Tips to Avoid Return Trip to the Hospital

TUESDAY, Feb. 19 (HealthDay News) --More than 1 million Americans end up back in the hospital just weeks after they're discharged, and many of those readmissions are preventable, according to an expert from Columbia University School of Nursing in New York City.

Patients can do their part to avoid return trips to the hospital by simply paying attention and speaking up when it's time to go home, advised Mary Donovan-Johnson, program director of the Acute Care Nurse Practitioner Program.

"Discharges are often rushed and patients may be overwhelmed during this stressful time," Donovan-Johnson said in a Columbia news release. "If you don't understand something a medical provider said, don't be afraid to ask your doctor or nurse to repeat the instructions... Ask the person accompanying you home to listen and take notes when instructions are being explained by your medical team."

Other steps you can take to reduce the odds of readmission after discharge include:

Get all discharge instructions and information in writing, including directions for wound care, medications and food restrictions. Keep these instructions in a place where they are easily accessed. After discharge, follow through on your treatment by filling prescriptions and taking medications as directed. If you have questions about your medications or other instructions, call your doctor. Schedule follow-up visits with your doctor and blood tests or other procedures as directed, and keep those appointments.

"Ideally, the same team of doctors and nurses who worked with the patient would discharge them since they know the protocol in their medications, wound care, and how to set up the safest environment at home for them. But unfortunately, that doesn't always happen," Donovan-Johnson said. "So the patient needs to be vigilant about being an active participant in their recovery."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Columbia University School of Nursing, news release, Feb. 18, 2013

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Human Teeth Healthier in the Stone Age Than Today: Study

TUESDAY, Feb. 19 (HealthDay News) -- Something to think about next time you're in the dentist's chair: Ancient humans had healthier teeth than people do today, researchers say.

This decline in oral health over the past 7,500 years is the result of changes in oral bacteria due to human evolution and industrialization, the study authors said. These changes have led to chronic oral and other health problems, according to the report published Feb. 18 in Nature Genetics.

"The composition of oral bacteria changed markedly with the introduction of farming, and again around 150 years ago," explained study leader Alan Cooper, a professor and director of the University of Adelaide's Australian Centre for Ancient DNA, in a center news release. "With the introduction of processed sugar and flour in the Industrial Revolution, we can see a dramatically decreased diversity in our oral bacteria, allowing domination by caries [cavities]-causing strains. The modern mouth basically exists in a permanent disease state."

The international team of researchers examined DNA that had been preserved in tartar -- calcified dental plaque -- found on 34 prehistoric northern European human skeletons. They used these samples to analyze how oral bacteria changed from the Stone Age to the last hunter-gatherers, medieval times and later with the introduction of food manufacturing in the Industrial Revolution.

The evolution of human behavior and diet have had a negative impact on oral health, the investigators said.

"This is the first record of how our evolution over the last 7,500 years has impacted the bacteria we carry with us, and the important health consequences," Cooper said. "Oral bacteria in modern man are markedly less diverse than historic populations and this is thought to contribute to chronic oral and other disease in post-industrial lifestyles," he pointed out.

Study lead author Christina Adler, now at the University of Sydney, added that "dental plaque represents the only easily accessible source of preserved human bacteria." And, she said in the news release, "Genetic analysis of plaque can create a powerful new record of dietary impacts, health changes and oral pathogen genomic evolution, deep into the past."

The researchers said their research is being expanded to include other periods in time, other areas of the world and other species, such as Neanderthals.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Australian Centre for Ancient DNA, news release, Feb. 18, 2013

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Drug, Alcohol Abuse More Likely Among High School Dropouts

TUESDAY, Feb. 19 (HealthDay News) -- The link between poor academic performance and substance abuse just got stronger, with a new U.S. government report showing ties between the two.

High school seniors who dropped out of school before graduating were more likely to drink, smoke cigarettes and use marijuana and other illegal drugs, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration.

The researchers said their findings should prompt communities to develop strategies to keep teens in school and prevent problems with substance abuse.

"The fact that nearly one in seven students drops out of high school has enormous public health implications for our nation," SAMHSA Administrator Pamela Hyde said in an agency news release. "Dropouts are at increased risk of substance abuse, which is particularly troubling given that they are also at greater risk of poverty, not having health insurance, and other health problems. We have to do everything we can to keep youth in school so they can go on to lead healthy, productive lives, free from substance abuse."

The study revealed high school seniors (typically between 16 and 18 years of age) who dropped out of school were more than twice as likely to be smokers, or have smoked in the past month, than students who stayed in school. The study also found that more than 31 percent of seniors who didn't receive their diploma used drugs, compared with about 18 percent of students who had finished high school.

The researchers also noted that about 27 percent of high school dropouts smoked marijuana, while close to one in every 10 abused prescription drugs. Meanwhile, only about 15 percent of those who completed high school used marijuana and just 5 percent abused prescription drugs.

