the brain is part of the body. Things that exer­cise your body can also help sharpen your brain: phys­i­cal exer­cise enhances neurogenesis. 

4. Prac­tice pos­i­tive, future-oriented thoughts until they become your default mind­set and you look for­ward to every new day in a con­struc­tive way. Stress and anx­i­ety, no mat­ter whether induced by exter­nal events or by your own thoughts, actu­ally kills neu­rons and pre­vent the cre­ation of new ones. You can think of chronic stress as the oppo­site of exer­cise: it pre­vents the cre­ation of new neurons.

5. Thrive on Learn­ing and Men­tal Chal­lenges. The point of hav­ing a brain is pre­cisely to learn and to adapt to chal­leng­ing new envi­ron­ments. Once new neu­rons appear in your brain, where they stay in your brain and how long they sur­vive depends on how you use them. “Use It or Lose It” does not mean “do cross­word puz­zle num­ber 1,234,567″. It means, “chal­lenge your brain often with fun­da­men­tally new activities”.
6. We are (as far as we know) the only self-directed organ­isms in this planet. Aim high. Once you grad­u­ate from col­lege, keep learn­ing. The brain keeps devel­op­ing, no mat­ter your age, and it reflects what you do with it. 

7. Explore, travel. Adapt­ing to new loca­tions forces you to pay more atten­tion to your envi­ron­ment. Make new deci­sions, use your brain. 

8. Don’t Out­source Your Brain. Not to media per­son­al­i­ties, not to politi­cians, not to your smart neigh­bour… Make your own deci­sions, and mis­takes. And learn from them. That way, you are train­ing your brain, not your neighbour’s.
9. Develop and main­tain stim­u­lat­ing friend­ships. We are “social ani­mals”, and need social inter­ac­tion. Which, by the way, is why ‘Baby Ein­stein’ has been shown not to be the panacea for chil­dren development. 

10. Laugh. Often. Espe­cially to cog­ni­tively com­plex humor, full of twists and sur­prises. Bet­ter, try to become the next Jon Stewart

Now, remem­ber that what counts is not read­ing this article-or any other-, but prac­tic­ing a bit every day until small steps snow­ball into unstop­pable, inter­nal­ized habits…so, pick your next bat­tle and try to start improv­ing at least one of these 10 habits today. Revisit the habit above that really grabbed your atten­tion, click on the link to learn more, and make a deci­sion to try some­thing dif­fer­ent today!


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Tattoo, Piercing And Breast Implantation Infections

16th European Congress of Clinical Microbiology and Infectious Diseases

Nice, France - In the USA, Canada, Australia and Northern Europe, between 8 and 13% of the population has tattoos and/or piercings, Jean-Baptiste Guiard-Schmid of the Paris Rothschild Hospital reported during the 16th European Congress of Clinical Microbiology and Infectious Disease (ECCMID). The congress, which is organized by the European Society of Clinical Microbiology and Infectious Disease (ESCMID), is currently underway in Nice and ends today.

In the USA alone, according to figures gathered in 2000, some 7 to 20 million Americans have tattoos, Guiard-Schmid said. Those with tattoos and piercings spanned various age and socio-economic groups. While piercings are more commonly found among teenagers; tattoos appear to be more popular with adults between the ages of 18 and 30. Other more extreme body modifications (scarification, foreign body implants, branding) are performed by a limited number of practitioners.

The main health complications associated with piercing and tattooing include infections, pathologic healing, allergic reactions, tissue damages, bleeding and odonto-stomatologic lesions.

Local bacterial infections are rare after tattooing but develop frequently from piercings, although they are usually minor. Between 10 to 20% of piercings are associated with local benign bacterial infection, according to the results of the few available studies on the topic. Typical symptoms of a local bacterial infection are redness, swelling, fever and pain. The main pathogens causing local infections, e.g. suppuration or abscesses, are Staphylococcus aureus, group A streptococcus and Pseudomonas spp. Impetigo has also been identified and is caused by Streptococcus pyogenes.

These infections may become chronic and lead to local pyogenic granuloma (also called botryomycoma). Bacterial infections occurring as a result of piercing rarely spread and rarely lead to severe or life-threatening infections. Erysipelas and cellulitis have been observed with S. aureus and S. pyogenes aetiology. Anecdotal case reports of leprosy, tuberculosis, syphilis, chancroid and tetanus have also been published in recent years.

The use of unsterilized needles, needle bars and tubes, forceps, jewelery, scalpels, dermographs and contaminated pigments can result in blood-borne infections, such as hepatitis B, C and HIV infection. HBV and HCV transmission have been well documented in cases reported about Dutch piercing shops in 1997 and in London tattooist shops during the late seventies. Similarly acute hepatitis C apparently originated from tattooing in an Australian prison population in 2001.

These viral infections may be asymptomatic in their early phases and therefore rarely diagnosed. Thus, their relationship to body modifications is not always realized. Piercing and tattooing are identified as risk factors for viral hepatitis in more than 20 epidemiological studies currently available. But debate continues among some authors who think that it is difficult to distinguish body modifications from other risk factors (use of intravenous drugs, incarceration, etc.) in the studied populations. Even if hepatitis B and C virus transmission rates are very low, the number of body modifications performed each year probably accounts for a significant number of hepatitis cases. Fortunately, the HBV vaccination should prevent at least half of these cases. HIV transmission has been documented by a case reported in 1997. The patient had been contaminated in a period of 3 months during which he underwent six piercings in different parts of his body, performed in different piercing shops in Europe and the USA. There were no biomolecular data on HIV strains in this report. The theoretical risk is probably very low since HIV is a fragile virus. However, piercing of genitals may be a risk factor for HIV infection, according to some authors. Piercers and tattooists generally work without medical supervision, and techniques are often passed on from one piercer or tattooist to another directly. Even though they have become very common, body modifications still exist within a context of "epidemiological silence". However, they have a significant impact on public health and concern all health care professionals, ranging from general practitioners to emergency units. Regulations on body modifications are heterogeneous, especially in Europe.

People seeking cosmetic breast surgery must be aware of the risk of infection. In fact, 2.5% of prostheses result in infection. This should be taken into consideration by those facing a mastectomy and wanting to reconstruct their breasts, Didier Pittet of the University of Geneva reported at the ECCMID.

Breast implants have to be divided into two categories: augmentation and reconstruction. In all the cases some adverse effects could occur: infections, wound dehiscence, capsular contracture, implant rupture, etc. But infection rates are 10-fold higher in breast reconstruction than in aesthetic implants.

Major predisposing and risk factors include pre-existing scarring, radiation therapy, simultaneous mastectomy or lymph node dissection. The origin of infection can be a contaminated implant, contaminated saline within the implant, contamination of the saline implant (some implants need to be filled by the surgeon during the intervention), contaminated surgical environment, seeding of the implant by remote infection.

Usually infections occur during the first month after implantation (on average between 10-12 days) and cause fever, rapidly evolving pain, marked breast erythema. The only way to deal with such effects is the surgical removal of the implants.
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Green Tea Polyphenols May Cause Liver Damage In High Doses

The polyphenols present in green tea plants or herbs could pose health risks to humans if extracted and packaged in highly concentrated doses, says a new University of Toronto study published in the current issue of Free Radical Biology and Medicine.

In small mammals, green and black tea phenolics -- a class of chemical compounds found in plants that include polyphenols -- have been proven to contain antioxidants that help reduce the risk of cancer and cardiovascular disease. Findings such as these have helped to make these teas popular choices among health-conscious tea drinkers around the world.

Working with a team of graduate students, Professor Peter O'Brien of the Leslie Dan Faculty of Pharmacy injected low and concentrated doses of polyphenols into mice. At low doses, "good" polyphenols protected the liver or isolated liver cells against oxygen radicals, while "bad" polyphenols caused liver toxicity at high concentrations.

