Desk-based employees 'should work standing up'

A group xperts have advised that people working in office environments stand for at least 2 hours a day during working hours, as part of a number of recommendations to protect those engaged with typically sedentary forms of work.

Breaking up long periods of sitting with activity is considered by most experts to be advantageous to the health of workers.

Workers whose jobs are predominantly desk-based should eventually progress to a total of 4 hours standing, advises the panel.

The recommendation comes as part of a set of guidelines, published in the British Journal of Sports Medicine, with the aim to provide guidance to employers and office workers to counteract the health risks that come with long periods of seated office work.

"For those working in offices, 65-75% of their working hours are spent sitting, of which more than 50% of this is accumulated in prolonged periods of sustained sitting," write the authors. "The evidence is clearly emerging that a first 'behavioral' step could be simply to get people standing and moving more frequently as part of their working day."

An increasing number of studies associate sedentary living - including time spent at work - with an increased risk of several serious illnesses and causes of death, including cardiovascular disease, diabetes and some forms of cancer.

Although much of the evidence the panel used to inform its recommendations comes from observational and retrospective studies, they state that "the level of consistent evidence accumulated to date, and the public health context of rising chronic diseases, suggest initial guidelines are justified."

The key recommendations of the guidelines for office workers during working hours are:

• Two hours daily, eventually progressing to 4 hours, of standing and light activity (such as light walking)
• Breaking up periods of seated work with standing work using adjustable sit-stand desks and workstations
• Avoiding prolonged static standing, which may also be harmful
• Altering posture and light walking to reduce fatigue and musculoskeletal pain while adapting to new work practices
• Employers should inform staff of the dangers of spending too much time sitting down, both at work and at home
• Employers should also promote the benefits of other healthful behaviors such as eating a balanced diet and not smoking.

Guidelines 'pose no significant physical or cognitive challenges' for workers

There is a growing interest in changing working environments so that they are no longer wholly sedentary. Many companies now provide office furniture with sit-stand attachments for desks or fully adjustable sit-stand desktops, allowing office employees to work without having to be seated.

While a number of companies have already begun investing in changes to enable their employees to work in a more active environment, many have not. The panel state those that have yet to do so should begin to evaluate how best they can implement these recommendations.

Potential measures that can be taken include making provisions for breaks that involve standing and movement and investing in desks and office designs that allow employees to work easily while standing up.

The panel warns, however, that simply changing a working environment may not be enough to alter behaviors in the long term. "Strategies and programs for implementing change will need careful organizational and behavioral support and public education to prevent current interests in active office environments from simply being a passing fad," they write.

"On the basis that there are a large number of occupations which involve people standing and moving for considerably more than 4 [hours a day] (e.g., hospital staff, teachers, factory workers, retail and catering staff), it is expected that for office-based workers, in general, this should not pose too many significant physical or cognitive challenges," the authors conclude.

The panel of international experts was commissioned by Public Health England and a British community interest company, Active Working CIC.

Continue to Read more ...

The dangers of working in an office

The office here at Medical News Today HQ is a pleasant place to work. It is a largely tranquil place (until somebody decides to use the shredder) where the tea is plentiful and occasionally a passing dog can be spotted through the window.

Posture is crucial to keeping healthy when working for long periods of time at a desk. This woman risks injuring her back and neck by hunching forward.

On the idyllic surface, it seems as though it would be a perfectly safe and healthy place to work. There are certainly no obvious hazards of the kind that are commonplace on construction sites or in factories, and many office workers enjoy the benefits of rigid working days, rather than having their body clocks thrown by changing shift patterns.

But offices are not without their hazards, even if these are not as overt as those in other environments. One significant problem comes from being sat at a desk for most of the day. A recent study has suggested that the amount of time spent sitting each day is associated with a higher risk of various diseases.

According to the US Bureau of Labor Statistics (BLS), around 21,638,470 people are employed in jobs defined as office and administrative support occupations. However, this figure does not include other occupations, such as management roles, business and financial operations occupations or computer occupations that are also likely to be based in office environments.

In this Spotlight, we investigate what the health-conscious office worker needs to be wary of if they are going to complete their 9-5 with both body and mind intact, and if there are any ways for them to maintain peak fitness during their employment.

Chained to your desk

As mentioned above, sitting for long periods of time every day is bad for your health. While sitting reduces the amount of time individuals can spend exercising, researchers have demonstrated that prolonged sitting time is associated with poor health outcomes regardless of the amount of physical activity performed.

Although sitting at a desk is a seemingly simple task, it is an easy one for people to do wrong. Workers often complain of sore wrists and pain in the back and neck, and this will frequently be due to the way they position their body while working.

If an individual is sitting or typing in an unhealthy way, it is likely that they will be putting strain on their body for most of their working day. That is a lot of strain for a body to take over the course of a week. Unsurprisingly, back pain is one of the most common reasons for employees missing work and is the second most common reason for visits to the doctor.

The American Chiropractic Association (ACA) state that back pain can be caused by poor posture, obesity and psychological stress among other factors, all of which can easily come into play in an office environment if work is tense and not allowing for employees to take leave from their desks.