Dropouts were also more likely to drink -- the study showed that nearly 42 percent of seniors who didn't finish high school drank and about a third engaged in binge drinking.

In contrast, about 35 percent of those students who stayed in school drank and only about one-quarter said they binged on alcohol.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: U.S. Substance Abuse and Mental Health Administration, news release, Feb. 14, 2013

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As Economy Rebounds, More Folks Try Turning Back Hands of Time

TUESDAY, Feb. 19 (HealthDay News) -- Evidence of the economic upturn can be found in more than housing starts and auto sales: A new report shows that the number of cosmetic procedures grew 5 percent in 2012.

Botox injections and other types of minimally invasive treatments led the way as more people opted for these types of facial rejuvenation procedures, while the number who chose to "go under the knife" remained relatively stable, the findings revealed.

In total, there were 14.6 million minimally invasive and surgical plastic surgery procedures in 2012. There were also 5.6 million reconstructive plastic surgery procedures last year, an increase of 1 percent from 2011, according to annual statistics from the American Society of Plastic Surgeons (ASPS).

Minimally invasive procedures increased 6 percent, with more than 13 million procedures in 2012. The top five were:

There were nearly 1.6 million cosmetic surgical procedures in 2012, a 2 percent decrease from 2011. The top five surgical procedures last year were:

Breast augmentation (286,000 procedures, down 7 percent)Nose reshaping (243,000 procedures, no change)Liposuction (202,000 procedures, down 1 percent)Eyelid surgery (204,000 procedures, up 4 percent)Facelift (126,000 procedures, up 6 percent).

While cosmetic breast surgeries among women decreased 2 percent between 2011 and 2012, male breast reduction surgeries increased 5 percent, to nearly 21,000 in 2012, the report said.

"For the third consecutive year, the overall growth in cosmetic surgery continues to be driven by a significant rise in minimally invasive procedures, while surgical procedures remain relatively stable. We are aware, however, that patients who begin with less-invasive treatments with a plastic surgeon may opt for more invasive, surgical procedures once required," Dr. Gregory Evans, ASPS president, said in a society news release.

Reconstructive plastic surgery increased by 1 percent in 2012 and the top five procedures were:

Tumor removal (4.2 million, up 1 percent)Laceration repair (291,000, down 4 percent)Maxillofacial surgery (209,000, up 7 percent)Scar revision (171,000, down 2 percent)Hand surgery (123,000, up 3 percent).

Reconstructive breast reduction increased 8 percent, with 68,000 procedures performed in 2012, the report noted.

"Although breast reduction has many physical and psychological benefits for women with overly large breasts, obstacles remain in acquiring insurance coverage," Evans said. "It's promising to see gains in this and other beneficial, medically necessary surgeries."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Society of Plastic Surgeons, news release, Feb. 19, 2012

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Fraudulent Data May Have Led to Use of Risky Treatment in ICUs

By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.

At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.

"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review.

Luckily for American patients, hydroxyethyl starch is not commonly used in the United States, Taylor said. But the new analysis serves as a cautionary tale on how fraudulent data can end up endangering patients' lives.

As Taylor explained it, critically ill patients often develop leaky vessels, and so quickly require intravenous fluids to keep their blood pressure stable and to improve organ function.

One such fluid is simple saline or salt water, known as crystalloid solution. This is the cheapest fluid available, but it tends to leak out of blood vessels, which means it can also leak into the lungs, under the skin and into various organs.

As a result, researchers have spent considerable time and effort trying to find less leaky alternatives to saline. The protein albumin, derived from human blood, is commonly used after cardiac surgery, when the risk of fluid collecting in the lungs is high, Taylor explained. Although albumin is less leaky than saline, it is more expensive.

Hydroxyethyl starch is similar to albumin, but it contains starch molecules, which are less likely to leak out of the blood vessels than saline.

Still, many researchers had reservations about using a starch-based solution from the beginning, Taylor said.

"If you have salt water and it leaks out, you just get some salt into the tissue and it goes away with a little bit of time," he explained. On the other hand, "if you have starch in the tissue it's not so easy to get starch out of there, and many people were worried about the possibility of complications."

It turns out there was even more reason to be suspicious of any alleged benefits of hydroxyethyl starch. In 2011, investigators discovered that the lion's share of research on the treatment that was conducted by German anesthesiologist Dr. Joachim Boldt was fraudulent and had to be retracted.

So the author of the current paper wondered: Would the purported benefits of hydroxyethyl starch hold up once Boldt's data was excluded?

Led by Dr. Ryan Zarychanski, of the University of Manitoba in Winnipeg, Canada, the team pooled data from 38 previous studies on the issue, including those by Boldt.

That analysis concluded that patients who received hydroxyethyl starch did not fare any better than other types of fluid.

But when the Boldt studies were excluded from the mix, hydroxyethyl starch was actually associated with an increased risk of death, kidney failure and need for dialysis among patients, the new research found.

