Tuesday, August 21, 2012

40Over40: A New Campaign To Tackle Low Awareness Of Erectile Dysfunction And Its Health Implications In Younger Men

A new survey of 1,000 men aged over 40, commissioned by Eli Lilly and Company Limited (Lilly UK) as part of a new erectile dysfunction awareness campaign, 40over40, reveals that just over 10% of men in their early 40s are aware that ED strikes regularly in the fourth decade even though evidence suggests that 40% of men aged 40 or over have some form of ED.

Additionally, most men were unaware that erection problems could be a warning sign that they may have a more serious condition; less than a fifth of all the men surveyed knew that ED could be a sign of underlying, organic heart disease or other potentially serious conditions, despite evidence of such a link in 80% of cases (in men of 70). In fact, three times as many survey respondents in their 40s rated hair loss ahead of losing their erections as a major health concern.1

Further, the survey shows that less than one fifth of men have visited their GP in the last 12 months, and that men in their 40s are likely to put off visits to their GP until they consider their symptoms to be long-term or worsening. But these men can be optimistic about finding a solution; 95% of ED cases can now be treated by the healthcare professional once reported.

The survey was commissioned as part of the new ED disease awareness campaign 40over40, from Lilly UK, which has been designed to educate men on the causes of ED and who it affects, and encourage them to seek help. The campaign will launch nationwide on 30 June 2008, when a new website http://www.40over40.com will go live, accompanied by the roll-out of a national TV advertising campaign.

The strapline from the campaign is Talk, Test, Treat, Today (4T), and visitors to the website will be able to download information and advice about ED.

Dr Mark Porter believes GPs should get behind the campaign. "The survey results are interesting because they show us that a significant number of younger men are compromising their sex lives unnecessarily - and may even be endangering their long term health. Sexual fulfilment aside, too few men are aware that their erectile difficulties could be a sign of underlying health problems like smoking related damage, high blood pressure and raised cholesterol levels. I'm hopeful that the 40over40 campaign will really start to tackle some of the misconceptions surrounding ED encouraging more patients to come through the door sooner. As GPs we need to throw our weight behind the campaign and look for ways to proactively ask about ED in our male, 40 plus patients."

Campaign resources include educational literature for patients and HCPs which will be available on http://www.40over40.com website and via Lilly UK as sponsors of the campaign.

- The 40over40 campaign is sponsored by Lilly and was conducted by Opinion Health, and involved interviews with 1013 men aged 40+ and currently living in the UK.

- 71.7% claimed their sex life was sporadic, while 17.4% said their sex life was spontaneous.

- 45.2% stated that an active sex life was important to them, and 28.3% stated that it was very important to them.

- 11.3% aged 40-44 thought ED might affect them in the next 10 years compared to 32.0% aged 40-44 who thought hair loss might affect them in the next 10 years.1

- 16.4% believed underlying disease may be one of the main causes of ED while 26.2% said they didn't know the causes of ED.

- 15.3% of men in the survey have not visited their GP in the last 12 months5 and 45.8% of men in the survey said they are usually prompted to visit the GP when they experience prolonged or worsening symptoms.6

- 24.5% of men use the internet as their main source of information on health.


1. Lilly UK: 4T Survey of 1,000 men aged over 40 Q3 - What health issues do you think will concern you in the next 10 years?

2. Feldman HA et al, J Urol. 1994 Jan;151(1):54-61

3 Lilly UK: 4T Survey of 1,000 men aged over 40 Q14 - What do you understand is the main cause of ED?

4. Diabetes UK viewed 02 June 2008

5. Lilly UK: 4T Survey of 1,000 men aged over 40 Q6 - How often did you consult your doctor in the last 12 months?

6. Lilly UK: 4T Survey of 1,000 men aged over 40 Q7 - What usually prompts you to consult a doctor?

7. WGBH Educational Foundation 2006, Impotence: Causes and Treatments, viewed 02 June 2008 http://www.pbs.org.wgbh/nova/impotence/causes

8. Lilly UK: 4T Survey of 1,000 men aged over 40 Q11 - How would you describe your current sex life?

9. Lilly UK: 4T Survey of 1,000 men aged over 40 Q16 - How important is an active sex life to you?

10. Lilly UK: 4T Survey of 1,000 men aged over 40 Q14 - What do you understand is the main cause of ED?

11. Lilly UK: 4T Survey of 1,000 men aged over 40 Q5 - What is your main source of information on health?

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The Importance Of Exercise

It is common knowledge that regular exercise supports physical and mental well-being. Despite this and recommendations from health care providers, the majority of patients with chronic illnesses remain inactive.

In a new study, University of Missouri researchers found that adults with chronic illness who received interventions focused on behavior-changing strategies significantly increased their physical activity levels. In contrast, interventions based on cognitive approaches, which attempt to change knowledge, beliefs and attitudes, and are most commonly used by health care providers, did not improve physical activity.

"The information that physicians are giving patients isn't working. Patients are not motivated when they hear 'exercise is good; it will improve your health.' What works is providing patients with simple, action-orientated strategies to increase their activity levels," said Vicki Conn, professor and associate dean of research in the MU Sinclair School of Nursing.

Behavior strategies include feedback, goal setting, self-monitoring, and stimulus or cues. Self-monitoring, any method where participants record and track their activity over time, significantly increased awareness and provided motivation for improvement, Conn said.

"It is important for care providers to set very specific, manageable goals with patients," Conn said. "For example, ask them to exercise for 20 minutes, three times a week and track their progress by writing it down. Have them schedule exercise on their calendars, or prompt them by setting their walking shoes by their doors. Ask how they can reward themselves if they accomplish the goal. This will help incorporate activity into their daily routines and provide them with a sense of accomplishment."

Conn completed a meta-analysis incorporating data from 22,527 participants in 163 research reports. No previous analysis has examined physical activity levels following interventions among adults with diverse chronic illnesses. Conn found that interventions were similarly effective regardless of gender, age, ethnicity and socioeconomic status.

"Behavior interventions increased participants' activity by an average of 48 minutes per week, which is enough to provide them with health benefits," Conn said. "People may feel overwhelmed by the thought of exercise, or think they have to work out 60 minutes, five days a week, but doing just 12 minutes per day may get them started toward better health."
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Scientists Close In On Taurine's Activity In The Brain

Taurine is one of the most plentiful amino acids in the human brain, but neuroscientists are still puzzled by just how brain cells put it to use. Now, a team of researchers at Weill Cornell Medical College in New York City has uncovered a prime site of activity for the molecule, bringing them closer to solving that mystery.

"We have discovered that taurine is a strong activator of what are known as GABA receptors in a regulatory area of the brain called the thalamus," says study senior author Dr. Neil L. Harrison, professor of pharmacology and pharmacology in anesthesiology at Weill Cornell Medical College. "We had discovered these receptors two years ago and showed that they interact with a neurotransmitter called gamma-aminobutyric acid (GABA) -- the brain's key inhibitory transmitter -- that is also involved in brain development. It seems that taurine shares these receptors."

The finding is a surprise and opens the door to a better understanding of taurine's impact on the brain, the researchers report in this month's issue of the Journal of Neuroscience.

And while the amino acid is made naturally by the body, it's also a much-touted ingredient in so-called "energy drinks" such as Red Bull. "Its inclusion in these supplements is a little puzzling, because our research would suggest that instead of being a pick-me-up, the taurine actually would have more of a sedative effect on the brain," Dr. Harrison says.

Still, the prime focus of the new study was simply to find a site for the neurological activity of taurine; such a site has been missing despite many years of study.

"Scientists have long questioned whether taurine might act on an as-yet-undiscovered receptor of its own," notes lead researcher Dr. Fan Jia, postdoctoral scientist in the Department of Anesthesiology. "But after some recent work in our lab, we ended up zeroing in on this population of GABA receptors in the thalamus."

The thalamus, located deep in the brain's center, is involved in what neuroscientists call "behavioral state control," helping to regulate transitions between sleep and wakefulness, for example. "It's like a railway junction, controlling information traffic between the brainstem, the senses and the executive functions in the cortex," Dr. Harrison explains. "When you're sleeping, the thalamus is discharging slowly and isolates the cortex from sensory input. But when you're awake, the thalamus allows information from the sensory system to activate the cortex."

Investigating further, the researchers exposed thin slices of thalamic tissue from the brains of mice to concentrations of taurine that were similar to what might be found in the human brain.

"We found that taurine is extraordinarily active on this population of GABA receptors in the thalamus," Dr. Harrison says. "It came as a bit of a surprise that the same receptor was used by both taurine and GABA. Nevertheless, finding taurine's receptor has been like discovering the 'missing link' in taurine biology."Of course, the question of what taurine actually does in the brain remains unanswered for now. "Unraveling that mystery is the prime goal of that research, and that's where we're headed next." Dr. Harrison says.

There's already one leading theory: "GABA is important for forging new cell-to-cell connections within the developing brain, and because taurine shares a receptor with GABA, it, too, may play a role in neurological development," the researcher speculates.