Good posture at the desk is the first step to be taken in protecting your health when working in the office. This can be achieved with efficient office ergonomics. Making sure that all objects that will be needed are situated close by reduces excessive stretching.

When sitting in front of a computer, the body should be positioned centrally to the monitor and keyboard. You should sit up straight with feet rested flat on the floor. If this is not possible, a footrest should be used. Thighs should ideally be horizontal with the knees and level with the hips.

The forearms should also be level or tilted up slightly. When typing, wrists should be in a straight and natural position. Using a wrist rest can reduce stress on the wrists and help prevent specific awkward positioning.

There are a number of common posture mistakes that can be made when sitting and can easily become part of a routine if not addressed:

• Slouching - this position places a lot of pressure on the lower back, damaging the ligaments, joints and soft tissue in this area and can lead to hunching
• Sitting cross-legged - this position tucks in the hip, making it difficult to sit up straight and leading to slouching. Sitting cross-legged can also lead to muscle imbalances in the hips that cause pain and stiffness
• Hunching forward - can lead to a tight chest and weak upper back, potentially leading to the development of a rounded upper back that is susceptible to pain and stiffness
• Poking the chin forward - sometimes a symptom of a hunched back or sitting too low as an attempt to compensate for excess downward pressure, this can lead to muscle weakness around the neck
• Phone cradling - employees that have to use a phone frequently may hold their phone handset between their ear and shoulder in order to leave their hands free to operate a computer or write. This can weaken the neck muscles and lead to muscle imbalances that cause headaches.

Office workers are advised to get up and move around whenever they can. The nature of many office jobs, however, usually results in long periods of sitting down. If you are going to be sitting down at a desk for any length of time, it is a good idea to get the basics right.

"The number one thing that gets people into trouble as far as a downgrade in their health is their posture," says Luis Feigenbaum, a director of sports physical therapy at the University of Miami's Miller School of Medicine, in conversation withABC News.

Computers: one-eyed monsters of the office

These days, most people sitting at a desk will have a computer sitting right in front of them. Although they make a lot of jobs easier, they also make keeping healthy in the office a lot harder.

Many office workers will be familiar with computers, and using them properly is important for keeping healthy.

Firstly, where a computer and its related hardware are positioned can drastically influence posture. The height of a computer monitor will affect the height of an office chair - a monitor should be positioned directly in front of the user, about an arm's length away, with the top of the screen just below eye level.

As well as posture, using a computer can wear down other parts of the body that are directly using it, namely the eyes and the wrists.

To avoid eye strain, both the computer monitor and the office lighting need to be addressed. The screen should be adjusted so that its brightness and contrast levels suit the lighting conditions in the room, which should not be too bright.

Screen glare is a major cause of eyestrain and can be reduced by ensuring that monitors are not positioned opposite windows where possible. If situated close to a window, use shades and blinds to reduce the amount of light that falls on the monitor.

If the font size of text being read on a computer is too small it can lead to eyestrain as well as harming posture, as a worker may be inclined to hunch forward to read text more closely. Increasing font size or zooming in on a page that is being read protects employees from this risk.

Typing is a repetitive action that puts the hands and wrists under great pressure. If performed forcefully enough and for long enough periods of time, it can lead to disabling pain. In office workers, it can lead to repetitive strain injuries, whereby the tissue surrounding the joints becomes inflamed or stress fractures develop.

Wrist injuries through typing can be prevented or at least reduced by maintaining a good typing posture. As mentioned earlier, wrists should be kept in a relaxed, natural position. Foam or gel wrist supports can provide extra protection.

One of the key messages when it comes to using computers in the office is how important it is to take regular breaks. The US Occupational Safety and Health Administration (OSHA) recommend that workers take a 10 minute break for every hour spent on a computer, allowing the body to recover and reducing the risk of strain.

These breaks can include working on other tasks that do not involve using a computer. They also represent an opportunity for employees to get out of the sitting position. Alternatively, if employees have the freedom to do so, breaks could involve seeking sustenance to refuel their bodies.

Here be vending machines

The office environment is often full of temptation when it comes to eating healthily. Many offices are home to vending machines filled with sugary drinks and fatty snacks that sing out to workers eager to get a quick energy boost.

Bringing a packed lunch from home is good for both your health and your wallet.

A desire for this kind of unhealthy food is increased if an individual hasn't eaten properly in the morning or obtained enough sleep the night before. Finding time for both sleep and breakfast helps reduce the lure of unhealthy food throughout the working day.

Bringing a lunch and snacks to work also helps keep office workers away from vending machines and restaurants, as well as saving them money. Snacking is fine if it is done healthily, and while vending machines are unlikely to stock fruit, vegetables, hummus and seeds, workers can bring these in themselves.

"It's really important to eat at least every four hours," Beth Thayer tells ABC. "You need to make sure you're setting some time aside to make sure you're getting food in."