It's impossible to gauge how many patients were damaged by Boldt's falsified research, but this new study highlights "how the inclusion or exclusion of the Boldt papers associated with research misconduct can shift the balance toward harm," said Dr. Massimo Antonelli, author of an editorial accompanying the new study.

"It showed also how the worldwide administration of starches for volume replacement therapy have caused the increase of acute renal failure and affected mortality," said Antonelli, a professor of intensive care and anesthesiology at the Catholic University-A.Gemelli University Hospital in Rome.

He added that a task force of the Surviving Sepsis Campaign, an organization devoted to reducing death from sepsis, recently issued guidelines warning against using starches for fluid replacement.

"These findings will reinforce [those] recommendations," he said.

Taylor stressed, however, that it would still be helpful to find alternatives to both albumin and saline.

A person in the intensive care unit (ICU) can have 1-2 liters more of fluid going into their body than out, said Taylor. Each liter weighs 1 kilogram, or 2.2 pounds.

"It's possible to gain anywhere from 8-10 pounds in fluid [in the ICU] so it would be a great to have an alternative to 10 pounds of weight," he said. However, a starch solution "is not a good alternative because it increases the risk of dying or needing dialysis," Taylor said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Taylor, M.D., chairman, pulmonary and critical care medicine, Ochsner Health System, New Orleans; Massimo Antonelli, M.D., professor, intensive care and anesthesiology, Catholic University-A. Gemelli University Hospital, Rome; Feb. 20, 2013, Journal of the American Medical Association

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Blame Common Colds on Your Chromosome 'Caps?'

By Amy Norton
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Some people seem to catch a cold every few weeks while others appear immune. Now a preliminary study suggests that the protective "caps" on your chromosomes could partly explain the mystery.

The study, reported in the Feb. 20 issue of the Journal of the American Medical Association, found that healthy young adults were more prone to catching a cold when their immune system cells had relatively short telomeres.

Telomeres are lengths of DNA that sit at the ends of your chromosomes. Think of them like the plastic caps at the ends of a shoelace: Telomeres help keep your chromosomes -- which carry your genes -- from fraying and sticking together.

As people age, their telomeres gradually get shorter, and research has linked shorter telomere length to older adults' risks of developing and dying from infections, cancer and heart disease.

"But there's been very little known about telomere length in young people, certainly in relation to health," said Sheldon Cohen, a professor of psychology at Carnegie Mellon University in Pittsburgh who led the new study.

Because colds and other respiratory infections are the most common health woe in younger people, Cohen's team decided to see whether telomere length mattered in their risk of developing a cold.

The researchers recruited 152 healthy 18- to 55-year-olds, and measured telomere length in the volunteers' T cells -- immune system cells that fight off infection. They then exposed the men and women to a cold virus via nasal drops, and quarantined them in a hotel to be monitored.

Over the next five days, 22 percent of the volunteers developed cold symptoms, and the odds were higher among those with shorter telomeres in a particular subtype of T cell. Of the one-third with the shortest telomeres, 26 percent became sick, versus 13 percent among the one-third with the longest telomeres.

"This is something new and provocative," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved in the research.

"All of us know some people who get one cold after another, and others who seem like they're able to be around people with colds but remain robust," said Schaffner, who is also a spokesman for the Infectious Diseases Society of America.

These findings, Schaffner said, raise the possibility that there is some role for the telomeres in our T cells.

"We're not all created equal in terms of our telomeres," he said. "Just like some of us are short, and some are tall."

What does that mean for you during cold and flu season? Nothing right now, according to both Schaffner and Cohen.

For one, nobody knows if they have skimpy telomeres. And even if they did, it's not clear whether there's anything they could do about it.

"There is a lot of research interest right now in whether it's possible to alter telomere length, either through some kind of behavioral change or a medication," Cohen said. "But we're pretty far from that point."

What's more, the current findings do not prove that shorter telomeres, per se, mean more cold misery. The researchers did account for other factors, such people's age, weight and race. But Cohen said there could be other explanations. It's possible, for example, that some genetic factor makes people have shorter T-cell telomeres and renders them more vulnerable to colds.

On the other hand, shorter telomeres may impair T cells' ability to battle cold viruses, Cohen said.

Still, no one knows yet whether these findings could one day have practical use.

"This is really the first evidence that this biomarker of aging may be important for 25-year-olds as well as 65-year-olds, and for acute health conditions as well as chronic," Cohen said.

Of course, you do not need to wait for any telomere-lengthening therapy to curb your risk of catching a cold. "Wash your hands," Schaffner advised. "And try to avoid people who are sneezing and coughing."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Sheldon Cohen, Ph.D., professor, psychology, Carnegie Mellon University, Pittsburgh; William Schaffner, M.D., chair, preventive medicine, Vanderbilt University School of Medicine, Nashville, Tenn.; Feb. 20, 2013, Journal of the American Medical Association

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Injuries Rising Among Young Dancers

TUESDAY, Feb. 19 (HealthDay News) -- A new study finds that 113,000 children and teens were treated for injuries related to dancing from 1991 to 2007, and the annual number of injuries grew by more than a third over that period.