And what about the energy-drink connection? "Remarkably little is known about the effects of energy drinks on the brain. We can't even be sure how much of the taurine in the drink actually reaches the brain!" Dr. Harrison says. "Assuming that some of it does get absorbed, the taurine -- which, if anything, seems to have a sedating effect on the brain -- may actually play a role in the 'crash' people often report after drinking these highly caffeinated beverages. People have speculated that the post-Red Bull low was simply a caffeine rebound effect, but it might also be due to the taurine content."

This work was funded by the U.S. National Institutes of Health (NIH).

Co-researchers include Dr. Minerva Yue, Dr. Angelo Keramidas and Dr. Peter A. Goldstein -- all of Weill Cornell Medical College as well as Dr. Dev Chandra and Dr. Gregg E. Homanics, of the University of Pittsburgh.

-- How good are these energy drinks?
-- The Perils Of Mixing Energy Drinks With Alcohol
-- French ban on Red Bull (drink) upheld by European Court

Weill Cornell Medical College

Weill Cornell Medical College -- Cornell University's Medical School located in New York City -- is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, infectious disease, obesity, cancer, psychiatry and public health -- and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College -- in its commitment to global health and education -- has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial for gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and, most recently, the world's first successful use of deep brain stimulation to treat a minimally-conscious brain-injured patient.

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Brazilian Acai Berry Antioxidants Absorbed By Human Body

A Brazilian palm berry, popular health food though little research has been done on it, now may have its purported benefits better understood.

In the first research involving people, the acai (ah-sigh-EE) berry has proven its ability to be absorbed in the human body when consumed both as juice and pulp. That finding, by a team of Texas AgriLife Research scientists, was published in a recent issue of the Journal of Agricultural and Food Chemistry. Showing the berry's absorption in humans is important because it is known to contain numerous antioxidants. The berry is heavily marketed in the U.S. as a health food.

The study involved 12 healthy volunteers who consumed a single serving of acai juice or pulp. Researchers believe the results point to the need for continued research on the berry which is commonly used in juices, beverages, smoothies, frozen treats and dietary supplements.

"Acai is naturally low in sugar, and the flavor is described as a mixture of red wine and chocolate," said lead investigator Dr. Susanne Talcott, "so what more would you want from a fruit?"

Talcott, who also is assistant professor with the Texas A&M University's nutrition and food science department, said that previous studies have shown the ability of the human body to absorb target antioxidants (from other produce), but "no one had really tested to see if acai antioxidants are absorbed in humans."

Sales of acai products have increased dramatically in the U.S. where it has been touted as a metabolism booster, weight reducer and athletic enhancer. Advertisements use buzzwords such as health, wellness, energy, taste and organic.

About the only buzzword not used with acai is "local." The berries are harvested in the Brazilian rainforest from acai palms that may reach heights in excess of 60 feet - one of the same palms used to harvest edible hearts of palm.

The fruit is about the size of a large blueberry yet only the outermost layers of the fruit, the pulp surrounding a large internal seed, are edible, Talcott noted.

Talcott and her co-researcher and husband Dr. Steve Talcott began studying the palm- berry in 2001. His first scientific report on acai, apparently the first such study in English, was published in 2004.

Initially, their studies on the berry examined antioxidant and nutritional components in pulp and juice. Later studies showed the berry's activity against cancer cells, Talcott noted.

With that background, the researchers then decided to find out whether those elements were actually being absorbed into the human body or being eliminated unused as waste.

"Like vitamin C, the body can only absorb so much at a time," Steve Talcott explained.

He said the researchers now "need to determine potential disease-fighting health benefits, so we can make intelligent recommendations on how much acai should be consumed.

For the clinical trial, people were given acai pulp and acai juice containing half the concentration of anthocyanins as the pulp and each compared to the control foods: applesauce and a non-antioxidant beverage.

Blood and urine samples at 12 and 24 hours after consumption showed significant increases in antioxidant activity in the blood after both the acai pulp and applesauce consumption, she said. Both acai pulp and acai juice showed significant absorption of antioxidant anthocyanins into the blood and antioxidant effects. The research couple said future studies hopefully will help determine whether the consumption of acai will result in any disease-preventing health benefit and the proper serving sizes for a beneficial dose for people.

"Our concern has been that it is sold as a super food - and it definitely has some good attributes - but it is not a solution to all diseases," she said. "There are a great number of foods on the market, and this could just be part of a well-balanced diet."
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Dangers Of Cod Liver Oil

Using the strongest language published to date, the group condemned the current (1997) Food and Nutrition Board (FNB) recommendations for vitamin D, stating "The 1997 FNB recommendations offend the most basic principles of pharmacology and toxicology, leading us to conclude that the current official guidelines and limitations for vitamin D intakes are scientifically indefensible."

In addition to warning about the consumption of cod liver oil, the above experts recommended healthy children take 1,000 IU/day of vitamin D for every 25 pounds of body weight. In some cases this is more than ten times current recommendations for children by the government and professional organizations.

Finally, the group recommended that "children with chronic illness such as autism, diabetes, and/or frequent infections" may need to take even more vitamin D, "doses adequate to maintain their 25-hydroxy vitamin D in the mid normal of the reference range (65 ng/ml) - and should be so supplemented year around." Less than one percent of American children currently have such levels.

"Cod Liver Oil, Vitamin A Toxicity, Frequent Respiratory Infections, and the Vitamin D Deficiency Epidemic"
John J. Cannell, MD; Reinhold Vieth, MS, PhD; Walter Willett, MD, DrPH; Michael Zasloff, MD, PhD; John N. Hathcock, MSc, PhD; John H. White, PhD; Sherry A. Tanumihardjo, MSc, PhD; D. Enette Larson-Meyer, PhD; Heike A. Bischoff-Ferrari, MD, MPH; Christel J. Lamberg-Allardt, PhD; Joan M. Lappe, PhD, RN; Anthony W. Norman, PhD; Armin Zittermann, PhD; Susan J. Whiting, MSc, PhD; William B. Grant, PhD; Bruce W. Hollis, PhD; Edward Giovannucci, MD
Annals of Otology, Rhinology & Laryngology - 2008;117:864-870

John Cannell, MD
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Statins And Memory Loss In Women

The media is reporting stories of doctors observing that cholesterol lowering statins caused loss of memory and thinking skills in some of their female patients. At the moment this "evidence" is purely anecdotal, but it appears to be gathering pace, and doctors are sufficiently concerned to say there should be more studies on the link between statins and cognition, particularly in women.

The Wall Street Journal (WSJ) reported this week on a luncheon meeting sponsored by Project ALS*, where Dr Orli Etingin, vice chairman of medicine at New York Presbyterian Hospital, and founder director of the Iris Cantor Women's Health Center, also in New York, spoke about the effect of a statin, Lipitor, made by Pfizer Inc, on some female patients.

Etingen described the effect in one patient in particular, a woman in her 40s who was unable to concentrate or remember words. They ran tests and found nothing, but when she stopped taking Lipitor, her symptoms disappeared, and when she started it again, they came back.

"This drug makes women stupid," said Etingen, who claimed having seen these symptoms in about dozen female patients.

According to the WSJ, Pfizer said that Lipitor had been tested in 400 trials and has a track record of safe and effective use in over 145 million patient years, none of which shows a causal link between the drug and memory loss. The company added that the evidence comes from a variety of sources and not from "anecdotal inferences by individual providers with a limited data pool".

Many scientists would agree, saying that anectodotal evidence is not a basis on which to do risk-benefit assessments for deciding treatment options. The nature of anecdotes is that they are selective, become "embellished" in the telling, and they don't take into account extenuating factors. However, they have a strong emotional and political effect, they have more appeal because they are highly personal stories that people identify with, and when they gather pace, they can undermine patient confidence in a drug.

Perhaps for this reason, a new study will be welcomed by all sides. And such a study is about to complete. Researchers at the University of California at San Diego UCSD) are coming to the end of a randomized controlled trial on the effect of statins on behaviour, mood, thinking skills, and quality of life.

However, what is interesting about this study is that the researchers are also carrying out a separate investigation of anecdotal, first hand, accounts from thousands of patients who have reported good and bad experiences with statins.

Beatrice Golomb, lead researcher on the UCSD study, told the WSJ they had received some "compelling cases" and related the story of Jane Brunzie, a 69 year old woman from San Diego who at first thought she had Alzheimer's because her memory skills got so bad. She said within 8 days of stopping her statin medication she was "back to normal".

Her doctors tried three different statins on her, but each one had the same effect. She has stopped them altogether now and is trying to reduce her cholesterol count with diet and exercise. She said she was back doing voluntary work at her local school. In her story to the researchers she said:

"I feel very blessed; I got about 99 per cent of my memory back. But I worry about people like me who are starting to lose their words who may think they have just normal aging and it may not be."

There are many doctors, and cardiologists in particular, who are not worried about these stories. For them, the risks are very small compared to the benefits of statins.