"The low concentration is roughly equivalent to what people consume when they drink green or black tea," O'Brien says. "But the health benefits are not clear as only a small amount of the polyphenols in the teas seems to get absorbed across the intestine. We won't know how much is absorbed or metabolized without running large clinical trials involving humans."

O'Brien has no plans to stop drinking green or black tea anytime soon, but cautions those who might want to exploit the antioxidant and health promoting properties of tea polyphenols against consuming concentrated doses in pill form as this could create more health problems than it might fix.

"New drugs are subjected to exhaustive clinical trials," he says. "Our findings demonstrate that there simply isn't enough known at this time to substantiate green tea's health-promoting properties if taken in high concentrations."
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Medical Condition Causes Boys, Men To Grow Breasts

Who would think an invitation to a beach, lake, or pool party could strike terror in a boy's -- or man's -- heart? Yet these summer pastimes can seem a fate worse than death for a boy or man with gynecomastia, the development of breast tissue that leads many males to hide in shame and humiliation.

In his new book, Demystifying Gynecomastia: Men With Breasts, psychotherapist Merle Yost reports that up to one-third of males may have to deal with problem gynecomastia at some time. Although adolescent onset is most common, adult-onset gynecomastia is on the rise with men's increased use of prescription drugs -- including anti-depressants -- and this country's obesity epidemic.

Yost himself has been affected since age 11. "I was a skinny little boy who grew noticeable A-cup breasts," says Yost. "They called me 'tits' in junior high. Girls offered bras; boys twisted and taunted." He suffered through school, hiding his body as best he could.

After breast reduction surgery at age 34, Yost posted a gynecomastia page on his therapy practice website. It got so much traffic that he launched a dedicated site,, a free information and discussion service that now gets 1.2 million hits per year.

Gynecomastia can be a normal part of adolescence, with a mild form affecting up to 70 percent of boys. Their livers can't keep up with the testosterone raging through their bodies, Yost explains, and what the liver can't process converts to estrogen, causing painful nipples, puffy breasts or both. This usually disappears once the liver adjusts. But for some, breast growth is obvious and permanent, causing emotional harm and life-long body self-consciousness.

Yost says many doctors know little about gynecomastia and assure boys they'll grow out of it. Millions don't, however, instead growing up humiliated and ashamed.

Yost's book is sprinkled with heart-wrenching quotes:

-- "I haven't taken my shirt off in public since I was 8."

-- "I have back pain because I slump over to try to reduce the effect."

-- "I pretend to be a strong, carefree individual, when in fact I hate myself sometimes."

"Gynecomastia itself is benign -- it's simply development of a secondary female characteristic," says Yost. "It signals underlying issues that may need treatment, from a pituitary gland tumor or liver dysfunction to weight gain."

Recent increases in the use of steroids, certain anti-depressants, acid reflux, blood pressure and prostate drugs are causing a wave of adult-onset gynecomastia.

Demystifying Gynecomastia explains the condition, causes and potential solutions. The book is available online at
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Bird Flu Has Now Hit 35 Countries - See The List

In 2003 bird flu (H5N1) was found in Vietnam, South East Asia. It gradually moved its way further into Asia. Over the past few months the geographic spread has taken on a new speed, like a snowball going down a hill gaining momentum. Now (28 February, 2006) 35 countries have been hit by the bird flu virus.

Here is the list

-- Austria
-- Azerbaijan
-- Bulgaria
-- Cambodia
-- China (human cases confirmed)
-- Croatia
-- Cyprus
-- Egypt
-- France
-- Germany
-- Greece
-- Hungary
-- India
-- Indonesia (human cases confirmed)
-- Iran
-- Iraq (human cases confirmed)
-- Italy
-- Japan
-- Kazakhstan
-- Kuwait
-- Laos
-- Malaysia (human cases confirmed)
-- Mongolia
-- Niger
-- Nigeria
-- Romania
-- Russia
-- Slovakia
-- Slovenia
-- South Korea
-- Sweden
-- Thailand (human cases confirmed)
-- Turkey (human cases confirmed)
-- Ukraine
-- Vietnam (human cases confirmed)

Perhaps there are more, maybe there are some dead birds lying around in some other countries that we have not yet found, who knows? It is strange that North Korea, which borders countries that have reported bird flu in their territories (South Korea and China) does not appear on the list.

How many countries bordering Nigeria perhaps already have the virus? So far, only Niger has confirmed the presence of infected birds.

Is there anywhere that is safe from bird flu? According to ornithologists, only Australia and New Zealand stand a chance of staying out of this unpleasant league of bird flu infected countries. Australia and New Zealand do not lie in the paths of bird migration.

(The H5N1 virus itself was first detected in Hong Kong, in 1997)
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Cream Makes Skin Produce Sunless Tan

A cream which has been shown to trigger the skin to produce a tan without direct exposure to sunlight has been developed by scientists at the Dana-Farber Cancer Institute and Children's Hospital Boston, USA. Studies on genetically engineered, fair-skinned, red-haired mice, were successful.

You can read about this experiment in the journal Nature.

The mice were genetically engineered to have a disorder called xeroderma pigmentosum, their skin behaves in a similar way to skin of fair-skinned and/or red-haired people who do not tan, but burn when exposed to UV radiation (sunlight). The cells in their skin can't repair DNA damage caused by radiation.

The cream makes the skin behave as if it were hit by the sun's ultraviolet light. Fair-skinned people, as well as people with red hair, do not tan properly. They have a MC1R defect, a receptor which when triggered produces pigmentation. This defect means lower production of cAMP, a chemical which stimulates the melanocytes to produce pigmentation. In simple terms, this means that these people do not tan - they burn when exposed to sunlight. Many people with this rare genetic disorder have to stay in indoors while the sun is shining.

The more your skin is burned when exposed to sunlight the higher your chances are of developing skin cancer.

The scientists applied a cream, which contained Forskolin, a chemical from the Forskohli plant, a tropical mint plant from India, to the skin of the mice. Forskolin is known to raise cAMP levels. The mice's skin got darker as a result - they developed a tan. The scientists found that the tan looked virtually identical to the tan achieved from exposure to the sun.

If human skin reacts in the same way to this cream, it will mean that fair-skinned and/or red haired people can be triggered to produce the same pigmentation.

Apart from developing a sunless sun tan, the cream also seems to protect the skin better from exposure to UV light, meaning better protection from skin cancer.

Whether or not this cream can benefit humans in the same way as the genetically-engineered mice remains to be seen. Human skin is much thicker than the skin of mice. The cream needs to penetrate deeply enough to trigger the production of pigments.

Dr David Fisher, team leader, said "These studies suggest that a drug-induced rescue of the tanning mechanism may correspondingly rescue at least some aspect of skin cancer protection. Such sunless tanning may also dissuade sun-seeking behaviours, which undoubtedly contribute significantly to high skin cancer incidence."

Topical drug rescue strategy and skin protection based on the role of Mc1r in UV-induced tanning
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Beans That Don't Give You Wind

Beans are nourishing and a staple food in many parts of the world. The only concern many people have with eating beans is the flatulence they bring on. 'Don't eat beans before a meeting,' I was often told when I was a young man.

A team of scientists from Simon Bolivar University, Caracas, Venezuela, have developed a way of preparing beans that don't fill you up with gas later on. It involves fermenting the beans with a bacterium that reduces the level of compounds which cause flatulence.

If your food, especially fibre, has not been digested early on, it will end up in the large intestine undigested, containing many compounds which produce gas when digested. There are bacteria in the large intestine which break down this undigested food - if it contains these fibres, gas will be produced. Beans are full of these compounds.