Thayer, a registered dietitian and spokesperson for the American Dietetic Association, recommends packaging and preparing your own meals. "Small bags of nuts or snack mix you make yourself, or a small bag of fruit like apples or grapes," she suggested. "Fruit works well for people who drive a lot."

Eating is a great opportunity for workers to escape from their workstations, but few take advantage of it. According to a survey conducted by the American Dietetic Association in 2011, 62% of Americans eat lunch at their desks.

As well as preventing workers from getting away from work and keeping them sitting down in the same place, eating at the desk can lead to a build-up of bacteria if the correct hygiene precautions are not taken.

"We need to wash our hands and clean up the area after we eat at our desks," Thayer warns. "Don't let desks become places for bacterial growth."

Leaving the desk for a break allows workers to regroup and collect themselves away from their work. Doing this can be particularly important in mentally demanding roles. Taking a proper break can help reduce stress levels that can be responsible for a wide range of health problems.

How to improve your fitness at work

Although the office can often be a comfortable place to work, it is important that workers do not allow unhealthy practices to become comfortable and routine. Remaining sedentary, using office equipment incorrectly and eating unhealthily can eventually lead to debilitating health problems that could stop individuals from working altogether.

Thankfully, office work also provides a number of options for keeping fit, and if these are incorporated into a working routine then there is no reason why working in an office should condemn employees to a life of ill health.

• Travel to work by walking or biking. Get off public transport a stop earlier than normal or park your car further away from the office
• Stand instead of sitting when working as much as possible. Find as many excuses to get out of your chair as possible
• Spend time during breaks to go for a brisk walk or do some stretching to keep the muscles loose and strong.

On the surface, working in an office appears to be a simple form of employment. While that may be true in comparison with some other jobs, it is important that office workers do not get complacent and sit idly as their health runs away from them.

Dr. Timothy Church, from the Preventive Medicine Laboratory at Pennington Biomedical Research Center, Louisiana State University, told MNT that the biggest risk to the health of office workers is the sedentary lifestyle.

"The answer is getting active," he said. "Get up at least every 45 minutes and obtain at least 7,000 steps per day."

Continue to Read more ...

The dangers of working in an office

The office here at Medical News Today HQ is a pleasant place to work. It is a largely tranquil place (until somebody decides to use the shredder) where the tea is plentiful and occasionally a passing dog can be spotted through the window.

Posture is crucial to keeping healthy when working for long periods of time at a desk. This woman risks injuring her back and neck by hunching forward.

On the idyllic surface, it seems as though it would be a perfectly safe and healthy place to work. There are certainly no obvious hazards of the kind that are commonplace on construction sites or in factories, and many office workers enjoy the benefits of rigid working days, rather than having their body clocks thrown by changing shift patterns.

But offices are not without their hazards, even if these are not as overt as those in other environments. One significant problem comes from being sat at a desk for most of the day. A recent study has suggested that the amount of time spent sitting each day is associated with a higher risk of various diseases.

According to the US Bureau of Labor Statistics (BLS), around 21,638,470 people are employed in jobs defined as office and administrative support occupations. However, this figure does not include other occupations, such as management roles, business and financial operations occupations or computer occupations that are also likely to be based in office environments.

In this Spotlight, we investigate what the health-conscious office worker needs to be wary of if they are going to complete their 9-5 with both body and mind intact, and if there are any ways for them to maintain peak fitness during their employment.

Chained to your desk

As mentioned above, sitting for long periods of time every day is bad for your health. While sitting reduces the amount of time individuals can spend exercising, researchers have demonstrated that prolonged sitting time is associated with poor health outcomes regardless of the amount of physical activity performed.

Although sitting at a desk is a seemingly simple task, it is an easy one for people to do wrong. Workers often complain of sore wrists and pain in the back and neck, and this will frequently be due to the way they position their body while working.

If an individual is sitting or typing in an unhealthy way, it is likely that they will be putting strain on their body for most of their working day. That is a lot of strain for a body to take over the course of a week. Unsurprisingly, back pain is one of the most common reasons for employees missing work and is the second most common reason for visits to the doctor.

The American Chiropractic Association (ACA) state that back pain can be caused by poor posture, obesity and psychological stress among other factors, all of which can easily come into play in an office environment if work is tense and not allowing for employees to take leave from their desks.

Good posture at the desk is the first step to be taken in protecting your health when working in the office. This can be achieved with efficient office ergonomics. Making sure that all objects that will be needed are situated close by reduces excessive stretching.

When sitting in front of a computer, the body should be positioned centrally to the monitor and keyboard. You should sit up straight with feet rested flat on the floor. If this is not possible, a footrest should be used. Thighs should ideally be horizontal with the knees and level with the hips.

The forearms should also be level or tilted up slightly. When typing, wrists should be in a straight and natural position. Using a wrist rest can reduce stress on the wrists and help prevent specific awkward positioning.