Antonio Gotto, past president of the American Heart Association and currently dean of the Weill-Cornell Medical School, told the WSJ:

"I would hate to see people frightened off taking statins because they think it's going to cause memory loss."

Part of the difficulty for doctors is pinning down exactly what constitutes thinking and memory problems, and distinguishing an effect of one drug from what could be a gradual effect from a separate unrelated cause, for instance as an age progressive condition or side effect from other drugs.

The important thing is to keep a close eye on a patient who is put on statin for the first time, or changes from one type to another, and if there is a sudden onset of thinking and memory problems, and these wear off when they are taken off the drug, then perhaps trying an alternative is advisable.

Gayatri Devi, associate professor of neurology and psychiatry at New York University School of Medicine told the WSJ she had seen half a dozen patients in over ten years of practice whose cognitive skills changed very soon after starting on a statin, and returned quickly when they stopped. It might just be a handful of patients, she said, but "for them, it made a huge difference".

Lipitor is a prescription drug used with a low fat diet and exercise to reduce cholesterol. It is prescribed for patients with multiple risk factors for heart disease (such as family history, high blood pressure, age, low "good" HDL cholesterol, or smoking), to reduce the risk of heart attack and stroke. It is also used by patients with type 2 diabetes and one other risk factor for heart disease.

Lipitor should not be taken by anyone with liver problems, nursing mothers, and women who are or could become pregnant.

*Project ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's motor neurone disease) campaigns to raise awareness and better treatments for ALS, which attacks neurones in the spine and parts of the brain.
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New Guidelines: Antibiotic Prophylaxis

Until recently, it was recommended that many patients with cardiac conditions receive short-term antibiotics prior to receiving dental treatment to prevent the risk of infective endocarditis (IE). The American Heart Association (AHA) has since revised those guidelines and the revisions bring good news for most cardiac patients: many patients who have taken prophylactic antibiotics routinely in the past no longer need them.

The American Dental Association (ADA) provided input to the AHA on the new guidelines, which were also developed in part by the Infectious Diseases Society of America and the American Academy of Pediatrics. This group reviewed and analyzed information from both national and international experts on IE and revised guidelines were released last April.

The updated guidelines state that patients who have taken prophylactic antibiotics in the past but no longer need them include people with:

-- Mitral valve prolapse

-- Rheumatic heart disease

-- Bicuspid valve disease

-- Calcified aortic stenosis

-- Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

These revisions are based on scientific evidence that conclude that the risks of taking preventive antibiotics, such as adverse reactions to the antibiotics and development of drug resistant bacteria, outweigh the benefits for most patients.

However, as with any guidelines, there are exceptions. Preventive antibiotics prior to dental procedures are still advised for patients with:

-- Artificial heart valves

-- History of IE

-- Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

-- A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure or any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

-- Any cardiac transplant that develops a problem in a heart valve

The Pennsylvania Dental Association (PDA) stresses the importance of maintaining good oral hygiene habits as an essential and easy way to prevent IE, and offers the following tips:

-- Brush your teeth twice a day with an ADA-accepted fluoride toothpaste. Replace your toothbrush as soon as the bristles become frayed, about every three to four months. Floss daily to remove plaque stuck between the teeth.

-- Eat a well-balanced diet, limiting sugary snacks and beverages.

-- See your dentist regularly for cleanings and oral exams.

For more information on other oral health topics, visit PDA's website at http://www.padental.org.

Pennsylvania Dental Association
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What Is Mesotherapy Treatment?

Mesotherapy treatment is a non surgical cosmetic solution aimed at diminishing problem areas in your body such as cellulite, excess weight, body contouring, and face/neck rejuvenation, just to name a few. It is administered via numerous injections containing various types of FDA approved medicines, vitamins, and minerals.

-- It is introduced into the mesoderm, the layer of fat and tissue underneath the skin.
-- The content mixture of the injection varies in accordance with each unique case and specific area to be treated.
-- Mesotherapy can also assist in reducing pain, and in replenishing hair loss in both men and women.

It's a Revolution!

The immediate weight loss results associated with liposuction cannot be compared to the results of mesotherapy treatments. Liposuction is by far the most effective and quickest method available for fat reduction; however, mesotherapy is less expensive and less invasive.

Mesotherapy vs Liposuction

-- Mesotherapy is a relatively painless procedure due to the use of anesthetic creams applied to the area prior to injection, while liposuction often results in some pain after the surgery, as well as during the healing weeks that follow.

-- Mesotherapy causes virtually no scarring although swelling and light bruising may appear in the area for a few days; liposuction can cause scarring ranging from moderate to severe.

-- Sedation is not necessary with mesotherapy, and the patient can walk out of the office a few moments after the treatment.

Though it is new to the United States, mesotherapy has been widely used for the last 30 to 40 years in France. The reviews in the U.S. are outstanding, though controversial, as many doctors firmly believe that cosmetic surgery is the better option.

The following outline is a standard estimate of what each mesotherapy treatment entails
(the number of injections and amount of medication varies from patient to patient):

Fat Reduction/Weight Loss: Usually 2 to 4 treatments (injections) are required at intervals of 2 to 4 weeks. Depending on the problem area, the number of procedures could increase. Because mesotherapy treatments for weight loss do not produce drastic changes, it is generally recommended for patients who require a little fat reduction in specific areas, as with body contouring.

Cellulite Reduction: Approximately 3 to 4 treatments are necessary at intervals of 3 to 4 weeks. While cellulite treatment is the least effective of the mesotherapy options, it is nonetheless successful in dealing with mild degrees of cellulite.

Lower Blepharoplasty: 1 or 2 treatments are recommended at 6 week intervals (at times the second treatment is not necessary). For Lower Eye Belpharoplasty, the patient should take cortisone prior to the procedure, and the swelling could possibly last for up to 6 weeks.

Facial Rejuvenation: 4 treatments are required at 2 to 3 week intervals. It is one of the most popular mesotherapy treatments, as satisfied patients notice a substantial improvement in their facial appearance.

Needless to say, mesotherapy treatments are here to stay. Many people are welcoming this simple, non-surgical procedure into their arms…or thighs….or face.
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Viagra-Like Effects From Watermelon

A cold slice of watermelon has long been a Fourth of July holiday staple. But according to recent studies, the juicy fruit may be better suited for Valentine's Day.

That's because scientists say watermelon has ingredients that deliver Viagra-like effects to the body's blood vessels and may even increase libido.

"The more we study watermelons, the more we realize just how amazing a fruit it is in providing natural enhancers to the human body," said Dr. Bhimu Patil, director of Texas A&M's Fruit and Vegetable Improvement Center in College Station.

"We've always known that watermelon is good for you, but the list of its very important healthful benefits grows longer with each study."

Beneficial ingredients in watermelon and other fruits and vegetables are known as phyto-nutrients, naturally occurring compounds that are bioactive, or able to react with the human body to trigger healthy reactions, Patil said.

In watermelons, these include lycopene, beta carotene and the rising star among its phyto-nutrients - citrulline - whose beneficial functions are now being unraveled. Among them is the ability to relax blood vessels, much like Viagra does.

Scientists know that when watermelon is consumed, citrulline is converted to arginine through certain enzymes. Arginine is an amino acid that works wonders on the heart and circulation system and maintains a good immune system, Patil said.

"The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes," said Patil. "Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it."

While there are many psychological and physiological problems that can cause impotence, extra nitric oxide could help those who need increased blood flow, which would also help treat angina, high blood pressure and other cardiovascular problems.

"Watermelon may not be as organ specific as Viagra," Patil said, "but it's a great way to relax blood vessels without any drug side-effects."

The benefits of watermelon don't end there, he said. Arginine also helps the urea cycle by removing ammonia and other toxic compounds from our bodies.

Citrulline, the precursor to arginine, is found in higher concentrations in the rind of watermelons than the flesh. As the rind is not commonly eaten, two of Patil's fellow scientists, drs. Steve King and Hae Jeen Bang, are working to breed new varieties with higher concentrations in the flesh.

In addition to the research by Texas A&M, watermelon's phyto-nutrients are being studied by the U.S. Department of Agriculture's Agricultural Research Service in Lane, Oklahoma.

As an added bonus, these studies have also shown that deep red varieties of watermelon have displaced the tomato as the lycopene king, Patil said. Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

"Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes," he said. "But now we know that it's found in higher concentrations in red watermelon varieties."

Lycopene, however, is fat-soluble, meaning that it needs certain fats in the blood for better absorption by the body, Patil said.

"Previous tests have shown that lycopene is much better absorbed from tomatoes when mixed in a salad with oily vegetables like avocado or spinach," Patil said. "That would also apply to the lycopene from watermelon, but I realize mixing watermelon with spinach or avocadoes is a very hard sell."

No studies have been conducted to determine the timing of the consumption of oily vegetables to improve lycopene absorption, he said.