The researchers found that if you naturally ferment beans with a bacteria called Lactobacillus casei, they contain lower amounts of these compounds. Raffinose, a wind-causing compound found in beans, was reduced by 88% with this method. Soluble fibre content went down by over 60%. The amount of insoluble fibre went up 97%. Insoluble fibre is the good fibre, it helps rid the intestines of toxins.

Therefore, this method could have two benefits:

1. People can eat beans and fart less.
2. The beans will be better, nutritionally.

Nutritionists stress that beans, even if they may cause flatulence, are good for you. Flatulence, in itself, is not bad for the health. Flatulence's undesirability is due to social factors.

Bear in mind that excess flatulence may be a symptom of some gastrointestinal problem, such as IBS.

You can read about this in the Journal of the Science of Food and Agriculture.
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Puricase, First New Drug Treatment Approach For Gout In 40 Years, Could Potentially Revolutionise Treatment For Some

The first new class of drug to emerge in 40 years for treating chronic gout has the potential to radically alter the outlook for thousands of patients unable to benefit from currently available therapies, says the drug's developer Savient Pharmaceuticals Inc. who presented Phase II data at this year's annual meeting of the European rheumatology community, EULAR.

Puricase (PEG-Uricase), a drug currently in Phase III clinical trials has been shown in smaller trials to rapidly eliminate body stores of excess uric acid (urate). Uric acid can lead to the formation of crystals which are deposited in joint tissues where they accumulate as tophi causing pain and inflammation. Often these clump together to form disfiguring nodules. Gout has been described as the most painful of all rheumatological conditions.

Savient Pharmaceuticals Inc, the small New Jersey-based company developing the treatment says Puricase is a polyethylene-glycolated recombinant version of the porcine enzyme, uricase. All mammals except humans and primates produce the uricase enzyme which breaks down uric acid leaving very low levels in the blood circulation with no untoward effects. Uricase converts uric acid to the more water-soluble metabolite allantoin that can be readily excreted.

The drug is administered by two-hour intravenous infusions every two or four weeks and would probably be indicated initially for patients with hyperuricaemia - excess blood levels of uric acid resulting in severe tophaceous gout, resistant to or intolerant of conventional therapy.

In the US around 3 to 5 million people suffer from gout and similar numbers are affected in Europe. A tendency to develop the condition is genetically determined but beer-drinking and consumption of purine-rich, high protein foods are implicated to a small extent in its development. Gout typically develops in men in their 40s or 50s or less frequently in women after menopause. Treatment is based either on inhibiting production of uric acid or increasing its excretion. In addition, tissue inflammation can be treated with colchicine or non-steroidal anti-inflammatory drugs (NSAIDs).

Some 2 million people in the US are treated with allopurinol tablets - a drug that decreases the production of urate by inhibiting another enzyme, xanthine oxidase. Up to 5 per cent of patients are unable to tolerate allopurinol, however, because of adverse reactions of which the most serious is a life-threatening sensitivity reaction. In others, the drug can be ineffective. Approximately a quarter to one third of all gout sufferers - around half a million people in the US -develop tophi and gout flares despite conventional therapy, said Savient's Chief Medical Officer Zeb Horowitz.

Puricase has been shown in Phase II trials to successfully and rapidly reduce plasma urate levels and gouty tophi. President and CEO Christopher Clement commented: "Puricase is increasingly being recognised among the rheumatological community as a potential breakthrough treatment for this orphan gout patient population." Anecdotal reports testify to patients on Puricase treatment finding themselves able to wear normal shoes again or use their fingers properly, he noted.

Savient presented several posters at EULAR. One showed photographic and radiographic evidence of the dramatic effects that Puricase can achieve in individuals who have failed other treatments. Phase II data show 8mg of PEG-uricase every two weeks achieved rapid reductions in plasma urate to below target levels which were maintained 92 per cent of the study duration. Pre-treatment levels of 9.1mg/dl were reduced to a mean plasma urate level of 1.4mg/dl over 12 weeks. A level of 6mg/dl is required to avoid flares.

Dr Herbert Baraf, a US rheumatologist and Puricase trialist from Wheaton, Maryland, US, said conventional treatment, if effective, reduces uric acid levels very slowly taking up to five years to obtain complete resolution of painful tophi. Puricase however is able to radically reduce uric acid crystal stores within three to 12 months.

"Many physicians and patients believe older therapies are sub optimal and want better treatments," commented Dr Horowitz. Early intervention with Puricase as an alternative to conventional therapy could potentially prevent the accumulation of uric acid crystals that form tophi and keep patients from experiencing flares, he suggested. However, this would have to be the topic of further investigations. Puricase would need to be administered over six to 12 months only to eradicate body stores of uric acid. Because uric acid stores take decades to build up to the level where they cause symptoms, no further treatment might be needed. Most gout therapies however need to be taken regularly for life.

Savient has world rights to Puricase, which was originally developed by researchers at Duke University in North Carolina, and will market it in the US itself. It is currently seeking a partnership with a European company to develop Puricase for the European gout market.
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Revealed Why H5N1 Is So Deadly For Humans

The H5N1 bird flu strain has killed over half of the 241 humans it has infected since 2003. A team of scientists from the Oxford University Clinical Research Unit may have found out why H5N1 bird flu infection is so much more deadly than normal human influenza viruses. It is all to do with the patient's viral load and the subsequent inflammatory response.

You can read about this study in Nature Medicine.

Before the study the team had noted that H5N1 causes severe disease in humans, but why it is virulent was unclear. In vitro and animal studies had indicated that high viral load is important for disease pathogenesis. They wanted to asses the relevance of these findings for human patients.

The researchers looked at 27 people at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. 18 of them had been infected with H5N1 while the other 9 had been infected with normal human influenza virus subtypes.

They found that those infected with H5N1 had much higher viral loads - concentrations of H5N1 in their blood and pharynx (throat) - than those with normal human flu. They also found that the H5N1 infected patients who had died had much higher viral loads than the H5N1 infected patients who did not die.

Those with a high H5N1 viral load had the highest levels of cytokines. Cytokines control your body's response to infection. The patients who died also had much lower levels of T-lymphocytes.

Put simply, it means that the higher level of H5N1 a patient has, the greater are his/her chances of dying.

High levels of cytokines, low levels of of lymphocytes, and the resulting intense inflammatory responses, probably contributed to more severe lung damage and a greater chance of death, say Dr. Menno and team. They stressed that preventing this intense cytokine response should be the focus of clinical management. This entails early diagnosis and effective antiviral treatment.

This research points to swift and effective use of antivirals, such as Tamiflu or Relenza, in order to prevent virus levels from rising too fast.

Menno D de Jong, Cameron P Simmons, Tran Tan Thanh, Vo Minh Hien, Gavin J D Smith, Tran Nguyen Bich Chau, Dang Minh Hoang, Nguyen Van Vinh Chau, Truong Huu Khanh, Vo Cong Dong, Phan Tu Qui, Bach Van Cam, Do Quang Ha, Yi Guan, J S Malik Peiris, Nguyen Tran Chinh, Tran Tinh Hien & Jeremy Farrar
Nature MedicinePublished online: doi:10.1038/nm1477
Click Here To View Abstract Online
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What Is Bipolar Disorder? Bipolar Symptoms And Treatments

Bipolar disorder - also known as manic-depression or manic-depressive illness - is a mental illness characterized by mood instability that is often serious and disabling. A person with bipolar disorder has unusual shifts in mood, energy, and ability to function that can last for weeks or months. The fluctuations of bipolar disorder are different from the general "ups" and "downs" that everyone goes through because symptoms are severe and can result in damaged relationships, poor job or school performance, or even suicide. There are treatments available for bipolar disorder that have allowed people to lead full and productive lives.