There are a number of common posture mistakes that can be made when sitting and can easily become part of a routine if not addressed:

• Slouching - this position places a lot of pressure on the lower back, damaging the ligaments, joints and soft tissue in this area and can lead to hunching
• Sitting cross-legged - this position tucks in the hip, making it difficult to sit up straight and leading to slouching. Sitting cross-legged can also lead to muscle imbalances in the hips that cause pain and stiffness
• Hunching forward - can lead to a tight chest and weak upper back, potentially leading to the development of a rounded upper back that is susceptible to pain and stiffness
• Poking the chin forward - sometimes a symptom of a hunched back or sitting too low as an attempt to compensate for excess downward pressure, this can lead to muscle weakness around the neck
• Phone cradling - employees that have to use a phone frequently may hold their phone handset between their ear and shoulder in order to leave their hands free to operate a computer or write. This can weaken the neck muscles and lead to muscle imbalances that cause headaches.

Office workers are advised to get up and move around whenever they can. The nature of many office jobs, however, usually results in long periods of sitting down. If you are going to be sitting down at a desk for any length of time, it is a good idea to get the basics right.

"The number one thing that gets people into trouble as far as a downgrade in their health is their posture," says Luis Feigenbaum, a director of sports physical therapy at the University of Miami's Miller School of Medicine, in conversation with ABC News.

Computers: one-eyed monsters of the office

These days, most people sitting at a desk will have a computer sitting right in front of them. Although they make a lot of jobs easier, they also make keeping healthy in the office a lot harder.

Many office workers will be familiar with computers, and using them properly is important for keeping healthy.

Firstly, where a computer and its related hardware are positioned can drastically influence posture. The height of a computer monitor will affect the height of an office chair - a monitor should be positioned directly in front of the user, about an arm's length away, with the top of the screen just below eye level.

As well as posture, using a computer can wear down other parts of the body that are directly using it, namely the eyes and the wrists.

To avoid eye strain, both the computer monitor and the office lighting need to be addressed. The screen should be adjusted so that its brightness and contrast levels suit the lighting conditions in the room, which should not be too bright.

Screen glare is a major cause of eyestrain and can be reduced by ensuring that monitors are not positioned opposite windows where possible. If situated close to a window, use shades and blinds to reduce the amount of light that falls on the monitor.

If the font size of text being read on a computer is too small it can lead to eyestrain as well as harming posture, as a worker may be inclined to hunch forward to read text more closely. Increasing font size or zooming in on a page that is being read protects employees from this risk.

Typing is a repetitive action that puts the hands and wrists under great pressure. If performed forcefully enough and for long enough periods of time, it can lead to disabling pain. In office workers, it can lead to repetitive strain injuries, whereby the tissue surrounding the joints becomes inflamed or stress fractures develop.

Wrist injuries through typing can be prevented or at least reduced by maintaining a good typing posture. As mentioned earlier, wrists should be kept in a relaxed, natural position. Foam or gel wrist supports can provide extra protection.

One of the key messages when it comes to using computers in the office is how important it is to take regular breaks. The US Occupational Safety and Health Administration (OSHA) recommend that workers take a 10 minute break for every hour spent on a computer, allowing the body to recover and reducing the risk of strain.

These breaks can include working on other tasks that do not involve using a computer. They also represent an opportunity for employees to get out of the sitting position. Alternatively, if employees have the freedom to do so, breaks could involve seeking sustenance to refuel their bodies.

Here be vending machines

The office environment is often full of temptation when it comes to eating healthily. Many offices are home to vending machines filled with sugary drinks and fatty snacks that sing out to workers eager to get a quick energy boost.

Bringing a packed lunch from home is good for both your health and your wallet.

A desire for this kind of unhealthy food is increased if an individual hasn't eaten properly in the morning or obtained enough sleep the night before. Finding time for both sleep and breakfast helps reduce the lure of unhealthy food throughout the working day.

Bringing a lunch and snacks to work also helps keep office workers away from vending machines and restaurants, as well as saving them money. Snacking is fine if it is done healthily, and while vending machines are unlikely to stock fruit, vegetables, hummus and seeds, workers can bring these in themselves.

"It's really important to eat at least every four hours," Beth Thayer tells ABC. "You need to make sure you're setting some time aside to make sure you're getting food in."

Thayer, a registered dietitian and spokesperson for the American Dietetic Association, recommends packaging and preparing your own meals. "Small bags of nuts or snack mix you make yourself, or a small bag of fruit like apples or grapes," she suggested. "Fruit works well for people who drive a lot."

Eating is a great opportunity for workers to escape from their workstations, but few take advantage of it. According to a survey conducted by the American Dietetic Association in 2011, 62% of Americans eat lunch at their desks.

As well as preventing workers from getting away from work and keeping them sitting down in the same place, eating at the desk can lead to a build-up of bacteria if the correct hygiene precautions are not taken.

"We need to wash our hands and clean up the area after we eat at our desks," Thayer warns. "Don't let desks become places for bacterial growth."

Leaving the desk for a break allows workers to regroup and collect themselves away from their work. Doing this can be particularly important in mentally demanding roles. Taking a proper break can help reduce stress levels that can be responsible for a wide range of health problems.