"One final bit of advice for those Fourth of July watermelons you buy," Patil said. "They store much better uncut if you leave them at room temperature. Lycopene levels can be maintained even as it sits on your kitchen floor. But once you cut it, refrigerate. And enjoy."
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Achilles Tendon Surgery Advances Speed Recovery

Many Achilles tendon surgery patients are getting back on their feet faster, thanks to new procedures and techniques.

The introduction of tissue graft products, bone anchors, radio frequency treatments and new arthroscopic procedures provides patients with less invasive treatments and speedier recovery times. More than 1,000 foot and ankle surgeons are learning about the latest treatments and techniques for foot and ankle conditions at the American College of Foot and Ankle Surgeons (ACFAS) 66th Annual Scientific Conference in Long Beach this week.

"Whether it's getting back to work faster, or getting back to marathon training, these surgical advances will shorten recovery times for many types of patients," says Des Moines, Iowa foot and ankle surgeon Michael S. Lee, DPM, FACFAS. Lee serves on the ACFAS board of directors.

The Achilles tendon connects the calf muscle to the heel bone in the back of the leg and facilitates walking. The most common Achilles condition is tendonitis, an inflammation of the tendon. Most tendonitis cases can be successfully treated with non-surgical methods such as rest, ice, anti-inflammatory medications and physical therapy.

But some tendonitis patients develop scar tissue on the tendon, or their tendon fibers weaken and develop microscopic tears, a condition called Achilles tendonosis. Fixing these problems can require invasive surgery and weeks to months of recovery.

Recently-introduced radio frequency technology can slash recovery time for some patients by using radio waves to stimulate healing in the tendon. The procedure requires smaller incisions to insert the wand-like radio frequency device. Smaller incisions mean less damage to skin and muscle, less pain, and lower risk of surgical infections. Patients recover faster.

Overuse, especially in athletes, can cause the Achilles tendon to tighten and pull so hard on the heel bone that a bone spur, or bump, develops. Shoes can rub against the spur and cause pain. In addition, a painful fluid-filled sac called a bursa can develop between the heel bone and the tendon. Traditionally, correcting this tightness involved severing the tendon, removing the bone spur or bursa, and then reattaching the tendon.

New arthroscopic techniques can provide a minimally invasive option to removing bone spurs and bursas without significant damage to the Achilles tendon. When the tendon does have to be surgically detached, new bone anchor constructs (screws that are drilled into the heel bone to secure the tendon and tissues) can reattach the tendon, minimizing the chance of a potentially painful knot on the back of the heel.

Achilles tendon ruptures are the most serious Achilles injuries. Most patients require surgery to decrease the likelihood of a re-rupture. Various techniques are available, and increasingly may include tissue grafts used as a bridge to link the severed tendon lengths. The graft provides a scaffold on which new tissue grows, increases the overall strength of the repair, and is usually absorbed by the body within a year.

Go to the ACFAS consumer Web site, http://FootPhysicians.com, for more information on Achilles tendon conditions.
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Chewing Gum Sweetener Can Cause Dangerous Weight Loss

Many sugar-free chewing gums contain a sweetener called sorbitol. Sorbitol is a laxative which is poorly absorbed by the small intestine. An article in this week's British Medical Journal (BMJ) warns of the dangers of excess sorbitol intake.

The warning comes after doctors came across two patients who had chronic diarrhea, abdominal pain and dangerously excessive weight loss. After lengthy investigations which could not identify why the patients were losing so much weight and had chronic diarrhea and pains, a detailed analysis of eating habits put the problem down to eating too much chewing gum with sorbitol.

One of the patients, a 21-year-old woman, had been eating the equivalent of 18-20g of sorbitol each day. The average stick of gum has about 1.25g sorbitol - so, she was chewing through 15-18 sticks of gum each day. The other patient, a 46-year-old man, was chewing about 20 sticks of sorbitol-containing gum plus approximately 200g of sweets (candy) each day - his total sorbitol daily intake was about 30g, the authors wrote.

As soon as sorbitol intake was stopped, both patients started having normal bowel movements (diarrhea subsided) and normal weight gain was achieved.

The authors say consumers are generally unaware of the possible side-effects of sorbitol, even though details are included in the small print of foods containing it. When consumers have gastronomical problems they are unaware that they may be caused by the laxative effects of sorbitol.

The authors conclude that sorbitol consumption may not only cause chronic diarrhea and functional bowel complaints, but also significant unplanned weight loss of about 20% of body weight. Any investigation of unexplained weight loss should include a detailed dietary history with regard to sorbitol-containing foods.

What is Sorbitol?
(Source - Wikipedia)

Sorbitol, or glucitol, is a sugar alcohol which our bodies metabolize slowly.

Sorbitol can be found in cough syrups, sugar free mints, chewing gum, diet foods, diet drinks and ice creams. Sorbitol occurs naturally in some stone fruits and berries from trees of the Sorbus genus. Apples and pears also have natural amounts of sorbitol.

Sorbitol, which retains 60% of its sweetness, provides dietary energy of 2.6 kilocalories (11 kilojoules) per gram, compared to sugar which provides about 4 kilocalories (17 kilojoules).

As a food additive Sorbitol has an E-number E420.

Sorbitol is also used as a non-stimulant laxative. It is either an oral suspension or a suppository. It stimulates bowel movements by drawing water into the large intestine.
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Concern Over Strong Media Influence On Women's Body Image

As France's parliament considers a landmark bill that would outlaw media images glamorizing the extremely thin, psychology researchers are reporting some of the most definitive findings yet on how these images affect women.

In the May issue of Psychological Bulletin, University of Wisconsin-Madison postdoctoral researcher Shelly Grabe and psychology professor Janet Hyde describe a sweeping analysis of 77 previous studies involving more than 15,000 subjects. In it, they found that exposure to media depicting ultra-thin actresses and models significantly increased women's concerns about their bodies, including how dissatisfied they felt and their likelihood of engaging in unhealthy eating behaviors, such as excessive dieting.

Although on one level the results seem obvious, Grabe believes many people still resist the idea that a societal influence, like the media, can have a real impact on how women view themselves. When individual experiments have found this relationship in the past, she explains, critics have often dismissed them for focusing on groups of particularly body-conscious women, such as college students, or exposing test subjects to unusually racy photos.

Grabe and Hyde, in contrast, analyzed data from every well-designed study on the topic they could find, thus avoiding much of this criticism.

"We've demonstrated that it doesn't matter what the exposure is, whether it's general TV watching in the evening, or magazines, or ads showing on a computer," says Grabe. "If the image is appearance-focused and sends a clear message about a woman's body as an object, then it's going to affect women."

The effect also appears to be growing. The researchers' analysis reveals that, on average, studies conducted in the 2000s show a larger influence of the media on women's body image than do those from the 1990s, says Grabe.

"This suggests that despite all our efforts to teach women and girls to be savvy about the media and have healthy body practices, the media's effect on how much they internalize the thin ideal is getting stronger," she says.

The results are troubling because recent research has established body dissatisfaction as a major risk factor for low self-esteem, depression, obesity, and eating disorders, such as bulimia. At the same time, women's displeasure with their bodies has become so common that it's now considered normal, says Grabe. She hopes that wider recognition of the media's role will encourage people to see the issue as a societal one, rather than as a problem of individual women as it's viewed now.

"I think we need to consider how we're using media images as a culture to share the values we think are important, and the effect that has on our well-being, " she says.

The approach Grabe and Hyde took in their study, called meta-analysis, offers a way to quantitatively examine an entire body of research at once. In their case, this meant 77 carefully selected studies of the effects of appearance-focused media images on women's body dissatisfaction, investment in their looks, adoption of the thin ideal, and eating behaviors and beliefs. The analysis also included controlled, experimental studies, in which these effects were tested directly, and investigations that correlated body concerns with women's self-reported consumption of media.

In simple terms, the meta-analysis placed test subjects from every study into two groups: those who were exposed to media images portraying women's bodies and the thin ideal, and those who weren't. It then asked whether differences existed between the two and the magnitude of the differences.

In the end, the researchers did find a significant difference, with women who were exposed to media reporting less satisfaction with their bodies. Notably, this difference was also seen across all four measures of body image concerns.

So, what's the answer? The French government may try to control the media, but don't women also need to learn to be a little less concerned with their looks"

Grabe replies that the issue lies not with our attraction to images of beauty or with women's desire to emulate them, but with what we've come to define as beautiful: bodies that are unnaturally and unhealthily thin.

"I want to stress that it's totally normal for women to want to be attractive," says Grabe. "But what's happening in our society is that many women are striving toward something that's not very realistic or obtainable, and that leads to a lot of health consequences."
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Why Is Broccoli Good For You?

Broccoli has high levels of antioxidants

"Eating steamed broccoli reduces the risk of a heart attack by boosting the body's ability to fight off cell damage", The Daily Telegraph reported.

New research suggests that a mechanism involving antioxidants found in the Brassicaceae family of vegetables (cauliflower, broccoli, cabbage and Brussels sprouts) prevents the build-up of free radicals. Excessive production of free radicals can harm cells and even trigger cancers. The paper quotes other researchers who have long believed that antioxidant substances have health benefits. However, many studies have failed to show an effect.