Bipolar disorder can be classified into the following types:

  • Bipolar I disorder: At least one manic episode, with or without previous depressive episodes.

  • Bipolar II disorder. At least one episode of depression and at least one hypomanic episode (a brief and less severe manic episode). The periods of depression are usually much longer than the periods of hypomania in bipolar II disorder.

  • Cyclothymia: A mild form of bipolar disorder with mood swings and less severe highs and lows compared to full bipolar disorder.
Many people have their first symptoms of bipolar disorder during late adolescence or early adulthood, but some have first symptoms during childhood and others later in life. People often suffer for years because it can be difficult to diagnose and, therefore, may not be properly treated.

What causes bipolar disorder?

Although we do not know the exact cause of bipolar disorder, there are several factors that are thought to be associated with causing the disorder and triggering bipolar episodes. For example, physical changes in the brain have been observed by analyzing biochemicals in the brains of people with bipolar disorder. Brain chemicals called neurotransmitters and certain hormonal imbalances are likely involved in triggering episodes.

Bipolar disorder may also be a hereditary condition. That is, the disorder is more common in people who have family members that also have the condition. Currently it is unknown which genes are responsible for bipolar disorder.

Environmental factors - such as self-esteem problems, significant loss, childhood trauma, or high stress - may also cause bipolar disorder or bipolar episodes.

What are the symptoms of bipolar disorder?

Symptoms of bipolar disorder differ from the periods of lows and highs - the episodes of depression and mania. The changes in mood occur with similar changes in energy and behavior. Although symptoms may vary from person to person, a summary of common ones is below.

Signs and symptoms of manic episodes (mania):
  • Euphoria
  • Excessively "high," overly good mood
  • Inflated self-esteem
  • Poor judgment
  • Rapid speech and racing thoughts
  • Aggressive and intrusive behavior
  • Agitation and extreme irritability
  • Increased energy, activity, and restlessness
  • Risky behavior
  • Spending sprees
  • Increased drive to perform or achieve goals
  • Increased sexual drive
  • Decreased need for sleep
  • Tendency to be easily distracted and difficulty concentrating
  • Drug abuse, particularly cocaine, alcohol, and sleep aides
  • Unrealistic beliefs in one's abilities and powers
  • Denial that anything is wrong
Signs and symptoms of depressive episodes (depression):
  • Sadness
  • Feeling of emptiness
  • Hopelessness or pessimism
  • Decreased energy
  • Suicidal thoughts or behavior
  • Anxiety
  • Guilt, worthlessness, and helplessness
  • Sleep problems
  • Appetite problems
  • Unintentional weight gain or loss
  • Fatigue
  • Loss of interest in daily activities
  • Lack of desire for sex
  • Problems concentrating
  • Difficulty making decisions
  • Irritability
  • Chronic pain without a known cause

Who is at risk of having bipolar disorder?

About one percent of the population has bipolar disorder, but this number is estimated to be as high as six percent when additional forms of the disorder and undiagnosed or misdiagnosed cases are taken into consideration. Although bipolar I disorder affects men and women equally, bipolar II disorder is much more common in women. Both sexes are at highest risk between the ages of 15 and 30. Additional risk factors include a family history of bipolar disorder, periods of high stress, drug and alcohol abuse, and significant life changes such as the death of a loved one.

How is bipolar disorder diagnosed?

In order to diagnose bipolar disorder, physicians will conduct a series of tests. A standard physical exam will provide information on height and weight, heart rate, blood pressure, heart and lung function, and abdominal state. Blood and urine may be sent to a laboratory for a complete blood count (CBC), thyroid test, and urinalysis.

The key piece of the bipolar diagnosis comes from a psychological evaluation. Thoughts, feelings, and behaviors will be evaluated by a mental health provider such as a psychologist or psychiatrist. The doctor may ask about alcohol and drug abuse and may ask to talk to close friends and family members in order to better understand symptoms and the events during mania or depressive episodes.

A diagnosis of bipolar I disorder usually requires one or more manic or mixed episodes with or without a major depressive episode. A bipolar II disorder diagnosis usually requires hypomanic episodes and at least one major depressive episode. A diagnosis of cyclothymia usually requires a presence or history of hypomanic episodes with periods of depression, but not major depressive episodes.

Bipolar disorder treatments

Bipolar disorder treatments primarily consist of medications and psychotherapy. In order to reduce the frequency and severity of both manic and depressive episodes, it is important to treat the disorder during episodes and during periods of remission. Additional complications, such as alcohol or substance abuse, should also be treated since they may exacerbate bipolar disorder symptoms.

A psychiatrist or other mental health professional may prescribe one or several medications to help control bipolar disorder. Because many medications have side effects like diabetes, obesity and high blood pressure, it may take some time to find the optimal treatment regimen.

Common medications prescribed to treat bipolar disorder include:
  • Mood stabilizers - Lithium, for example, is one of the most frequently prescribed medications for bipolar disorder.

  • Anti-seizure medications (anticonvulsants) - Valproic acid, divalproex, and lamotrigine are often used as mood regulators.

  • Antidepressants - Though they may lead to manic episodes, antidepressants have been carefully prescribed for bipolar disorder.

  • Atypical antipsychotics and anti-anxiety - Olanzapine, risperidone, and quetiapine are common antipsychotics, and benzodiazepines are common anti-anxiety drugs.
Psychotherapy treatments for bipolar disorder include:
  • Cognitive behavioral therapy - Individual therapy that focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones as well as managing stress and coping with upsetting situations.

  • Family therapy - Group therapy that focuses on identifying and reducing stressors within your family and improving communication and problem-solving.

  • Group therapy - With other bipolar disorder sufferers that focuses on communication and learning from others.
An additional treatment for bipolar disorder is electroconvulsive therapy (ECT) - electricity is passed through the brain to trigger a seizure. It is primarily for those who have episodes of severe depression with suicidal tendencies or for people who have not seen improvements in their symptoms after other treatments. Sometimes, people with bipolar disorder may benefit from inpatient hospitalization and psychiatric treatment.

How is bipolar disorder prevented?

Unfortunately, there is no sure way to prevent bipolar disorder. Treatment at the earliest sign of mental health disorder can help prevent bipolar disorder from worsening, and long-term preventive treatment can help prevent minor episodes from becoming full manic or depressive episodes.
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Eye Infection In 17 States Caused By Lense Solution, FDA Warns

The FDA and the CDC have issued an alert to health care professionals and patients about a lense solution that can cause a rare eye infection caused by a fungus, Fusarium. The infection is rare, but serious - and can cause permanent loss of vision.

The FDA reports that several patients have experienced significant loss of vision. Many have needed corneal transplants.

Investigators have identified the fungus as Fusarium. Since April 9, 109 cases of Fusarium Keratitis are being investigated by the CDC and authorities in 17 US states.

Dr. Daniel Schultz, FDA's Center for Devices and Radiological Health Director, said "This is a serious infection and soft contact lens users should be mindful of the potential to develop this problem. We're advising consumers to practice good basic hygiene and follow manufacturers' instructions for proper use, cleaning and storage of their lenses, and report any signs of infection to their doctors."

Authorities are advising clinicians who diagnose microbial keratitis to refer their patient to an ophthalmologist, if appropriate to obtain a specimen for lab analysis.

The FDA and CDC urgently advise contact lens users to make sure their soft lenses and products used to maintain them are not contaminated.

The following measures should be taken:

-- Wash your hands with soap and water (lint-free method) before touching the lenses

-- Replace your lenses according to the timetable given to you by your doctor

-- Carefully follow the instructions given to you by your doctor and manufacturer regarding cleaning and storage of the lenses

-- Replace your contact lense case every 3-6 months

-- Make sure you keep your contact lense case clean

-- If you experience redness, pain, tearing, increasing light sensitivity, blurry vision, discharge or swelling - remove the lenses immediately and see your doctor.