How to improve your fitness at work

Although the office can often be a comfortable place to work, it is important that workers do not allow unhealthy practices to become comfortable and routine. Remaining sedentary, using office equipment incorrectly and eating unhealthily can eventually lead to debilitating health problems that could stop individuals from working altogether.

Thankfully, office work also provides a number of options for keeping fit, and if these are incorporated into a working routine then there is no reason why working in an office should condemn employees to a life of ill health.

• Travel to work by walking or biking. Get off public transport a stop earlier than normal or park your car further away from the office
• Stand instead of sitting when working as much as possible. Find as many excuses to get out of your chair as possible
• Spend time during breaks to go for a brisk walk or do some stretching to keep the muscles loose and strong.

On the surface, working in an office appears to be a simple form of employment. While that may be true in comparison with some other jobs, it is important that office workers do not get complacent and sit idly as their health runs away from them.

Dr. Timothy Church, from the Preventive Medicine Laboratory at Pennington Biomedical Research Center, Louisiana State University, told that the biggest risk to the health of office workers is the sedentary lifestyle.

"The answer is getting active," he said. "Get up at least every 45 minutes and obtain at least 7,000 steps per day."

Continue to Read more ...

Erectile Dysfunction Tied To Long Term Painkiller Use

A new study suggests that long term use of opioid prescription painkillers for back pain is tied to a higher risk of erectile dysfunction (ED). The findings are published in the 15 May online issue of the journal Spine.

Lead author Richard A. Deyo, an investigator with the Kaiser Permanente Center for Health Research says in a statement:

"Men who take opioid pain medications for an extended period of time have the highest risk of ED."

With his colleagues, Deyo, who is also Professor of Evidence-based Family Medicine at Oregon Health & Science University, found the link by analyzing electronic health records of over 11,000 men enrolled in a health plan.

They believe theirs is the first study to find such a link using electronic health records.

The reason they did the study was because men with chronic pain sometimes experience erectile dysfunction because of depression, smoking, age, or opioid-related hypogonadism (low testosterone due to painkiller use).

But little is known, they note, about how common ED is in men with back pain, and which risk factors may be important.

So they searched the electronic records to find out if men taking prescription painkillers were also the ones most likely to be prescribed testosterone replacement or medications for ED.

They found 11,327 men in Oregon and Washington enrolled in the Kaiser Permanente health plan who went to see their doctor complaining of back pain in 2004.

For each patient they identified, they looked at his pharmacy records covering six months before and six months after the back pain visit to find out if they had received opioids and testosterone replacement or ED medications.

The analysis showed that over 19% of men who took high-dose opioids (classed as more than 120 mg of morphine-equivalent) for at least four months were also prescribed testosterone replacement or medications for ED. This compared with only 7% who received ED prescriptions but did not take opioids.

Of the men who took low-dose opioids for at least four months, 12% also received prescribed testosterone replacement or medications for ED.

In looking at other factors, Deyo and colleagues found being over 60, having depression or other illnesses, or taking sleeping pills (sedative hypnotics like benzodiazepines), were all independently linked to ED. Age was the biggest factor, with men aged 60 to 69 being 14 times more likely to be receiving prescriptions for ED medications than men aged 18 to 29.

However, when they took out the effects of these factors in the figures, they found patients taking high-dose opioids were still 50% more likely to be given prescriptions for ED than men those who did not take the painkillers.

Deyo says just because they have found this link, it does not necessarily mean that prescription painkillers actually cause ED, but it is "something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain."

Deyo has spent over 30 decades studying treatments for back pain. He says that while there is "no question" that for some patients taking opioids is the right treatment for back pain, "there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now erectile dysfunction".

The US Centers for Disease Control and Prevention (CDC) say prescription opioid use in the United States has grown enormously. Between 1999 and 2010, sales quadrupled.

A survey published in 2008 in the journal Pain, suggested that 4.3 million adult Americans regularly use opioids. The ones most commonly prescribed are hydrocodone, oxycodone, and morphine.

Researchers from the CDC also reported recently that in 30% of deaths from overdosing on opioid painkillers, patients had also taken benzodiazepines.

Written by Catharine Paddock PhD

Continue to Read more ...

What Is Inflammation? What Causes Inflammation?

Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body's response to it.

The word inflammation comes from the Latin "inflammo", meaning "I set alight, I ignite".

Inflammation is part of the body's immune response. Initially, it is beneficial when, for example, your knee sustains a blow and tissues need care and protection. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating. More inflammation is created in response to the existing inflammation.

According to Medilexicon's medical dictionary, Inflammation is:

"A fundamental pathologic process consisting of a dynamic complex of histologically apparent cytologic changes, cellular infiltration, and mediator release that occurs in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent, including the local reactions and resulting morphologic changes; the destruction or removal of the injurious material; and the responses that lead to repair and healing.

The so-called cardinal signs of inflammation are rubor, redness; calor, heat (or warmth); tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present."

Plaque in coronary artery disease linked to inflammation - scientists from Stanford University, California, linked 25 new genetic regions to coronary artery disease. They found that people with coronary artery disease, the leading cause of death globally, are most likely predisposed to the disease because they have gene variants linked to inflammation.