The rats which were fed broccoli during this study showed some changes in proteins and heart function compared to those fed only water. However, without knowing if the activation of heart-protective proteins in response to antioxidants would be the same in humans, it would be premature to claim that eating broccoli specifically reduces your chance of a heart attack, as opposed to a healthy eating pattern in general.

Where did the story come from?

Subhendu Mukherjee and two colleagues at the Cardiovascular Research Center, University of Connecticut School of Medicine in the US, carried out this research. The study was published in the scientific journal The Journal of Agricultural and Food Chemistry.

What kind of scientific study was this?

This was a laboratory study conducted in rats which investigated whether eating broccoli could be beneficial to the heart. The researchers suspected this might be the case as broccoli contains high amounts of selenium, an inorganic chemical that is thought to mop up free radicals and glucosinolates (organic compounds derived from sugar and also found in many other green vegetables). Glucosinates are toxic in high doses, but are converted to sulphoraphanes by chewing and these are thought to protect against cancer and heart disease.

The researchers fed broccoli (in a slurry made with water) to a group of six rats, while six control animals were fed only water. After 30 days, the hearts of the animals were removed and the blood supply cut off for 30 minutes, followed by two hours where the blood flow was returned. This was intended to be the experimental equivalent of a heart attack. The researchers then performed a variety of tests on the hearts and the heart muscle cells.

What were the results of the study?

When compared to the control group, the rats which were fed broccoli showed improved heart muscle function after the experimental heart attack: they had a smaller amount of dead heart muscle and heart muscle cells. These changes were accompanied by changes in several proteins found in the cell nuclei, and other chemicals thought to protect the heart.

What interpretations did the researchers draw from these results?

The researchers report that the experimental heart attack led to the death of heart muscle cells by causing a change in the mitochondria within these cells and the release of a protein that 'programmes' the cell for death. Broccoli consumption appeared to reduce the number of heart muscle cells programmed for cell death and also the levels of protein released, which indicated that it was able to generate some kind of "anti-cell death" signal. They examined several components of these pathways and claim that broccoli appears to rescue the heart muscle in the experimental model heart attack through some form of survival pathway.

What does the NHS Knowledge Service make of this study?

This study has investigated the pathways thought to protect heart muscle from cell death during a heart attack, using a rat model of the disease.

The researchers claim that broccoli is a unique vegetable in this respect, and implied in the title of their paper that their results might apply to mammals in general. However, how these results apply to heart attacks in humans remains to be seen. It is also not known whether these results could be achieved with other vegetable diets in rats.

Until further research can confirm these findings, the best advice may be to protect heart muscle by following conventional advice: eat healthy food, engage in moderate physical activity and avoid smoking. There is also no harm in eating broccoli as part of a healthy, balanced diet.
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Paralysis Outbreak In Meat Workers Handling Pigs' Brains

The US Centers for Disease Control and Prevention issued an update last week to its investigation of an outbreak of a paralysing condition that is affecting certain meat processing plant workers who use compressed air to remove the brains from the heads of pig carcases.

The illness is called Progressive Inflammatory Neuropathy (PIN) and its symptoms range from acute paralysis to gradual increase of weakness on both sides of the body, which in some cases happens over 8 days and in others over 213 days. The symptoms vary in severity from slight weakness and numbness to paralysis that affects mobility, mostly in the lower extremities.

The current thinking, which is yet to be proved, is that the meat workers are being exposed to splatter and aerosol droplets of pig brain tissue created by the compressed air blast, which liquefies the tissue before expelling it from the pig skull. Once inhaled, small particles of pig brain tissue are then is attacked by the worker's immune system which uses antibodies that also attack the body's own almost identical human nerve tissue.

Following the PIN outbreak in a Minnesota meat processing plant, the CDC launched a nationwide survey of large slaughterhouses and found two more meat plants that had used the compressed air system recently. One of the plants was also reporting cases of a neurologic illness among its meat processing workers.

The outbreak came to the attention of the Minnesota Department of Health (MDH) in October last year, when it started getting reports of an unexplained neurologic illness among meat processing workers in a swine slaughterhouse in Southeast Minnesota, and which the CDC calls "plant A".

The MDH conducted a full and detailed investigation of the plant, which employs some 1,200 workers and processes 18,000 pigs a day. They interviewed workers and looked at health records, and found a total of 12 employees who have either been confirmed as having PIN (8 so far), probably have it (2), or possibly have it (2).

The 12 workers, six of whom are female, started having symptoms between November 2006 and November 2007 and reported being healthy beforehand. They ranged in age from 21 to 51 years.

According to the MDH, 11 of the 12 workers affected showed evidence of axonal or demyelinating peripheral neuropathy (damage to nerve fibres and surrounding protective tissue). Spinal fluid taken from 7 of the workers showed they had high protein levels with little or no rise in pleocytosis or white blood cell count. A raised white blood cell count is usually evidence of inflammation.

However, five patients showed evidence of inflammation when examined by spinal MRI (magnetic resonance imaging), four of them in peripheral nerves or roots and one in the anteorior spinal cord.

All 12 affected workers said they either worked at or had contact with the area of the plant where pig heads were processed (called the "head table"). The head table was in an area of the plant known as the "warm room".

The MDH conducted a case-controlled study that included 10 of the 12 workers (the 8 confirmed and the 2 probable cases of PIN), and two control groups: a random selection of 48 healthy workers from the warm room, and all 65 healthy workers from the head table. After examining throat swabs and blood samples from the consenting participants, the MDH to date has not found any infectious agent that could explain the PIN symptoms.

Futher results from the case-control study showed that 7 of the 10 workers with PIN (70 per cent of the case patients) were seven times more likely to have worked at the head table than the controls from the warm room (25 per cent, or 12 of 48). Case patients were also more likely to have handled brains and muscle from pigs' heads than members of either control group.

Travel outside the US or inside the US, exposure to chemicals, including fertilizers and insecticides, or having had vaccinations, were also not found to be causes of the PIN illness.

The health authorities then investigated the processing methods and safety equipment in the warm room and the head table in particular, and concluded, for now, that the compressed air method used to liquefy and remove the brain tissue from the pigs' heads could be causing the PIN through creating aerosol droplets of brain tissue that is then inhaled by the workers.

The plant operator has suspended use of the compressed air equipment voluntarily and stepped up use of personal protective equipment (PPE), including face shields and long sleeves for the head table workers and any other workers who want to use additional PPE, said the CDC report.

Following the Minnesota plant A outbreak report, the CDC surveyed all 25 federally inspected swine slaughterhouses in the US with more than 500 employees. They found three plants, including Minnesota plant A, using the compressed air method to remove pigs' brains. The other two are in Nebraska and Indiana. Of those, only the Indiana plant has reported cases of suspected PIN, which are currently being further assessed. In the meantime, all three plants have stopped using the compressed air method to remove brain tissue, said the CDC.

The CDC said that:

"Whether compressed-air devices are being used for pig-brain extraction in other slaughterhouses or processing facilities, in the United States or internationally, is unknown."

"Clinicians should provide CDC with information regarding swine slaughterhouse workers who might have illnesses similar to PIN, including patients with peripheral neuropathy, myelopathy, or features of both."

If doctors se any patients who work in slaughterhouses with these symptoms, they should report them to their state health department and also let the CDC know on 770-488-7100.

A puzzling feature of this outbreak was raised by the plant owner at one of the affected plants, who started as a floor walker in 1970. He told the Washington Post that they had been "harvesting pig brains since 1998, using the same method and the same 70-pound pressure air hose." So why did the outbreak not take place ten years ago, when they started using the method? The plant owner said that was the "million-dollar question".

"Investigation of Progressive Inflammatory Neuropathy Among Swine Slaughterhouse Workers --- Minnesota, 2007---2008:."
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Nausea During Pregnancy (Morning Sickness)

It is common for a pregnant woman to live through nausea and vomiting during her first few months of pregnancy. It is difficult to predict whether it is going to happen. Some women have no nausea during their first pregnancy, but feel sick with subsequent pregnancies.

"Nausea and vomiting are the commonest symptoms experienced in the first trimester of pregnancy, affecting 70-85% of women"
(British Medical Journal, 2004;328:503 28 February, doi:10.1136/bmj.328.7438.503)

The severity of the nausea varies from pregnancy to pregnancy. Some will feel a bit queasy during the morning hours, others may vomit just in the mornings. Others will feel bad all day long, and throw up at any time. The term "morning sickness" may seem meaningless to the mother who is throwing up in the evening.

In most cases the nausea goes away during the end of the third or beginning of the fourth month. It can, however, continue right up to the end of the fifth month.

Why do some pregnant women experience nausea?

Doctors and scientists are not completely sure. As hormonal changes take place when a woman becomes pregnant it makes sense to suppose that they are the cause. Some say an imbalance in the blood sugar could also be to blame.