The FDA and CDC also advise wearers to perform a 'rub and rinse' lens cleaning method, instead of the 'no rub method'. This will minimize the number of germs and reduce the likelihood of infection.

So far, 30 patients have been investigated fully. 28 of them use soft contact lenses, two don't use any contact lens at all. 26 of those 28 soft lens users used Bausch & Lomb ReNu cleaning solution, or a generic brand made by the same company. Five of those 26 used other solutions as well as the ReNu brand. 9 of the patients kept the lenses on overnight (in their sleep).

Sleeping with your lenses on at night increases the risk of microbial keratitis.

Dr. Schultz added "It is important to note that some of the affected patients had used other solutions in addition to the ReNu brand, and that the source of this fungus has not yet been identified. But we're working with CDC and Bausch & Lomb -- and we're investigating other possible causes -- to prevent these infections."

Bausch and Lomb has voluntarily stopped shipping the ReNu Moisture Loc and are investigating the cause of the infections.

The FDA advises any soft contact lens wearer who has existing stocks of Renu Moisture Loc to use the product with caution and report any symptoms of eye infection immediately.

In February of this year Bausch & Lomb voluntarily suspended sales of its ReNu multipurpose solutions in Singapore and Hong Kong after several people reported eye infections.
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Division Of The Penile Suspensory Ligament Often Leads To Less Than Satisfactory Results In Augmentation Phalloplasty - Division of the penile suspensory ligament with or without the additional procedures of suprapubic fat pad excision and inverted VY plasty is a simple and commonly used penile lengthening technique. A recent study by C. Y. Li and colleagues from London examined patient satisfaction with penile suspensory ligament division for penile augmentation. The manuscript is published in the March 2006 issue of European Urology.

The suspensory ligament of the penis is comprised of two components, the suspensory ligament proper and the arcuate subpubic ligament that attaches the tunica albuginea to the midline of the pubic symphysis. Its function is to support the erect penis in an upright position to aid in vaginal penetration. Surgical division of this ligament may allow the penis to lie in a more dependent position and therefore give the appearance that the penile length has increased.

Various penile lengthening procedures have been described; the most widely used is division of the penile suspensory ligament to gain some length at the expense of slight instability. The average penile length in white men is 12.5 cm + 2.7 cm and the most common request for penile enhancement surgery is in patients with a normal penile size who have a subjective altered body perception, rather than a clinical assessment that their penis is too small. This is known as penile dysmorphic disorder.

Over a 7 year period, 42 patients underwent division of the penile suspensory ligament for penile lengthening. Twenty-seven patients (64%) had penile dysmorphic disorder as the preoperative diagnosis. Outcomes were assessed objectively based on increase in flaccid stretched penile length and subjectively using rates of patient satisfaction. The procedure is outlined in detail with intraoperative photos included. With the penis stretched, a transverse or inverted V suprapubic incision was used to divide the suspensory ligament close to the pubic symphysis until all midline attachments have been freed. In latter patients in the series, a small silicone buffer, a testicular prosthesis was placed in this space and anchored to the base of the pubic symphysis to prevent reattachment of this ligament and to push the penis forward. In obese patients, excision of the suprapubic fat pad was performed. Patients were then encouraged to perform penile stretching with either weights, a vacuum constriction device, or the use of a penile stretcher device.

Analysis of the results revealed that the mean increase in stretched penile length was 1.3 cm + 0.9cm (range -1.0 to +3.0cm) when the suspensory ligament was divided. The only specific technique that significantly lengthened the penis (0.7 + 1.0 cm) was the addition of the silicone buffer to prevent ligamentous reattachment following division. The mean increase in penile length was 1.6 cm and 1.2 cm in those that performed and those that did not perform postoperative penile stretching- this was not statistically significant.

Overall only 35% of the patients were satisfied with the outcome of the surgery. Satisfaction rates were lowest in patients with dysmorphobia (27%) or Peyronie's disease (17%). A second operative procedure was requested in 20 men with 17 undergoing an additional division. Only 2 patients were eventually satisfied with their penile length, raising the overall satisfaction rate to 40%. Complications were low with 4 men having postoperative wound infections and a wound breakdown in one; all five men were managed conservatively.

The authors suggest that men with penile dysmorphic disorder should be evaluated by a psychiatrist and be discouraged from surgery. Surgical intervention should be reserved as a last resort and only when the patient understands the limitations of the expected outcome.
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Tragic Drug Trial Participant Has Early Signs Of Cancer

David Oakley, who took part in a drug trial that went tragically wrong earlier on this year in London, says he has now developed early signs of cancer. He is seeking compensation from Parexel, the company that carried out the trial. The drug trial made six healthy volunteers become seriously ill in March 2006, two of them almost died.

According to Oakley, some blood tests he had done a couple of months ago indicated that there were cells in his blood that should not be there. Apparently, these strange cells indicate the onset of cancer. He says doctors have told him that as it has been detected very early his illness is treatable.

Speaking to The Mail on Sunday, a British tabloid newspaper, Okley said "I'm going to try and be as positive as I can and if mind over matter has anything to do with it, well, I'll give it (treament) a good try. I can't dwell on it because if I dwell on it I'm just going to go down in a heap."

Oakley added that he is extremely concerned about damage that may have been done to his immune system. He worries more about developing such diseases as rheumatoid arthritis or multiple sclerosis where he is 'stuck in intense pain' without being able to anything about it, than the cancer. He said that someone has to be held accountable, Parexel should be accountable as the mistake was theirs.

The MHRA (Medicines and Healthcare products Regulatory Authority), UK, did find that Parexel had not followed procedures properly. Apparently, there was no contract between TeGenero, the makers of the drug, and Parexel, who carried out the trial. Parexel claimed it had followed procedures to the letter.

The experimental drug was aimed at treating chronic inflammatory conditions and leukaemia. During the trial the neck of one of the volunteers had swollen to three times its normal size. A girlfriend of one of the trial participants, in a BBC interview in March 2006, said her boyfriend 'looks like Elephant Man'. According to her, his head had become wider than his waist.

There were eight healthy volunteers in the trial for TGN 1412 (name of experimental drug). Two were given a placebo while the other six were given the experimental drug. All six who received the drug became seriously ill, two of whom nearly died. The ones who took the placebo were fine.

The Association of the British Pharmaceutical Industry (APBI) said it had never heard of anything comparable to that tragedy in a clinical trial. The trial was in its first phase of tests on humans.

The volunteers were paid £2000 ($3,800) each for taking part in the trial.
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Antibiotic Ear Drops Favored Over Popular Oral Antibiotics For Ear Infections

A multicenter study on treating common ear infections in children with ear tubes adds to a growing body of evidence that favors antibiotic ear drops over antibiotics swallowed in pill or liquid form in such cases, a UT Southwestern Medical Center researcher reports.

The latest study, involving 80 children, showed that antibiotic ear drops performed better and faster in treating middle ear infections in children with ear tubes than merely taking oral antibiotics such as swallowing a pill or liquid. The findings are available online in the journal Pediatrics.

"With the use of ear drops, you can put more potent medicine just where you need it," said Dr. Peter Roland, chairman of otolaryngology at UT Southwestern and one of the study's authors.

The latest study looked at children ages 6 months to 12 years who had ear tubes, middle ear infections, and visible drainage in the ear. Both the oral and topical antibiotics cure the infections in more than 70 percent of cases. But the topical drops resolved the ear drainage three to five days faster and resulted in more clinical cures overall - 85 percent for those taking drops, compared to 59 percent for oral administration of medication - according to the study.