Inflammation helps wounds heal

Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body's attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation - the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal.

Neuroscientists at the Lerner Research Institute at the Cleveland Clinic in Ohio found that inflammation actually helps to heal damaged muscle tissue. Their findings clash with how sportspeople with inflammation are treated - health professionals always try to control the inflammation to encourage healing. The researchers say their findings may lead to new therapies for acute muscle injuries caused by freeze damage, medications, chemicals and trauma.

Lan Zhou, M.D., Ph.D., said that patients should be very closely monitored when therapies to combat inflammation are used to make sure that the benefits of inflammation are not completely eliminated.

Inflammation is part of our innate immunity

Our innate immunity is what is naturally present in our bodies when we are born, and not the adaptive immunity we get after an infection or vaccination. Innate immunity is generally non-specific, while adaptive immunity is specific to one pathogen:

Whooping cough vaccine - example of immunity being specific to one pathogen

After being vaccinated for whooping cough (pertussis), we develop immunity to Bordetella pertussis or Bordetella parapertussis, types of bacteria that cause pertussis. This is an example of adaptive immunity - the immunity was not there before receiving the vaccine.

Inflammation is seen as a mechanism of innate immunity.

What is the difference between chronic inflammation and acute inflammation?

Acute inflammation - starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.

Examples of diseases, conditions, and situations which can result in acute inflammation include: acute bronchitis, infected ingrown toenail, sore throat from a cold or flu, a scratch/cut on the skin, exercise (especially intense training), acute appendicitis, acute dermatitis, acute tonsillitis, acute infective meningitis, acute sinusitis, or a blow.

Chronic inflammation - this means long-term inflammation, which can last for several months and even years. It can result from:

• Failure to eliminate whatever was causing an acute inflammation
• An autoimmune response to a self antigen - the immune system attacks healthy tissue, mistaking it (them) for harmful pathogens.
• A chronic irritant of low intensity that persists

Examples of diseases and conditions with chronic inflammation include: asthma, chronic peptic ulcer, tuberculosis, rheumatoid arthritis, chronic periodontitis, ulcerative colitis and Crohn's disease, chronic sinusitis, and chronic active hepatitis (there are many more).

Our infections, wounds and any damage to tissue would never health without inflammation - tissue would become more and more damaged and the body, or any organism, would eventually perish.

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

What happens during acute inflammation?

Within a few seconds or minutes after tissue is injured, acute inflammation starts to occur. The damage may be a physical one, or might be caused by an immune response.

Three main processes occur before and during acute inflammation:

• Arterioles, small branches of arteries that lead to capillaries that supply blood to the damaged region dilate, resulting in increased blood flow


• The capillaries become more permeable, so fluid and blood proteins can move into interstitial spaces (spaces between tissues).


• Neutrophils, and possibly some macrophages migrate out of the capillaries and venules (small veins that go from a capillary to a vein) and move into interstitial spaces. A neutrophil is a type of granulocyte (white blood cell), it is filled with tiny sacs which contain enzymes that digest microorganisms. Macrophages are also a type of white blood cells that ingests foreign material.
  
  Klaus Ley, M.D., a scientist at the La Jolla Institute for Allergy & Immunology, reported in a study published in Nature that neutrophils are the human body's first line of defense; they are the main cells that protect us from bacterial infections. Their protective function is a positive one, however, they also have inflammatory properties that may eventually lead to heart disease and several autoimmune diseases, such as lupus. Effectively manipulating neutrophils is vital in disrupting inflammatory diseases.

When our skin is scratched (and the skin is not broken), one may see a pale red line. Soon the area around that scratch goes red, this is because the arterioles have dilated and the capillaries have filled up with blood and become more permeable, allowing fluid and blood proteins to move into the space between tissues.

Edema - the area then swells as further fluid builds up in the interstitial spaces.

The five cardinal signs of acute inflammation - "PRISH"

An ingrown toenail with the five PRISH signs; pain, redness, immobility, swelling and heat



• Pain - the inflamed area is likely to be painful, especially when touched. Chemicals that stimulate nerve endings are released, making the area much more sensitive.
• Redness - this is because the capillaries are filled up with more blood than usual
• Immobility - there may be some loss of function
• Swelling - caused by an accumulation of fluid
• Heat - as with the reason for the redness, more blood in the affected area makes it feel hot to the touch

The five classical signs of inflammation

Although Latin terms are still used widely in Western medicine, local language terms, such as English, are taking over. PRISH is a more modern acronym which refers to the signs of inflammation. The traditional Latin based terms have been around for two thousand years:

• Dolor - Latin term for "pain"
• Calor - Latin term for "heat"
• Rubor - which in Latin means "redness"
• Tumor - a Latin term for "swelling"
• Functio laesa - which in Latin means "injured function", which can also mean loss of function

Dolor, Calor, Rubor, and Tumor were first described and documented by Aulus Cornelius Celsus (ca 25 BC-ca 50), a Roman encyclopaedist. Celcius is famous for creating De Medicina, which is thought to be the only surviving section of a vast encyclopedia. De Medicina was the main source of medical reference in the Roman world for pharmacy, surgery, diet and some other medical fields.