Sprains and strains, or both, were most common, causing 52 percent of injuries, followed by falls, responsible for 45 percent of dance-related mishaps.

The study looked at dance injuries among children and young adults aged 3 to 19. All were treated in U.S. emergency rooms.

"Adolescents are still growing into their bodies and as such often develop imbalances that can lead to injury," said Eric Leighton, an athletic trainer in sports medicine at Nationwide Children's Hospital, in a hospital news release. "It's critical that intervention and injury prevention be made available to them to address balance, strength and functional body control deficits as they grow."

According to the study, the annual number of dance-related injuries grew from 6,175 injuries in 1991 to nearly 8,500 injuries in 2007. Forty percent of injuries occurred in dancers aged 15 to 19.

"We believe this could be due to adolescent dancers getting more advanced in their skills, becoming more progressed in their careers and spending more time training and practicing," Kristin Roberts, lead study author and a senior research associate at the Center for Injury Research and Policy at the hospital, said in the news release. "We encourage children to keep dancing and exercising. But it is important that dancers and their instructors take precautions to avoid sustaining injuries."

Senior author Lara McKenzie, principal investigator at the Center for Injury Research and Policy, added: "Safety precautions such as staying well-hydrated, properly warming up and cooling down, concentrating on the proper technique and getting plenty of rest can help prevent dance-related injuries."

The study appears in the February issue of the Journal of Physical Activity and Health.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Nationwide Children's Hospital, news release, Feb. 11, 2013

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Cold and Flu Sufferers Should Ease Back Into Fitness Routine

TUESDAY, Feb. 19 (HealthDay News) -- Although physical activity can help boost your immune system, people who are sick should tone down their workout or skip it altogether, experts advise.

"Regular exercise is a great way to reduce stress and sleep better at night. This helps boost your immune system. However, vigorous exercise and extreme conditioning can have a negative impact on your health if you're sick," Joe Berg, a personal trainer and fitness specialist at Loyola Center for Health, said in a Loyola University news release.

"When fighting a viral illness, it's best to keep your exercise session short and not as intense. If you have a fever or stomach bug it might be best to hold off," Berg added.

For those recovering from an illness, it's best to ease back into a workout routine slowly. Berg recommends starting small with some light aerobics, such as walking and cycling at an easy pace as well as body weight squats, push-ups and planks. In the plank exercise, you rest your weight on your forearms with your elbows directly beneath your shoulders, keeping your body in a straight line from your head to your feet.

"These exercises cover the major muscles of the body and when performed in moderation, can help boost your immune system," explained Berg.

For people worried about being exposed to germs at the gym, Valerie Walkowiak, medical integration coordinator at the Loyola Center for Fitness, pointed out that heading outside or working out at home may be a good way to stay healthy and fit during the cold and flu season.

"Weather permitting, it's always great to just get out of the house and walk or run to get in some cardio exercise. Just make sure you wear the proper clothes to keep warm. This includes layers of clothing, a hat, scarf, gloves and appropriate shoes," said Walkowiak.

When the weather makes exercising outdoors impossible, there are ways people can work out at home -- even if they don't have special equipment. Walkowiak said you can get your heart rate up without leaving the house by climbing the stairs, jogging in place or doing jumping jacks. She added that a home-based circuit training routine can be created by alternating two to three minutes of these cardio exercises with 30 to 60 seconds of strength-training moves, such as push-ups, squats, seated rows or heel raises.

"You don't have to have dumbbells, bands or tubing to get in some strength training at home. Try using household items to add resistance such as soup cans, gallon jugs of water or your own body weight," Walkowiak noted.

In order to target all the muscle groups, Walkowiak recommended doing the following exercises:

Chest, shoulder and triceps: do push-ups on the floor or against a wallBack, rear shoulders and biceps: try seated or standing row exercises using soup cans Legs, glutes and core: perform squats, sit-to-chair stands or lunges Calfs: do heel raises on the edge of a step Core: do planks, abdominal crunches, abdominal twists and leg raises Biceps: do bicep curls using soup cansTriceps: using a soup can or weighted object do kickbacks or over presses

Anyone who does go to the gym should remember to wipe down machines and wash their hands often, the experts advised.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Loyola University Health System, news release, Feb. 14, 2013

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Sharp Rise Seen in Robotically Assisted Hysterectomies

By Serena Gordon
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Nearly 10 percent of hysterectomies in the United States are performed robotically, say researchers who found the "robo" procedures jumped dramatically between 2007 and 2010.

But they question whether robotic surgery is preferable to another minimally invasive procedure, laparoscopic surgery, for women having their uterus removed for non-cancerous conditions. While the two procedures have similar complication rates, the robotically assisted hysterectomy costs roughly $2,200 more than the laparoscopic procedure, according to the new study.