That-s in line with previous research and other findings that support increased use of topical antibiotics over oral antibiotics in other cases involving middle ear infections, one of the most common childhood afflictions, said Dr. Roland, who heads the Clinical Center for Auditory, Vestibular and Facial Nerve Disorders at UT Southwestern and who is also chief of pediatric otology at Children-s Medical Center Dallas.

Middle ear infections are the most common diagnosis for which children receive antibiotics, and insertion of ear tubes is the most common surgery performed on children.

Many doctors treat these infections with oral antibiotics like amoxicillin, which is absorbed through the blood stream, said Dr. Roland.

The tubes, researchers reported, provide better access to the middle ear, behind the ear drum, so more of the ear drops medicine reach the infection, avoiding potential intestinal and blood absorption that occurs with oral antibiotics. Researchers discovered that the concentration at the infection can be a thousandfold greater than when oral or IV medication is used.

In addition, because the antibiotic is not distributed throughout the body, there is less chance of developing antibiotic resistance.

Dr. Roland has previously demonstrated that middle ear infections are often caused by micro-organisms that are not susceptible to antibiotics approved for pediatric patients. But the ear infections are sensitive to topical ear drops. That research showed that children with ear tubes have different micro-organisms than those without the tubes, thereby requiring different treatment.

Previous research has shown other advantages to topical antibiotics for middle-ear infections as well:

* They tend to be more tolerable for children, so parents are more likely to comply with the whole regimen.

* They tend to cause fewer gastrointestinal problems, such as diarrhea, gastroenteritis, dermatitis or complications from yeast infections than the oral antibiotics.

* They lead to less antibiotic resistance, a major goal of the Centers for Disease Control and Prevention since 1995.


Researchers involved in the Pediatrics study included groups from Texas, Pennsylvania, South Carolina, Utah and Florida.

The research was supported by a grant from Fort Worth-based Alcon Research Ltd. Dr. Roland is a paid medical monitor and consultant on the study.

About UT Southwestern Medical Center

UT Southwestern Medical Center, one of the premier medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. Its more than 1,400 full-time faculty members - including four active Nobel Prize winners, more than any other medical school in the world - are responsible for groundbreaking medical advances and are committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 89,000 hospitalized patients and oversee 2.1 million outpatient visits a year.

Dr. Peter Roland -,2356,16205,00.html
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Sulphasalazine Can Reverse Liver Disease Even For Heavy Drinkers

Sulphasalazine, a cheap drug currently used for arthritis and IBD (inflammatory bowel disease) can reverse the scarring that comes with cirrhosis of the liver, say scientists from the University of Newcastle, UK. Doctors had always thought that fibrosis - scarring associated with cirrhosis - was irreversible. This new study on animals has shown the damage can be reversed with Sulphasalazine.

In the UK, about 10% of the adult population have liver problems, mainly due to heavy drinking and obesity/overweight.

The liver has hepatic myofibrobrlasts, these are cells that create scar tissue when the organ is injured. Hepatic myofibrobrlasts produce proteins which makes it more difficult to break down the scar tissue. In a healthy liver the scars gradually disappear and new healthy ones replace them. This does not happen when the liver tissue is diseased - and the scar tissue spreads.

The scientists found that Sulphasalazine stops the hepatic myofibrobrlasts from producing the protein that protects the scar tissue cells. In other words, it helps the scar tissue to gradually melt away.

If human trials show similar results, it could mean treating and-stage patients with Sulphasalazine rather than having them undergo a liver transplant. The scientists say they will start trials with heavy drinkers who no longer drink, but whose livers are not able to recover on their own.

This drug could be a Godsend for alcoholics who have given up drinking. Even a seemingly small recovery of 10% can make a huge difference to the patient's general health and quality of life, say the researchers.

The researchers say Sulphasalazine could halve the cirrhosis death rate in the UK. Treatment would cost �10 ($18.50) per week.

Some Facts About Cirrhosis

-- Responsible for 1.4 million deaths per year worldwide
-- Responsible for 5,000 - 10,000 deaths per year in the UK
-- Early stages are symptom free (so damage accumulates unnoticed)
-- There is currently no cure. The only end-stage treatment is a liver transplant
-- Most common causes are Hepatitis C (globally) and excessive alcohol consumption (developed countries)
-- Scotland has particularly high rates among developed countries

-- Useful Web Page (Wellcome Trust)
-- Hepatology and Gastroenterology (Newcastle University)
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More Drug Overdose Deaths From Prescription Pain Killers Than Cocaine Or Heroin In The US

Trends analysis of drug poisoning deaths has helped explain a national epidemic of overdose deaths in the USA that began in the 1990s, concludes Leonard Paulozzi and colleagues at the Centers for Disease Control and Prevention in Atlanta, USA. The contribution of prescription pain killers to the epidemic has only become clear recently. This research is published this week in the journal, Pharmacoepidemiology and Drug Safety.

Drugs called "opioids" are frequently prescribed to relieve pain, but if abused they can kill. Over the past 15 years, sales of opioid pain killers, including oxycodone, hydrocodone, methadone and fentanyl, have increased, and deaths from these drugs have increased in parallel.

In 2002, over 16,000 people died in the USA as a result of drug overdoses, with most deaths related to opioids, heroin, and cocaine. Opioids surpassed both cocaine and heroin in extent of involvement in these drug overdoses between 1999 and 2002.

The situation appears to be accelerating. Between 1979 and 1990 the rate of deaths attributed to unintentional drug poisoning increased by an average of 5.3% each year. Between 1990 and 2002, the rate increased by 18.1% per year. The contribution played by opioids is also increasing. Between 1999 and 2002 the number of overdose death certificates that mention poisoning by opioid pain killers went up by 91.2%. While the pain killer category showed the greatest increase, death certificates pointing a finger of blame at heroin and cocaine also increased by 12.4% and 22.8% respectively.

In an accompanying 'comment' article, David Joranson and Aaron Gilson of the University of Wisconsin School of Medicine and Public Health Comprehensive Cancer Centre; Pain & Policy Studies Group, of Madison, Wisconsin. They caution against increasing unwarranted fears of using opioid analgesics in pain management, noting that much of the abuse of opioid analgesics is by recreational and street users and individuals with psychiatric conditions rather than pain patients.

Joranson and Gilson also point to the large quantity of opioid analgesics stolen from pharmacies every year, saying that "overdose deaths involving prescription medications do not necessarily mean they were prescribed. It is also crucial to know that most overdose deaths involve several drugs and these data cannot attribute the cause to a particular drug."

In a second commentary, Scott Fishman, Professor of Anaesthesiology and Pain Medicine at University of California, Davis concludes that drug abuse and under treated pain are both public health crises, but the solution to one need not undermine the other. "The least we can do is make sure that the casualties of the war on drugs are not suffering patients who legitimately deserve relief," he says.

Paulozzi, L. et. al: Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety; DOI: 10.1002/pds.1276

Pharmacoepidemiology and Drug Safety aims to provide an international forum for the communication and evaluation of data, methods and opinion in the emerging discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical and legal aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Communication. Pharmacoepidemiology and Drug Safety can be accessed at:

What are Opioids?

For more information on what opioids are, and opioid-induced constipation (OIC), please see:
All About Opioids and Opioid-Induced Constipation (OIC)

John Wiley & Sons Ltd., with its headquarters in Chichester, England, is the largest subsidiary of John Wiley & Sons, Inc. Founded in 1807, John Wiley & Sons, Inc., provides must-have content and services to customers worldwide. Its core businesses include scientific, technical, and medical journals, encyclopaedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centres in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley's Internet site can be accessed at
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Procyanidins In Red Wine Help You Live Longer

Procyanidins, compounds commonly found in red wine, are good for your blood vessels and are probably one of the factors contributing towards the long life spans of the people from the southwest of France and Sardinia, say researchers from the William Harvey Research Institute, Queen Mary, University of London.