It might be no coincidence that hCG, a pregnancy hormone, as well as estrogen rise in levels during the first trimester, and drop at about the same time the nausea starts going away.

Anecdotal reports by doctors, nurses and midwives indicate that women who carry twins/triplets are more likely to experience morning sickness during their first months of pregnancy, compared to mothers who are carrying a single baby.

Should I be worried about nausea during pregnancy?

If your vomiting is such that you are losing too much liquid and essential nutrients and minerals, if you are suffering from dehydration you should tell your doctor. If you suffer from hyperemesis gravidarum - the vomiting is causing fluid and electrolyte disturbance - your doctor may decide to give you fluids through a drip, this usually requires hospitalization.

You should see your doctor if you are losing weight, vomiting many times during the day for many days, becoming dehydrated, or your vomit has blood or a brownish color, your urine is dark colored and looks concentrated.

In the vast majority of cases the nausea will go away without anything to worry about.

How do I know if I am dehydrated?

The simplest way is to ask your doctor to do a urine test (ketone test).

Tips on Lessening the Severity and Frequency of Nausea

-- Don't get out of bed quickly, take your time.

-- Eat a little bit of something when you get up. Some women have found that eating a dry cracker or some dry cereal before getting out of bed helps.

-- Eat a little bit of something just before you go to bed at night.

-- Eat regularly, in small amounts, throughout the day.

-- Make sure you are having plenty of liquids.

-- Keep away from fatty foods.

-- Keep away from spicy foods.

-- Avoid caffeine.

-- Many women say dry foods, such as crackers or toast help.

-- If you are particularly sensitive to smells, remember that cold foods smell less.

-- Some women find ginger tea helps a lot.

-- Make sure you are getting enough physical rest. However, try to avoid having a nap immediately after you have eaten.

-- Try not to move around straight after eating.

-- There might be smells that make you feel sick - avoid them.

-- Get some light exercise each day, go for a walk.

-- Fresh air often helps.

-- Have a small snack next to your bed. If you wake up during the night, eat some of it. Many women find this helps stave off the nausea the following morning.

-- Eat snacks that are high in protein (March of Dimes).

Do not take anti-sickness tablets unless your doctor has prescribed them for you.
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What Is Norovirus Infection? What Causes Norovirus Infection?

Noroviruses, also known as Norwalk-like viruses, SRSV (small round structured viruses, are part of a group of viruses from the family Caliciviridae that are the most common cause of stomach upset (gastroenteritis) in the USA, Great Britain and Western Europe; about 90% of epidemic non-bacterial outbreaks of gastroenteritis around the world. Sometimes referred to as winter vomiting disease, norovirus infection often affects people during the winter months. However, people may be affected at any time of year.

After a person has a norovirus infection, immunity is only temporary - about 14 weeks - and usually incomplete. Individuals with blood type O are more susceptible to infection, while those with types B and AB are partially protected. Given the genetic variability of noroviruses, individuals are likely to be repeatedly infected throughout their lifetimes. However, experts say that having recurring infections does eventually provide some protection from future infection.

Norovirus infection outbreaks more commonly occur in closed or semi-closed communities, such as prisons, dormitories, cruise ships, schools, long-term care facilities and overnight camps - places where infection can spread rapidly from human-to-human or through tainted food and surfaces. Infection outbreaks may also occur from food that was handled by an infected person.

According to the Centers for Disease Control and Prevention (CDC) it is estimated that at least 50% of all foodborne outbreaks of gastroenteritis can be attributed to noroviruses. The National Health Service (NHS), UK, estimates that approximately between 600,000 and 1,000,000 British people every year are infected.

The norovirus can spread via human contact with an infected person, through contact with contaminated surfaces or objects, or by consuming contaminated water or food.

According to the CDC, USA, the majority of foodborne norovirus infection outbreaks most likely arise through direct contamination of food by an infected handler immediately before its consumption. Outbreaks have often been linked to cold food consumption, including salads, sandwiches and bakery products. Such liquid items as salad dressing or cake icing have also been implicated as outbreak causes. Sometimes oysters from contaminated waters have been linked to widespread gastroenteritis outbreaks.

Waterborne outbreaks of norovirus infection in community settings have commonly been caused by sewage contamination of wells and recreational water, says the CDC.

According to Medilexicon's medical dictionary:
    Caliciviridae is "A family of naked icosahedral single-stranded positive sense RNA viruses 30-38 mm in diameter associated with epidemic viral gastroenteritis and certain forms of hepatitis in humans."

What are the signs and symptoms of a norovirus infection?

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

Norovirus infection causes gastroenteritis - inflammation of the stomach and the small and large intestines.

Norovirus infection signs and symptoms include:
  • Nausea - usually the first symptom
  • Vomiting - sometimes violent and sudden
  • Stomachache (abdominal pain)
  • Abdominal cramps
  • Watery or loose diarrhea
  • Weight loss
  • Generally feeling unwell and lethargic (malaise)
  • Fever/chills, usually mild
  • Aching limbs
  • Headache
  • In rare cases patients may lose their sense of taste
During the brief period when symptoms are present people can feel very ill and vomit, often violently without warning, many times a day.

Signs and symptoms, which generally last from one to three days usually appear about 24 to 48 hours after initial infection (incubation period of 24 to 48 hours) - in some cases the incubation period may only be 12 hours. Sometimes the diarrhea can last longer than three days.

An individual's feces (stools) may still have noroviruses for some time after they have recovered. According to the CDC, USA, the virus can be in the stool and vomit of infected persons from the day they start to feel ill to as long as 2 weeks after they feel better.

It is possible to be infected and have no signs or symptoms. In such cases, the person is contagious (can pass it on to other people).

Diagnosing norovirus infection

In the vast majority of cases diagnosis is based on the patient's signs and symptoms alone. The norovirus can be identified by testing a stool sample

Treatment for norovirus infection

Doctors tend to let the norovirus infection run its course. No specific therapy exists for norovirus gastroenteritis.

Experts say that fasting will not speed up recovery. Therefore, patients should eat a light diet with foods that are easy to digest, such as rice, bread, soups or pasta. Babies should be given what they would normally eat.

It is important to replace the fluids that are lost through vomiting and/or diarrhea, especially with very young children and elderly people. Young children and elderly patients are particularly susceptible to dehydration. Patients who are not able to drink enough liquids may need to receive fluids intravenously.

What are the risk factors for norovirus infection?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. The following risk factors may increase a person's risk of becoming infected with the norovirus:
  • Weakened immune system - people whose immune systems are impaired, such as organ transplant recipients or individuals with AIDS have a higher risk of becoming infected and developing symptoms.
  • Living in a house where food hygiene procedures are not properly observed
  • Living with a child who goes to a child care center or attends preschool
  • Staying in hotels, cruise ships, vacation resorts where there are lots of people together
  • Living in in closed or semi-closed communities, such as nursing homes, hospitals or retirement centers

What are the causes of norovirus infection?

Noroviruses are shed in the feces (stools) and vomit of infected people and animals.

The infection can be transmitted by:
  • Consuming contaminated foods
  • Consuming contaminated water
  • Touching an infected person with your hand and then touching your mouth
  • Touching a contaminated surface with your hand and then touching your mouth
It is not easy to eliminate noroviruses because they can survive in both hot and cold temperatures, and are resistant to many disinfectants. Food and drinks can become contaminated with norovirus very easily because the virus is very small, and also because it probably takes fewer than 100 norovirus particles to make a person ill.

What are the possible complications of norovirus infection?

In the vast majority of cases a norovirus infection resolves itself within a few days and has no complications.

Less commonly, the following complications may occur:
  • Dehydration
  • Malnutrition
Some people are unable to drink enough liquids to replace those lost through vomiting and/or diarrhea, and may become dehydrated and require special medical attention. Young children, the elderly, and individuals of any age who are unable to take care of themselves are especially vulnerable. Examples of oral rehydration fluids (ORF) include: Infalyte, Kao Lectrolyte, Naturalyte, Oralyte, and Pedialyte. A double-blind trial of oral rehydration solutions for children with diarrhea and vomiting related to acute viral gastroenteritis found that Gatorade is as effective as Pedialyte in correcting dehydration and improving bowel symptoms.

Prevention of norovirus infection

Methods of prevention of the spread of foodborne noroviruses is based on the provision of safe food and water. Noroviruses can survive freezing, as well as temperatures as high as 60C (140F). Some people may even become infected after eating steamed shellfish. Noroviruses can survive up to 10 ppm chlorine, levels much higher than that found in current public water systems.

In spite of these features, experts say that fairly simple measures of personal and food hygiene substantially reduce foodborne transmission of noroviruses.

The following steps are known to considerably reduce the risk of norovirus infection:
  • Handwashing - wash your hands frequently and thoroughly with soap and warm water, especially after going to the toilet, changing a diaper (UK: nappy), and before preparing meals.
  • Possibly contaminated surfaces - clean them with disinfectant, preferably a bleach-based household cleaner. It is important to heed the instructions that go with the product. When possible, let the bleach remain on the surface for about ten minutes.