"The robotically assisted procedure was substantially more expensive," said the study's lead author, Dr. Jason Wright, an assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, in New York City.

Wright said more work is needed to determine which women would benefit from robotic hysterectomy.

"This data also raises a lot of questions about surgical innovations and the need to find ways to better study them before they diffuse into practice," he added.

Results of the study are published in the Feb. 20 issue of the Journal of the American Medical Association.

Hysterectomy is a common treatment for non-cancerous gynecological conditions, such as fibroids, endometriosis and excessive bleeding. As many as one in nine U.S. women will undergo such a procedure, according to the study.

Different surgical techniques exist for performing a hysterectomy. One choice is traditional open surgery, where a surgeon removes the uterus through a 5- to 7-inch opening in the abdomen. Another is vaginal hysterectomy -- removal of the uterus through the vaginal opening. Laparoscopy is done with special tools that allow surgeons to perform the surgery using only small incisions. Robotically assisted surgery is similar to laparoscopic surgery, but the surgeon uses a robotic device instead of a laparoscope to do the procedure.

Dr. Michael Zinner, chief of surgery at Brigham and Women's Hospital in Boston, said there are advantages to robotically assisted surgery in certain situations.

"The robotic device is easy to learn," Zinner said. "The wrist on the machine gives you [greater flexibility] unlike a straight laparoscope that's more like a chopstick. If the surgeon has any slight tremor, the machine evens it out," he said. In cases such as prostate surgery, where the surgery must take place in a very confined space and there's a significant risk of nerve damage, the delicate, articulating robotic device can be ideal, he said.

But for larger areas of the body, a laparoscope generally works just as well. "Nobody talks about using robotic surgery for removing the gallbladder," noted Zinner, because it would be more expensive without providing an additional benefit. Zinner co-wrote an editorial in the same issue of the journal.

In the current study, Wright and his colleagues reviewed data from more than 264,000 women who had a hysterectomy for a non-cancerous condition.

Robotically assisted hysterectomies were performed 0.5 percent of the time in 2007. By 2010, that number had jumped to 9.5 percent. The rate of laparoscopic surgery also increased during this time period, from 24.3 percent to 30.5 percent, according to the study.

At hospitals that introduced robotically assisted hysterectomy, its use quickly rose, the study found. But at hospitals without the robotic option, use of laparoscopic hysterectomy increased during the same time period. Overall, abdominal and vaginal hysterectomies declined.

Robotically assisted hysterectomy was less likely to lead to a hospital stay of two days or more compared to laparoscopic surgery, but the two procedures were similar in all other measured complications.

Where the two procedures differed most significantly was in cost, with $6,679 the median fee for a laparoscopic hysterectomy versus $8,868 for the robotically assisted procedure.

Joel Weissman, deputy director and chief scientific officer at the Center for Surgery and Public Health at Brigham and Women's Hospital and co-author of the editorial, said the robotic machine costs about $1.5 million and requires extra personnel.

"It's a little bit unclear who's paying the extra cost," he said. "It seems like at this point in time, insurers are paying the same whether the surgery is robotically assisted or not. But hospitals have to somehow pay those extra costs."

If you're considering a robotically assisted procedure, Zinner and Weissman advised talking with your doctor about which procedure will deliver better results. If two procedures are similarly effective, they suggested comparing costs.

In the case of hysterectomy, because robotically assisted surgery and laparoscopic surgery have similar results but significantly different costs, Zinner said he'd like to see more surgeons training in the laparoscopic procedure.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jason Wright, M.D., Levine Family Assistant Professor of Women's Health, Columbia University College of Physicians and Surgeons, New York City; Joel Weissman, Ph.D., deputy director and chief scientific officer, Center for Surgery and Public Health, and associate professor of health policy, Brigham and Women's Hospital, Boston; Michael Zinner, M.D., chief of surgery, Brigham and Women's Hospital, and clinical director, Dana Farber-Brigham and Women's Cancer Center, Boston; Feb. 20, 2013, Journal of the American Medical Association

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Fluorescent Tracer 'Lights Up' Brain Tumor for Surgery

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Neurosurgeons report that they harnessed the power of fluorescent light to illuminate a brain tumor so the entire growth could be removed.

A report describes a case in which a patient with glioblastoma swallowed a pill, called 5-ALA, and was taken to surgery about four hours later. The medication attached itself to tumor cells, causing them to glow brightly. Once the skull was opened, the doctors focused a blue light on the tumor, which gave the cancerous cells a pink glow, so the surgeons could differentiate malignant tissue from healthy tissue.

"This is a very, very good thing," said study author Mitchel Berger, chairman of neurosurgery at the University of California, San Francisco. "In this case, we just happened to notice we could see evidence of the tumor spreading along the way of the ventricles [a communicating network of brain cavities], which showed we could see tumor dissemination."