You can read about this study in the journal Nature, November 30 issue.

The researchers also found that levels of procyanidins are not the same in all wines. Wines from southwest France and Sardinia, where it is still made in the traditional way, tend to have higher levels of the compound - in some cases their levels were 10 times as high as wines from elsewhere.

People should bear in mind that the daily glass of wine could have varying degrees of benefit, depending on where it came from. The researchers specifically noticed the higher levels of procyanidins from the Nuoro area in Sardinia and the Gers region, Midi-Pyrenees, south west France. On average, the scientists found those two areas had procyanidin levels five times higher than wines from Spain, South America, the USA and Australia.

Roger Coder, team leader, said "The endothelial cells which line our arteries are an important site of action for the vascular protective effects of polyphenols. We purified the most biologically active polyphenols and identified them as procyanidins. The traditional production methods used in Sardinia and southwestern France ensure that the beneficial compounds, procyanidins, are efficiently extracted. This may explain the strong association between consumption of traditional tannic wines with overall well-being, reflected in greater longevity."

Corder added "There is a 19th Century expression - A man is only as old as his arteries - which can be taken to mean that those with the healthiest arteries live longer. So it was of great interest to us when we found both in Sardinia and in south-west France that the wines made in these in areas had higher levels of procyanidins."

When wine is made in the traditional way, the fermentation period of the grapes lasts three to four weeks, as opposed to the one-week period in more modern ways. The traditional method allows for the full extraction of procyanidins from the skin and seed.

The researchers also found that the Cabernet Sauvignon and the Nebbelio grapes made the wines with the highest levels of procyanidins.

Opinion by Editor of Medical News Today

If you never drink alcohol, I would strongly urge you not to start after reading this article. There are several ways of protecting your cardiovascular health and increasing your chances of living a long life, such as following a healthy and well balanced diet, doing plenty of exercise, getting enough sleep, and not smoking. If you do drink, make sure your consumption does not exceed recommended levels.

"Red wine procyanidins and vascular health"
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Physical Activity Helps Elderly Live Longer

Elderly people who are physically active are much more likely to live longer than elderly people who are not physically active, according to a six-year study carried out by researchers at the US National Institute on Aging. You can read about this study in more detail in the Journal of the American Medical Association (JAMA), 12 July issue.

Head researcher, Todd Manini, an Exercise Physiologist, said there were various reports out there showing that exercise, such as running or jogging had benefits for the elderly. The team wanted to find out whether just usual daily activities had a protective value.

The team looked at 302 volunteers, aged 70 to 82, and monitored them for six years. They concluded that any amount of regular activity, not necessarily formal exercise, was closely linked with a longer lifespan.

The volunteers drank water containing oxygen-18 and hydrogen-2, two harmless isotopes. Our bodies get rid of oxygen-18 in water. We get rid of hydrogen-2 in water and also carbon dioxide. The amount we eliminate depends on how much energy we expend. The team was able to accurately measure each person's energy expenditure by measuring water and carbon dioxide levels that left the body each day.

They found that the 30% most physically active volunteers were 69% less likely to die than the 30% least active.

The study, rather than measuring what type of physical activity people engaged in, just measured how much energy they used up each day. It could have been through formal exercise in a gym, household chores, walking for pleasure or to the shops. Despite some patterns common among the active people, the researchers concluded that it is the amount of energy you use up each day that matters - how you use it up is not important. In other words, if you are in the 30% most active, whether your energy is expended through jogging or gardening and household chores does not matter.

Those in the highest 30% burned about 600 more calories than those in the bottom third. The researchers also found that the more active 30% were much more likely to be in some kind of paid employment.

For elderly people, the researchers found, 600 calories means about 2 hours' worth of physical activity. This could be structured gym work or a variety of routine activities such as vacuuming the house, gardening or washing the dishes.

There are various ways elderly people can clock up those extra 600 calories. You can add lots of little things to your daily routine, such as:

1. Don't have a lawn mower you sit on, have one that you push.

2. Walk your dog. Get one if you don't have one and walk it regularly.

3. Park your car at the far end of the supermarket.

4. Walk up a flight of stairs a little more often each day.

5. Get yourself a remote phone and walk about each time you are chatting.

6. If your local store is nearby leave the car at home and walk to it.

7. Cancel your daily newspaper delivery and go out on foot each morning and buy it.

8. If you find long walks boring or cumbersome, break them up into little ones. Walk around your block once four separate times a day. If each walk takes 7 minutes, times four means 28 minutes of extra walking each day.

9. Every time there are adverts on TV get up and walk about for a couple of minutes. If you do that for two minutes each time, and do it just ten times a day, that's an extra 20 minutes' walking.

10. Hold on to doing as many household chores as you can. Only bring in paid help when you are really incapable of doing it any more.

11. Stop using your garden sprinkler and use a hose-pipe.

12. If you regularly use the bus, get off at an earlier stop.

If fact, these twelve tips apply to people of all ages.

"Daily Activity Energy Expenditure and Mortality Among Older Adults"
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Updated Statistics On The American Obesity Epidemic: Data From The CDC - The success of the fast food and soft drink industries has translated into an unprecedented rise in childhood and adult obesity. This epidemic has had a direct impact on our (urologists) practice due to its association with carcinogenesis in the prostate and kidney.

In the April 5 issue of JAMA, Ogden and colleagues from the CDC present updated estimates in the prevalence of childhood and adult obesity in the United States.

Height and weight measurements were recorded for 3958 children and 4431 adults in 2003 and 2004. These data, part of the National Health and Nutrition Survey, was compared from prior data from 1999 - 2000, and 2001-2002. Being overweight in children and adolescents was defined as having a BMI above the 95% for age. In adults, obesity and extreme obesity was defined as a BMI above 30 and 40, respectively.

Prevalence of Obesity: Children and Adolescents

At risk for overweight 28.2%
Overweight 13.9%

At risk for overweight 30.0%
Overweight 15.4%

At risk for overweight 33.6%
Overweight 17.1%

Risk of being overweight in children and adolescents

Male 1.00
Female 1.00

Male 1.73 (1.42 - 2.10)
Female 1.56 (1.28 - 1.88)

African American
Male 1.13 (0.91 -1.40)
Female 1.46 (1.22 - 1.73)

Prevalence of Obesity: Adults

Obese 30.5%
Extreme Obese 4.7%

Obese 30.6%
Extreme Obese 5.1%

Obese 32.2%
Extreme Obese 4.8%

Risk of obesity in adults

Men 1.00
Women 1.00

Men 1.02 ( 0.87 - 1.20)
Women 1.31 (1.11 - 1.55)

African American
Men 0.99 (0.86 - 1.15)
Women 2.01 (1.76 - 2.29)

Statistical analysis was significant for male and female children and adolescents, with a prevalence increase of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004. The prevalence of overweight in male children and adolescents rose from 14.0% to 18.2%. The prevalence of obesity in adult men rose from 27.5% to 31.1% over the period studied. No significant changes in weight were seen among women over the period studied. Significant ethnic differences persisted especially among Hispanic men and African American women.

By Ricardo S�nchez-Ortiz, MD

JAMA. 2006;295:1549-1555.
Link Here.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM.

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Diabetes Cases Rise From 30 Million To 230 Million In 20 Years

During the last 20 years the total number of people with diabetes worldwide has risen from 30 million to 230 million, according to the International Diabetes Federation. China and India now have the most diabetes sufferers in the world.