    Infected people may often vomit violently, without warning (the vomit is infectious). Any surfaces near the vomit should be thoroughly cleaned promptly.
  • Raw foods and food in general - if you are going to eat raw foods make sure they are from a reliable source. Avoid shellfish that may have come from contaminated waters. If you steam oysters your chances of becoming infected are significantly reduced.

    Any foods that may have been prepared by someone who was sick should be thrown out. Carefully wash fruit and vegetables.
  • Infected feces and vomit - make sure they are flushed away and clean the surrounding toilet area immediately with a bleach-based household cleaner.
  • Clothing and bed clothes - if they could have become contaminated wash with hot soapy water.
  • If you are infected - stay at home, especially if your job involves handling food.
  • Disposable towels - if you are especially vulnerable to infection, e.g. you are caring for an infected person, use disposable paper towels to dry you hands rather than cloth ones; the virus may survive for some time on objects.
  • Healthcare facilities - for example, hospitals should focus on methods to limit transmission by isolating patients.
  • Travelling - if you are travelling abroad, and sanitation is suspect, only drink bottled water, even for brushing your teeth. Avoid buffets and uncooked foods.
  • Disinfecting drinking water - if you suspect your water may be contaminated it is possible to disinfect it before consumption:

    • Boiling - a full boil should last for at least one minute (one minute bubbling). If you are over 2,000 meters altitude (6,500 feet) the water should be boiled for an additional minute.
    • Iodine - if possible, warm the water to 20C, add in the iodine, mix it, and let it stand for at least 20 minutes. If the water is colder let it stand for 40 minutes. Follow the manufacturer's instructions regarding how much to use.

      Pregnant women should not use iodine drops to purify water. Do not use iodine to disinfect water for long periods as there is a risk of thyroid gland problems.
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What Are The Different Types Of Schizophrenia? How Many Subtypes Of Schizophrenia Are There?

Schizophrenia, which is characterized by abnormalities in expression or perception of reality, is a mental illness that frequently consists of auditory hallucinations (hearing things that are not there), bizarre delusions, paranoid delusions, disorganized speech (in some types), disorganized thinking, and significant social or occupational dysfunction.

Most cases of schizophrenia, with the exception of Childhood Schizophrenia become apparent when the individual is in early adulthood. According to the CDC (Centers for Disease Control and Prevention), USA, approximately 0.4% to 0.6% of the population is affected.
There are several types (subtypes) of schizophrenia, some of which are listed below:

Schizoaffective Disorder

This type of schizophrenia is characterized by a combination of schizophrenia and mood (affective) disorder symptoms. Some experts disagree on whether this is a type of schizophrenia or a type of mood disorder. Some even wonder whether it should be treated as a distinct disorder.

The individual experiences a combination of schizophrenia symptoms (hallucinations, delusions) and mood disorder symptoms (mania or depression).

Catatonic Schizophrenia

This type of schizophrenia includes extremes of behavior, including:
  • Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
  • Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Sometimes an individual with catatonic schizophrenia may deliberately assume bizarre body positions, or manifest unusual limb movements or facial contortions, occasionally resulting in the misdiagnosis with tardive dyskinesia.

Childhood Schizophrenia

Also known as childhood-onset schizophrenia or early-onset schizophrenia. This is basically the same as schizophrenia, but onset takes place earlier in life. Onset means the first appearance of the signs or symptoms of an illness.

In some cases of childhood schizophrenia onset occurs at the age of ten; and even earlier. Childhood schizophrenia can have a considerable impact on the child's ability to function properly.

Disorganized Schizophrenia (Hebephrenia)

Also known as hebephrenia (hebephrenic schizophrenia), disorganized schizophrenia is thought to be an extreme expression of disorganization syndrome. It is characterized by incoherent and illogical thoughts and behaviors; i.e., disinhibited, agitated, and purposeless behavior.

Psychiatrists say disorganized schizophrenia is a more severe schizophrenia type because the patient cannot perform daily activities, such as preparing meals and taking care of personal hygiene (washing). People may not be able to understand what the patient is saying. The sufferer can become frustrated and agitated, causing him/her to lash out.

Paranoid Schizophrenia

In this type of schizophrenia the patient has false beliefs (delusions) that an individual or group of people are conspiring to harm them or members of their family.

As with most other types of schizophrenia, the patient commonly has auditory hallucinations (hearing things that are not real). The patient may also have delusions of personal grandeur - a false belief that they are much greater and more powerful and influential than they really are. He/she may spend a great deal of time thinking about ways to protect themselves from their supposed persecutors.
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Walnuts May Improve Sperm Quality

Healthy young men with a Western-style diet may be able to boost their sperm quality by eating a small packet of walnuts a day.

These are the findings of a new study that shows healthy American men in their 20s and 30s who ate a 75g (2.5 ozs) packet of walnuts a day were able to increase the vitality, motility and structure of their sperm compared to counterparts who did not eat walnuts.

A report on the study appeared online on 15 August in the Biology of Reproduction journal's papers-in-press section.

Infertility and subfertility is a common problem that affects about 70 million couples worldwide. Between a third and a half of cases are due to poor semen quality in the male partner, with scientists giving a number of reasons for this in industrialized societies: pollution, unhealthy lifestyles and the Western-style diet cited amongst them.

First author Wendie Robbins, of the University of California, Los Angeles (UCLA) and colleagues focused on the last of these, as they explained in their background information to the study:

"We tested the hypothesis that 75 gm of whole-shelled walnuts/day added to a Western-style diet of healthy young men would beneficially affect semen quality."

75 g is about 2.5 ozs, equivalent to one of those small snack-style packs you can get in the supermarket.

A small packet of walnuts a day appear to help improve the vitality of sperm

Walnuts are rich in polyunsaturated fatty acids (PUFAs), which play an important role in maturing sperm and preserving the integrity of the membrane around the cell which in turn affects its ability to fertilize an egg.

In the Western-style diet, PUFAs are usually found in fish, fish oil supplements, flax seed and walnuts. Walnuts also offer an important source of linolenic acid (ALA), a natural plant source of omega-3.

For their study, which was partially funded by the California Walnut Commission, Robbins and colleagues enrolled 117 healthy men aged 21 to 35 who followed a Western-style diet.

The participants were randomly assigned to one of two groups: 58 were asked to avoid eating tree nuts, and 59 were asked to eat 75 g of walnuts a day.

The researchers picked 75 g because other studies have suggested this is enough to change lipid levels in the blood but not enough to make healthy young men put on weight.

All the participants gave blood and semen samples before and after the study period, which lasted 12 weeks.

The researchers assessed semen quality using the traditional measures of male fertility. These include sperm concentration, vitality (living versus dead sperm), motility (how well they travel towards an egg), morphology (shape and structure), and chromosome abnormalities.

The results found at the end of the 12 weeks, neither group showed significant changes in body weight, body mass, or physical activity levels (these factors can also affect sperm quality).

However, the men in the walnut group had higher levels of omega-6 and omega-3 (ALA) fatty acids in their blood at the end of the study period than they did at the start.

The men in the walnut group also experienced improvements in sperm quality over the 12 weeks of eating walnuts, there were significant increases in measures of vitality, motility, and morphology. Their sperm also showed fewer chromosome abnormalities at the end of the 12 weeks than it did at the start of the study.

The control group, however, showed no such changes.

The researchers conclude that their:

"Findings demonstrated that walnuts added to a Western-style diet improved sperm vitality, motility and morphology."

Note that the study only looks at the effect of walnut consumption on semen quality in healthy young men: it doesn't show whether it would have the same effect in men with fertility problems, or whether the observed improvements in semen quality actually result in increased fertility.
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Like A Drug: The Rise Of American Megachurches

American megachurches use stagecraft, sensory pageantry, charismatic leadership and an upbeat, unchallenging vision of Christianity to provide their congregants with a powerful emotional religious experience, according to research from the University of Washington.

"Membership in megachurches is one of the leading ways American Christians worship these days, so, therefore, these churches should be understood," said James Wellman, associate professor of American religion at the University of Washington. "Our study shows that -- contrary to public opinion that tends to pass off the megachurch movement as consumerist religion -- megachurches are doing a pretty effective job for their members. In fact, megachurch members speak eloquently of their spiritual growth."

Wellman and co-authors Katie E. Corcoran and Kate Stockly-Meyerdirk, University of Washington graduate students in sociology and comparative religion respectively, studied 2008 data provided by the Leadership Network on 12 nationally representative American megachurches.

Corcoran will present their paper, titled "'God is Like a Drug': Explaining Interaction Ritual Chains in American Megachurches," at the 107th Annual Meeting of the American Sociological Association.

Megachurches, or churches with 2,000 or more congregants, have grown in number, size, and popularity in recent years, coming to virtually dominate the American religious landscape. More than half of all American churchgoers now attend the largest 10 percent of churches.