The authors noted that the best way to extend survival is to remove as much of the brain tumor as possible. The research is published in the Feb. 19 issue of the Journal of Neurosurgery.

It's not always easy to see precisely where a tumor has spread in the brain. Some types of tumors can be particularly difficult to identify and remove, even with the benefit of MRI and surgical microscopes.

The use of fluorescence appears to be more effective than MRI technology, at least in this case, because the glow allows surgeons to see microscopic remnants of the tumor and areas of the cancer that might be mistaken for edema, or swelling, Berger explained. "This is an inexpensive way to identify high-grade tumors," he said.

Glioblastomas are a fast-growing type of tumor that usually occurs in adults and affects the brain more often than the spinal cord, according to the U.S. National Cancer Institute.

Why do tumor cells respond differently to the fluorescent drug than the body's other cells do? Their metabolism involves porphyrin, which has a tremendous ability to absorb light, Berger explained. Porphyrin is an organic compound, like the pigment in red blood cells. The pill used in the case report is derived from porphyrin.

The report focused on the case of a 56-year-old man who had undergone resection of a glioblastoma located in the right occipital lobe of his brain in 2005. Several years later, when symptoms reappeared, an MRI scan showed three distinct, new sites of tumor in the patient's right temporal lobe.

In surgery, when the surgeons viewed the fluorescent tumor cells, they could tell rather than being a new tumor, the cancer had spread from its original location on the right side of the brain through a pathway along the wall of the right ventricle. The researchers found that the use of 5-ALA during surgery enabled them to see the actual pathway of the tumor as it had spread.

The use of 5-ALA changed the patient's prognosis. "Multi-centric disease worsens the prognosis," Berger explained.

While the technique has been used in Europe for several years, the U.S. Food and Drug Administration has not approved the use of 5-ALA in the United States. Any surgeons using 5-ALA do so with limited permission from the FDA, Berger noted. The medication, 5-ALA, is manufactured by DUSA Pharmaceuticals.

Dr. Michael Schulder, vice chairman of the department of neurosurgery at North Shore University Hospital in Manhasset, N.Y., explained that "while the FDA considers 5-ALA a drug, which would require a lengthy process for approval, neurosurgeons see it as a surgical aid, which would take far less time to get the OK."

While Schulder said he thinks 5-ALA probably will add about six months to the anticipated survival of patients with high-grade gliomas, he said that attempts to improve the ability to remove these tumors will only go so far. "In the end, however helpful the use of 5-ALA or similar compounds may be in the surgical removal of brain cancers, it won't be the answer. The treatments will have to be biological to truly have an impact on survival, and ultimately, on a cure."

Schulder said he thinks it would be possible for fluorescence to be used in other types of surgeries, if surgeons could become comfortable using a surgical microscope with the benefit of a special light (something neurosurgeons are accustomed to using). He noted that he also thinks the technique might apply to some spinal surgeries, where visualizing the spinal cord is critical.

Schulder said he thinks the use of fluorescence in cancer surgery is promising. "It's a very important concept: if you can see a tumor better, you can remove it without affecting healthy tissue."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mitchel Berger, M.D., professor and chairman, neurosurgery, department of neurological surgery, University of California, San Francisco; Michael Schulder, M.D., vice chairman, department of neurosurgery, North Shore University Hospital, Manhasset, N.Y.; Feb. 19, 2013, Journal of Neurosurgery

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Cold and Flu Sufferers Should Ease Back Into Fitness Routine

TUESDAY, Feb. 19 (HealthDay News) -- Although physical activity can help boost your immune system, people who are sick should tone down their workout or skip it altogether, experts advise.

"Regular exercise is a great way to reduce stress and sleep better at night. This helps boost your immune system. However, vigorous exercise and extreme conditioning can have a negative impact on your health if you're sick," Joe Berg, a personal trainer and fitness specialist at Loyola Center for Health, said in a Loyola University news release.

"When fighting a viral illness, it's best to keep your exercise session short and not as intense. If you have a fever or stomach bug it might be best to hold off," Berg added.

For those recovering from an illness, it's best to ease back into a workout routine slowly. Berg recommends starting small with some light aerobics, such as walking and cycling at an easy pace as well as body weight squats, push-ups and planks. In the plank exercise, you rest your weight on your forearms with your elbows directly beneath your shoulders, keeping your body in a straight line from your head to your feet.

"These exercises cover the major muscles of the body and when performed in moderation, can help boost your immune system," explained Berg.

For people worried about being exposed to germs at the gym, Valerie Walkowiak, medical integration coordinator at the Loyola Center for Fitness, pointed out that heading outside or working out at home may be a good way to stay healthy and fit during the cold and flu season.

"Weather permitting, it's always great to just get out of the house and walk or run to get in some cardio exercise. Just make sure you wear the proper clothes to keep warm. This includes layers of clothing, a hat, scarf, gloves and appropriate shoes," said Walkowiak.