Today, out of the top ten countries with diabetes sufferers, seven are developing countries. The Caribbean and the Middle East have regions where the percentage of adults with diabetes has reached 20%. In certain parts of Africa developing diabetes can mean a short route to death. While patients in developed countries, with access to proper treatment, can expect to live for several decades, in countries such as Mali and Mozambique developing diabetes often means a life expectancy of one or two years.

The International Diabetes Federation released its data at the American Diabetes Association's 66th Scientific Sessions.

The spread of diabetes type 2 today is due to lifestyle, diet and genetics. Many more people today have better access to food, eat more of the wrong nutrients and do much less exercise. This combination of bad diet and inactivity leads to weight gain, which in turn raises the risk of developing diabetes type 2.

Here are some facts

-- The number of people with diabetes is expected to reach 350 million by 2025.

-- Top five countries with the most diabetes sufferers in 2003 were: India (35.5 million, China 23.8 million, USA 16 million, Russia 9.7 million and Japan 6.7 million.

-- Top five countries with the highest percentage of adults with diabetes in 2003 were: Nauru 30.2 %, United Arab Emirates 20.1 %, Qatar 16%, Bahrain14.9%, and Kuwait 12.8%.

-- The number of diabetes sufferers by 2025 is expected to: Double in Africa, the Eastern Mediterranean and Middle East, and South-East Asia, and rise by 20% in Europe, 50% in North America, 85% in South and Central America and 75% in the Western Pacific.

-- There are 6 million new diabetes sufferers in the world each year.

-- Every ten seconds someone in the world dies as a result of having diabetes - 3 million deaths a year.

-- Diabetes is now the fourth biggest cause of death worldwide.

-- Half of all diabetes sufferers around the globe do not know they have it. In some parts of the world 80% of sufferers don't know.

-- Diabetes causes more cases of blindness and visual impairments in adults than any other illness in the developed world.

-- One million amputations each year are caused by diabetes. A diabetes sufferer is up to 40 times more likely to need a lower-limb amputation when compared to a person who does not have diabetes.

-- Diabetes raises the sufferer's risk of developing a cardiovascular disease by two to four times. Cardiovascular disease, the number one cause of death in the industrial world, will soon be the number one cause of death globally.

-- It is estimated that diabetes accounts for 5% to 10% of most nations' health budgets.

-- If more money were spent on early detection of diabetes and diabetes prevention the economic savings would be massive.

-- Good control of blood glucose levels significantly reduces the diabetes patients' risk of developing complications. Managing hypertension and raised blood lipids is also crucial.

-- One quarter of all the countries in the world have not made any specific provision for diabetes care in their health plans.

International Diabetes Federation
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Diet May Help Prevent Allergies And Asthma

A recent publication from the Global Allergy and Asthma European Network (GA2LEN) (1) provides new insights into the role that diet may play in the development of allergies, especially in children. The work suggests that the significant changes in European diets over the past 20-40 years may have contributed to the increased incidence of allergic diseases in both children and adults seen over this period. Members of the nutrition work package responsible for the report consider that its findings are just the beginning of GA2LEN's potential role in greater understanding of this complex area.

The prevalence of allergic diseases has increased dramatically over the past few decades, especially in children. One child in three is allergic today and one in two people in Europe are likely to be suffering from at least one allergy by 2015. It is generally agreed that a combination of heredity and environmental factors is responsible for the development of the allergy and asthma. However, the evolution of these diseases has been far too rapid for genetics to be the sole explanation. Among the wide range of environmental factors under discussion, changes in the European diet in the last 20-40 years are considered to be a possible explanation. Indeed, the way in which children are fed early in life may have a direct effect on the subsequent development of asthma and allergies, according to a recent publication from the Global Allergy and Asthma European Network (GA2LEN). (1)

In a paper entitled "Nutrition and allergic disease", published this year in Clinical and Experimental Allergy Reviews, 12 European experts working together in the GA2LEN nutrition work package present the evidence and define fertile topics for future research. (2) The work package team is led by Professor Philip C Calder, Institute of Human Nutrition, University of Southampton. (3)

Key findings: breastfeeding, early diet and probiotics

The three main areas producing key findings are breastfeeding, intake of certain nutrients, and probiotics. (4)

Exclusive breastfeeding, that is providing the infant with no other liquid or food other than breast milk, is believed to be effective in reducing subsequent development of allergies. It appears that exclusive breastfeeding for four months helps protect the child from cow's milk protein allergy until 18 months, reduces the likelihood of dermatitis (skin allergy) until three years, and reduces the risk of recurrent wheeze (or asthma) until six years' of age. However, the longer term effects of breast feeding on allergic outcomes are not known and require investigation.

The protective effect of four months of exclusive breastfeeding is important for all children but it is especially valuable for those at high risk of developing allergies. Children are at high risk of developing allergies if one or both parents are affected by allergic disease. If it is not possible for the high-risk child to be breastfed, hypoallergenic formula combined with avoidance of solid foods for 4-6 months offers an alternative source of protection. The studies show that hypoallergenic formula helps prevent cows' milk protein allergy developing before the age of five years and offers protection against atopic dermatitis (eczema or other skin allergy) until the age of four years.

A second major area of importance appears to be the components of the diet. For example, antioxidants in the diet, such as vitamin C, vitamin E and selenium coming mainly from fruit and vegetables, may have a protective effect. Furthermore, different fats found in milk, butter, vegetable oils and fish may have different effects on development of allergies and asthma. Although it is difficult to find clear-cut evidence, it appears that reducing sodium intake, increasing magnesium intake, eating apples and other fruit and vegetables, and avoiding margarine might help some asthmatics. However much of the research conducted to date has not been systematic in its approach and this makes the drawing of hard conclusions very difficult.

The role of probiotics and prebiotics in the diet is promising. Living organisms such as probiotics appear to protect against the development of allergies by producing changes in the bacteria in the gut that stimulate the immune system. A double blind, placebo-controlled study has recently shown that probiotics can help reduce the risk of atopic disease. This is an important area for future research.

Meeting the challenge

The review highlighted several areas in nutrition and diet that appear to be fruitful for future research in allergic disease, and therefore for future disease control. In particular, it has highlighted gaps in relation to specific effects of maternal and infant nutrition on allergy and asthma in later life. Patients, health professionals and policy makers alike would benefit from such research and from more large-scale studies on diet and allergy. Key focuses should be identification of dietary patterns or factors likely to be involved in altering risk of development of allergies and asthma, and developing the evidence base about whether supplementation with specific fats or probiotics could contribute both to the protection and treatment of allergic diseases. The studies required will need to be large and to be well planned, designed and executed. They are likely to require cross-country collaboration.



1. GA2LEN - the Global Allergy and Asthma European Network is a "Network of Excellence" funded by the European Union 6th Research Framework Programme. It consists of 26 research centres spread throughout Europe, as well as the European Academy of Allergology and Clinical Immunology (EAACI) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA).

2. The 72-page peer-reviewed paper entitled "Nutrition and allergic disease" is published in Clinical and Experimental Allergy Reviews 6: 117-188, 2006 Blackwell Publishing Ltd.

3. The article represents the work of Workpackage 2.1 of GA2LEN. Correspondence should be addressed to the workpackage leader, P. C. Calder, BSc, PhD, DPhil, Professor of Nutritional Immunology, Institute of Nutrition, University of Southampton, UK.

4. The full list of indicators comprises: Sodium and potassium, magnesium, lipids including fatty acids in milk, butter, vegetable oils and fish, antioxidants, including fruit and vegetable intake, flavonoids and flavonoid-rich foods, Vitamin C, Vitamin E, b-Carotene, Vitamin A, selenium, zinc and copper, and probiotics and prebiotics.
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