Functio laesa - it is not clear who first described and documented the fifth sign. The majority of attributions have gone to Thomas Sydenham (1624-1689) an English physician and Rudolph Carl Virchow (1821-1902), a German doctor, biologist, politician and pathologist. Virchow is seen as one of the founders of social medicine.

These five acute inflammation signs are only relevant when the affected area is on or very close to the skin. When inflammation occurs deep inside the body, such as an internal organ, only some of the signs may be detectable. Some internal organs may not have sensory nerve endings nearby, so there is be no pain, as is the case with some types of pneumonia (acute inflammation of the lung). If the inflammation from pneumonia pushes against the parietal pleura (inner lining of the surface of the chest wall), then there is pain.

Acute and chronic inflammation compared

The lists below show the difference between chronic and acute inflammation regarding the causative agents, which major cells are involved, features regarding onset, duration, and outcomes:

Acute Inflammation

• Causative agents - harmful bacteria or injury to tissue
• Major cells involved - mainly neutrophils, basophils (in the inflammatory response), and eosinophils (response to parasites and worms), and mononuclear cells (macrophages, monocytes)
• Primary mediators - eicosanoids, vasoactive amines
• Onset (when does the inflammation start) - straight away
• Duration - short-lived, only a few days
• Outcomes - the inflammation either gets better (resolution), develops into an abscess, or becomes a chronic inflammation

Chronic inflammation

• Causative agent - non-degradable pathogens that cause persistent inflammation, infection with some types of viruses, persistent foreign bodies, overactive immune system reactions
• Major cells involved - Macrophages, lymphocytes, plasma cells (these three are mononuclear cells), and fibroblasts
• Primary mediators - reactive oxygen species, hydrolytic enzymes, IFN-γ and other cytokines, growth factors
• Duration - from several months to years
• Outcomes - the destruction of tissue, thickening and scarring of connective tissue (fibrosis), death of cells or tissues (necrosis)

Sleep quality and duration impacts on inflammation risk

Scientists at Emory University School of Medicine in Atlanta, Georgia, found in a study that sleep deprivation or poor sleep quality raise inflammation, which in turn increase the risk of developing heart disease and stroke.

The team gathered data on 525 middle-aged volunteers who had completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, which asked detailed questions about sleep quality and duration.

They tested the participants' levels of various inflammatory markers, and then tried to see whether they could link them to quality and duration of sleep. The authors concluded:

"The researchers concluded that: "Poor sleep quality, and short sleep durations are associated with higher levels of inflammation."

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Prescription Drug Addiction Is Now An Epidemic

The abuse of prescription drugs is currently an epidemic because doctors are treating pain differently now than in past years.

Drug abuse was recently referred to as an "epidemic" in a newspaper article by a Nebraska State Patrol investigator. "Clinically, it's a very common problem," added Aly Hassan, M.D., assistant professor of psychiatry in the University of Nebraska Medical Center College of Medicine.

The '90s were considered to be the decade of treatment of pain, the Dr. explained. Not only was there a change in medication, but there was also a change in policy.

"An important aspect of that was to consider pain as the fifth vital sign," he said. The other four vital signs are:

• pulse rate
• body temperature
• blood pressure
• respiratory rate

Doctors' offices frequently have signs hanging that ask patients to rank their pain on a scale from 1 to 10. According to Dr. Hassan, this is not because people these days are weaker and can not handle the pain, it is because pain is very serious and people need to receive the proper treatment.

"The experience of pain is not only somatic. It's not just the nerve being stimulated," Dr. Hassan said. A patient's vital signs are impacted by acute pain, causing a change in the person's quality of health. However, with treatment, the vital signs become normalized.

For that reason, doctors began to emphasize the importance of treating pain, but that meant more drugs.

The drug prescribed the most in 2011 was hydrocodone, according to WebMD. However, the medical field was not too concerned about people becoming addicted to their prescribed drugs, at least at first.

"The pain patient can be treated with narcotics with little risk of developing the self-destructive behavior characteristic of addiction," stated a 1990 report: "The Use of Narcotics for the Treatment of Chronic Pain," by the Sacramento-El Dorado Medical Society.

In 2012, Dr. Hassan pointed out that several of these drugs have similar characteristics to other addictive drugs:

• absorb quickly
• the half-like of the medicine staying in your system goes very fast

"The opiates are very addictive for that reason," Dr. Hassan said, because it makes a person want to take another one.

This puts clinicians in a bad situation because it is their job to prescribe these potentially addictive drugs. "This is beyond the level of an individual practitioner," Dr. Hassan said. "This is really a state problem or even a national problem."

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Lower Back Pain (A Complete Guide)

Complete guide for Lower back pain: causes / symptoms of low back injuries, what can i do for back pain relief, tips for preventing, best position to: sit, standing and sleeping, useful back pain exercises and golden rules.