When the weather makes exercising outdoors impossible, there are ways people can work out at home -- even if they don't have special equipment. Walkowiak said you can get your heart rate up without leaving the house by climbing the stairs, jogging in place or doing jumping jacks. She added that a home-based circuit training routine can be created by alternating two to three minutes of these cardio exercises with 30 to 60 seconds of strength-training moves, such as push-ups, squats, seated rows or heel raises.

"You don't have to have dumbbells, bands or tubing to get in some strength training at home. Try using household items to add resistance such as soup cans, gallon jugs of water or your own body weight," Walkowiak noted.

In order to target all the muscle groups, Walkowiak recommended doing the following exercises:

Chest, shoulder and triceps: do push-ups on the floor or against a wallBack, rear shoulders and biceps: try seated or standing row exercises using soup cans Legs, glutes and core: perform squats, sit-to-chair stands or lunges Calfs: do heel raises on the edge of a step Core: do planks, abdominal crunches, abdominal twists and leg raises Biceps: do bicep curls using soup cansTriceps: using a soup can or weighted object do kickbacks or over presses

Anyone who does go to the gym should remember to wipe down machines and wash their hands often, the experts advised.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Loyola University Health System, news release, Feb. 14, 2013

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Fraudulent Data May Have Led to Use of Risky Treatment in ICUs

By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.

At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.

"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review.

Luckily for American patients, hydroxyethyl starch is not commonly used in the United States, Taylor said. But the new analysis serves as a cautionary tale on how fraudulent data can end up endangering patients' lives.

As Taylor explained it, critically ill patients often develop leaky vessels, and so quickly require intravenous fluids to keep their blood pressure stable and to improve organ function.

One such fluid is simple saline or salt water, known as crystalloid solution. This is the cheapest fluid available, but it tends to leak out of blood vessels, which means it can also leak into the lungs, under the skin and into various organs.

As a result, researchers have spent considerable time and effort trying to find less leaky alternatives to saline. The protein albumin, derived from human blood, is commonly used after cardiac surgery, when the risk of fluid collecting in the lungs is high, Taylor explained. Although albumin is less leaky than saline, it is more expensive.

Hydroxyethyl starch is similar to albumin, but it contains starch molecules, which are less likely to leak out of the blood vessels than saline.

Still, many researchers had reservations about using a starch-based solution from the beginning, Taylor said.

"If you have salt water and it leaks out, you just get some salt into the tissue and it goes away with a little bit of time," he explained. On the other hand, "if you have starch in the tissue it's not so easy to get starch out of there, and many people were worried about the possibility of complications."

It turns out there was even more reason to be suspicious of any alleged benefits of hydroxyethyl starch. In 2011, investigators discovered that the lion's share of research on the treatment that was conducted by German anesthesiologist Dr. Joachim Boldt was fraudulent and had to be retracted.

So the author of the current paper wondered: Would the purported benefits of hydroxyethyl starch hold up once Boldt's data was excluded?

Led by Dr. Ryan Zarychanski, of the University of Manitoba in Winnipeg, Canada, the team pooled data from 38 previous studies on the issue, including those by Boldt.

That analysis concluded that patients who received hydroxyethyl starch did not fare any better than other types of fluid.

But when the Boldt studies were excluded from the mix, hydroxyethyl starch was actually associated with an increased risk of death, kidney failure and need for dialysis among patients, the new research found.

It's impossible to gauge how many patients were damaged by Boldt's falsified research, but this new study highlights "how the inclusion or exclusion of the Boldt papers associated with research misconduct can shift the balance toward harm," said Dr. Massimo Antonelli, author of an editorial accompanying the new study.

"It showed also how the worldwide administration of starches for volume replacement therapy have caused the increase of acute renal failure and affected mortality," said Antonelli, a professor of intensive care and anesthesiology at the Catholic University-A.Gemelli University Hospital in Rome.

He added that a task force of the Surviving Sepsis Campaign, an organization devoted to reducing death from sepsis, recently issued guidelines warning against using starches for fluid replacement.

"These findings will reinforce [those] recommendations," he said.

Taylor stressed, however, that it would still be helpful to find alternatives to both albumin and saline.

A person in the intensive care unit (ICU) can have 1-2 liters more of fluid going into their body than out, said Taylor. Each liter weighs 1 kilogram, or 2.2 pounds.

"It's possible to gain anywhere from 8-10 pounds in fluid [in the ICU] so it would be a great to have an alternative to 10 pounds of weight," he said. However, a starch solution "is not a good alternative because it increases the risk of dying or needing dialysis," Taylor said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Taylor, M.D., chairman, pulmonary and critical care medicine, Ochsner Health System, New Orleans; Massimo Antonelli, M.D., professor, intensive care and anesthesiology, Catholic University-A. Gemelli University Hospital, Rome; Feb. 20, 2013, Journal of the American Medical Association

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Alcohol Blamed for 1 in Every 30 Cancer Deaths: Study

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 14 (HealthDay News) -- For anyone who still thinks that drinking does not contribute to cancer, a new report finds that alcohol is to blame for one in every 30 cancer deaths each year in the United States.