Megachurch services feature a come-as-you-are atmosphere, rock music, and what Wellman calls a "multisensory mélange" of visuals and other elements to stimulate the senses, as well as small-group participation and a shared focus on the message from a charismatic pastor.

The researchers hypothesized that such rituals are successful in imparting emotional energy in the megachurch setting -- "creating membership feelings and symbols charged with emotional significance, and a heightened sense of spirituality," they wrote.

As part of their study, Wellman, Corcoran, and Stockly-Meyerdirk analyzed 470 interviews and about 16,000 surveys on megachurch members' emotional experiences with their churches. Four themes emerged: salvation/spirituality, acceptance/belonging, admiration for and guidance from the leader, and morality and purpose through service.

The researchers found that feelings of joy felt in the services far exceed the powerful but fleeting "conversion experiences" for which megachurches are often stereotyped.

Many participants used the word "contagious" to describe the feeling of a megachurch service where members arrive hungry for emotional experiences and leave energized. One church member said, "(T)he Holy Spirit goes through the crowd like a football team doing the wave. ...Never seen it in any other church."

Wellman said, "That's what you see when you go into megachurches -- you see smiling people; people who are dancing in the aisles, and, in one San Diego megachurch, an interracial mix I've never seen anywhere in my time doing research on American churches. We see this experience of unalloyed joy over and over again in megachurches. That's why we say it's like a drug."

Wellman calls it a "good drug" because the message provides a conventional moral standard, such as being a decent person, taking care of family, and forgiving enemies and yourself. Megachurches also encourage their members, such as by saying, "Things can get better, you can be happy," he added.

This comforting message also is a key to megachurches' success, Wellman said. "How are you going to dominate the market? You give them a generic form of Christianity that's upbeat, exciting, and uplifting."

The researchers also found that the large size of megachurch congregations is a benefit rather than a drawback, as it results in resources for state-of-the-art technology -- amplifying the emotional intensity of services -- and the ability to hire more qualified church leadership.

Wellman said, "This isn't just same-old, same-old. This is not like evangelical revivalism. It's a new, hybrid form of Christianity that's mutating and separate from all the traditional institutions with which we usually affiliate Christianity."

Megachurches, which rarely refer to heaven or hell, are worlds away from the sober, judgmental puritan meetinghouses of long ago, Wellman said.

Wellman will continue studying the topic of the new American Christianity with a book-length profile of Michigan-based pastor and author Rob Bell due out in late fall, and a book in 2013 titled "High on God: How the Megachurch Conquered America."
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What's Your Lifetime Risk Of Developing Kidney Failure?

How likely are middle-aged adults to develop kidney failure during their lifetime? A study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) provides some insights, which may be used to help set priorities related to kidney care and to increase public interest in the prevention of kidney disease.

Kidney failure takes a significant toll on both individuals and the public as a whole, causing poor health in patients and generating considerable health care costs. Despite kidney failure's impact, researchers don't have a good estimate of people's likelihood of developing it over their lifetime.

To find out, from 1997 to 2008 Tanvir Chowdhury Turin, MD, PhD, Brenda Hemmelgarn, MD, PhD (University of Calgary, in Alberta, Canada), and their colleagues studied 2,895,521 adult Alberta residents who were free of kidney failure at the start of the study. "Given the high morbidity and cost associated with kidney failure, we wanted to quantify the burden of disease for kidney failure in an easily understandable index to communicate information for patients, health practitioners, and policy makers," said Dr. Turin.

Among the major findings:
  • Approximately 1 in 40 men and 1 in 60 women of middle age will develop kidney failure if they live into their 90s. This equates to a 2.66% risk of kidney failure for men and a 1.76% risk for women.
  • The risk is higher in people with reduced kidney function (men: 7.51% and women: 3.21%) compared with people with relatively preserved kidney function (men: 1.01% and women: 0.63%).
  • The lifetime risk of kidney failure is consistently higher for men at all ages and kidney function levels, compared with women.
The authors note that the actual current life expectancy is approximately 80 years, which changes the risks somewhat. "The observed probabilities indicate that, if the current estimates remains unchanged, approximately 1 in 93 (or approximately 1%) of men and 1 in 133 (or 0.8%) of women of middle age might develop kidney failure in their lifetime in Alberta, Canada,"
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Binge Drinking Culture, College And Happiness

Why do some colleges have persistently high levels of binge drinking? It may be because, at these schools, binge drinking is associated with high status and binge drinkers are happier with their college social experience than their non-binge drinking peers, suggests new research to be presented at the 107th Annual Meeting of the American Sociological Association.

"Binge drinking is a symbolic proxy for high status in college," said Carolyn L. Hsu, co-author of the study and an associate professor of sociology at Colgate University. "It's what the most powerful, wealthy, and happy students on campus do. This may explain why it's such a desirable activity. When lower status students binge drink, they may be trying to tap into the benefits and the social satisfaction that those kids from high status groups enjoy. And, our findings seem to indicate that, to some extent, they succeed."

According to the study, students from higher status groups (i.e., wealthy, male, white, heterosexual, and Greek affiliated undergraduates) were consistently happier with their college social experience than their peers from lower status groups (i.e., less wealthy; female; non-white; Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ); and non-Greek affiliated undergraduates).

In addition, students from higher status groups were more likely than their peers from lower status groups to binge drink. "Students, who are considered more socially powerful, drink more," said Hsu, who co-authored the study with Landon Reid, a former faculty member at Colgate who is now attending law school at NYU. "Binge drinking then becomes associated with high status and the 'cool' students on campus."

However, the study found that when students from lower status groups engaged in binge drinking, their social satisfaction was higher than that of their non-binge drinking peers from lower status groups and more similar to the levels of their higher status classmates, including binge drinkers and non-binge drinkers. Hsu said binge drinking tended to attenuate the negative effects of being from a low status group on students' college social experience.

Conversely, white, wealthy, Greek affiliated, heterosexual, and male students who did not binge drink, were less happy with their social lives than students from those groups that did binge drink.

"Among all groups, we found that binge drinking and social satisfaction were strongly connected," Hsu said.

The study relied on a survey of nearly 1,600 undergraduates attending a selective Northeastern residential liberal arts college in 2009.

"Drinking culture is campus specific," Hsu said. "But, our results suggest that binge drinking and social satisfaction may also be very much associated at similar predominately white colleges with high binge drinking rates, a large Greek presence, and a residential campus."

Binge drinking is defined as consuming at least four drinks for women and five drinks for men in a single drinking session. Binge drinkers have this kind of drinking session at least once every 14 days on average. In this study, the average binge drinker drank 13.7 drinks per week, while the average non-binge drinker consumed 4.2 drinks per week. The authors assessed social satisfaction using survey questions that asked students to evaluate their overall social experience on campus.

Additionally, the authors categorized high status groups and low status groups based on previous literature regarding low graduation rates, peer discrimination, and hostile campus environments.

For example, according to the authors, LGBTQ students commonly found their campuses to be unwelcoming; women, who often enjoy more collegiate academic success than men, were more likely than their male peers to experience prejudice and sexual harassment outside of the classroom; and minority students, particularly at predominately white schools, tended to have lower graduation rates and faced increased incidents of discrimination on campus.

The authors found that while binge drinking increased social satisfaction for students from a range of lower status groups, the positive effects of binge drinking on social satisfaction were particularly strong for low income, non-Greek affiliated, and female students. LGBTQ and minority binge drinking students enjoyed increased social satisfaction in college, but were not as socially satisfied as their binge drinking peers from higher and other lower status groups.

"Minority students and members of the LGBTQ community, more than other low status students, often face discrimination and struggle with their sense of belonging on predominately white, heterosexual campuses," Hsu said. "This may be lessening the potential ameliorating impact of binge drinking on low status."

Nevertheless, the authors found that across race, socioeconomic status, gender, sexuality, and Greek or non-Greek affiliation, the connection between binge drinking and satisfaction with the college social experience, remained consistent. "Students in all groups consistently liked college more when they participated in the campuses' binge drinking culture," Hsu said.

Students were motivated to binge drink as a way of fitting in, according to Hsu. In the open comments part of the survey, many students wrote that they did not want to binge drink, but felt that it was the only socially acceptable thing to do for fun.

Interestingly, the researchers did not find evidence that unhappy students were binge drinking to self medicate. Instead, the students in the sample with the most stress, anxiety, and experiences with discrimination or sexual abuse, were the least likely to drink. "It's the kids who say everything is great who drink the most," Hsu said.

The authors found that students saw binge drinking as a logical means to adapt, survive, and seek out the most favorable life while in college. "Low status students in particular seem to be using binge drinking as a vehicle for social mobility and as a way to contend with an otherwise hostile social environment," Hsu said.

According to the authors, despite binge drinking's potential positive social effects, binge drinking students were not exempt from the negative interpersonal and health outcomes associated with heavy alcohol consumption.

"It's not that binge drinking is the solution to complex social problems," Hsu said. "Rather, it is our hope that when universities and public health professionals design alcohol related programs for students, they take into account the full range and important social motivations underlying student binge drinking."
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