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AMRIX, A New Once-Daily Extended-Release Muscle Relaxant, Superior To Placebo

Cephalon, Inc. (Nasdaq: CEPH) announced the pooled analysis of two pivotal randomized, placebo-controlled clinical trials showing that AMRIX® (cyclobenzaprine hydrochloride extended-release capsules), a new once-daily extended-release skeletal muscle relaxant, was superior to placebo. AMRIX had similar efficacy to cyclobenzaprine immediate-release (CIR) taken three times a day in alleviating acute muscle spasm associated with lower back and neck pain. In addition, less daytime drowsiness was observed with AMRIX compared to CIR, although such a comparison was not pre-specified in the statistical analysis plan. These results were presented today at the 24th Annual Meeting of the American Academy of Pain Medicine in Orlando, FL.

"Typically, muscle relaxants are taken multiple times a day, which can make it difficult for some of my patients with acute muscle spasm associated with lower back and neck pain to adhere to their treatment regimen," said Arnold J. Weil, MD, of Non-Surgical Orthopaedics in Atlanta, GA, and the lead investigator in these studies. "With data supporting AMRIX as an effective once-daily treatment, health care professionals now have an easy-to-administer treatment option to offer their patients who are suffering from acute muscle spasm."

The data, which were the basis for the U.S. Food and Drug Administration approval of AMRIX, were pooled from two identical 14-day randomized, double-blind, placebo-controlled, multicenter studies, evaluating a total of 504 adults across four study arms (AMRIX 15 mg, AMRIX 30 mg, placebo, and CIR 10 mg three times daily). These participants had moderate-to-severe muscle spasm of cervical or lumbar origin associated with local pain, tenderness, limitation of motion, and restrictions of daily living. In these studies, patients and physicians assessed how helpful the medication was in the treatment of acute muscle spasm. Primary endpoints of the clinical trials were Patient's Rating of Medication Helpfulness at day four of treatment and Physician's Clinical Global Assessment at day four.

Study results of the Patient's Rating of Medication Helpfulness, a measure of efficacy, showed that a higher proportion of patients (p<0.025) taking AMRIX 15 mg (56.0 percent; n=116) and AMRIX 30 mg (56.7 percent; n=120) reported "good" to "excellent" responses compared with the placebo group (40.0 percent; n=115) at day four. The distribution of responses for AMRIX and CIR was similar. The trials did not demonstrate significant differences among the study groups on the Physician's Clinical Global Assessment at day four.

In a scale of Patient-Rated Daytime Drowsiness at day four, more patients in the AMRIX groups (15 mg, 50.4 percent, and 30 mg, 42.1 percent) had "no to very little" drowsiness compared with the CIR group (28.8 percent). As expected, more patients in the AMRIX groups had daytime drowsiness compared with placebo.


The majority of all adverse events reported in these trials were mild in intensity. The most common side effects of AMRIX (greater than or equal to three percent) were dry mouth, dizziness, fatigue, nausea, and constipation. Somnolence (a state of drowsiness) was the most common adverse event leading to discontinuation (two patients in the AMRIX 30 mg group and eight in the CIR group).

About AMRIX

AMRIX is indicated for short-term use (up to two or three weeks) for relief of muscle spasm associated with acute, painful musculoskeletal conditions. The first and only once-daily muscle relaxant, AMRIX is available in 15 and 30 mg dosage strengths.

AMRIX is contraindicated with concomitant use of monoamine oxidase (MAO) inhibitors or within 14 days after their discontinuation; in patients during the acute recovery phase of myocardial infarction; in patients with arrhythmias, heart block conduction disturbances, or congestive heart failure; and in patients with hyperthyroidism. AMRIX may enhance the effects of alcohol, barbiturates, and other CNS depressants. AMRIX should not be used in elderly patients or in patients with impaired hepatic function. AMRIX should be used with caution in patients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in patients taking anticholinergic medication.

http://www.amrix.com

About Cephalon, Inc.

Founded in 1987, Cephalon, Inc. is an international biopharmaceutical company dedicated to the discovery, development and commercialization of innovative products in four core therapeutic areas: central nervous system, pain, oncology and addiction. A member of the Fortune 1000, Cephalon currently employs approximately 3,000 people in the United States and Europe. U.S. sites include the company's headquarters in Frazer, Pennsylvania, and offices, laboratories or manufacturing facilities in West Chester, Pennsylvania, Salt Lake City, Utah, and suburban Minneapolis, Minnesota. The company's European headquarters are located in Maisons-Alfort, France.

The company's proprietary products in the United States include: PROVIGIL® (modafinil) Tablets [C-IV], FENTORA® (fentanyl buccal tablet) [C-II], TRISENOX® (arsenic trioxide) injection, AMRIX, VIVITROL® (naltrexone for extended-release injectable suspension), GABITRIL® (tiagabine hydrochloride), NUVIGIL™ (armodafinil) Tablets [C-IV] and ACTIQ® (oral transmucosal fentanyl citrate) [C-II]. The company also markets numerous products internationally.

Cephalon, Inc.

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