The connection is even more pronounced with breast cancer, with 15 percent of those deaths related to alcohol consumption, the researchers added.

And don't think that drinking in moderation will help, because 30 percent of all alcohol-related cancer deaths are linked to drinking 1.5 drinks or less a day, the report found.

Alcohol is a cancer-causing agent that's in "plain sight," but people just don't see it, said study author Dr. David Nelson, director of the Cancer Prevention Fellowship Program at the U.S. National Cancer Institute.

"As expected, people who are higher alcohol users were at higher risk, but there was really no safe level of alcohol use," he stressed.

Moderate drinking has been associated with heart benefits, Nelson noted. "But, in the broader context of all the issues and all the problems that alcohol is related to, alcohol causes 10 times as many deaths as it prevents," he said.

The best thing people who believe they are at risk for cancer can do is reduce their alcohol consumption, Nelson said. "From a cancer prevention perspective, the less you drink, the lower your risk of an alcohol-related cancer and, obviously, if one doesn't drink at all then that's the lowest risk," he said.

The report was published online Feb. 14 in the American Journal of Public Health.

To determine the risks related to drinking and cancer, Nelson's team compiled data from a variety of sources, including the 2009 Alcohol Epidemiologic Data System, the 2009 Behavioral Risk Factor Surveillance System and the 2009-2010 National Alcohol Survey.

Along with breast cancer in women, cancers of the mouth, throat and esophagus were also common causes of alcohol-related cancer deaths in men, accounting for about 6,000 deaths each year.

Each alcohol-related cancer death accounted for an average of 18 years of potential life lost, the researchers added.

Previous studies have shown drinking is a risk factor for cancers of the mouth, throat, esophagus, liver, colon, rectum and, in women, breast cancer, the researchers noted.

According to the American Cancer Society, it's not entirely clear how alcohol might raise cancer risk. Alcohol might act as a chemical irritant to sensitive cells, impeding their DNA repair, or damage cells in other ways. It might also act as a "solvent" for other carcinogens, such as those found in tobacco smoke, helping those chemicals enter into cells more easily. Or alcohol might affect levels of key hormones such as estrogen, upping odds for breast cancer.

One expert says the findings in this study are consistent with what has been shown before.

"Nobody is recommending that if you do not drink to start drinking for any reason," said Susan Gapstur, vice president of epidemiology at the cancer society. "If you do drink, limit your consumption."

Gapstur did point out that smoking is a much more powerful factor in cancer deaths than alcohol. Although some 20,000 cancer deaths can be attributed to alcohol each year, more than 100,000 cancer deaths are caused by smoking, she said.

To strike a balance between the cancer risk of drinking and its possible benefit in preventing heart disease, Gapstur suggested talking with your doctor about the risks and benefits of drinking.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Nelson, M.D., M.P.H., director, Cancer Prevention Fellowship Program, U.S. National Cancer Institute; Susan Gapstur, Ph.D., M.P.H., vice president of epidemiology, American Cancer Society; Feb. 14, 2013, American Journal of Public Health, online

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Cancer Chemotherapy Tied to Slight Rise in Risk for Leukemia

THURSDAY, Feb. 14 (HealthDay News) -- Chemotherapy can be a lifesaver for thousands of cancer patients, but a new study suggests that it might slightly raise the odds for a type of leukemia later in life.

Over the past 30 years, the risk for acute myeloid leukemia (AML) has increased for patients who underwent chemotherapy for certain forms of cancer, particularly non-Hodgkin lymphoma, the new study found.

On the other hand, the researchers from the U.S. National Cancer Institute said other cancer survivors may have a reduced risk for AML due to a change in chemotherapy agents that occurred decades ago.

One expert not connected to the study stressed that cancer patients need to put the findings into perspective.

"It's important to realize that the risk of developing acute myeloid leukemia related to prior chemotherapy is small and increases with the number of chemotherapy treatments given over time," said Dr. Jonathan Kolitz, chief of hematologic oncology at the North Shore-LIJ Cancer Institute in Lake Success, N.Y.

The study was published online Feb. 14 in the journal Blood.

The findings aren't a big surprise to oncologists.

"It has long been known that some types of chemotherapy are associated with a high risk of developing subsequent leukemia," explained study lead author Lindsay Morton, in NCI's Radiation Epidemiology Branch in the Division of Cancer Epidemiology and Genetics, in an NCI news release. "The goal of this study was to better understand how cancer patients' risk of developing leukemia has changed over time."

In conducting the study, the researchers assessed the risk for leukemia of more than 426,000 adults who received chemotherapy for cancer diagnosed between 1975 and 2008. Of these patients, 801 went on to develop AML.

Patients who survived non-Hodgkin lymphoma were at greater risk for AML, the team found. According to the researchers, that may be due to prolonged survival for forms of the disease that require multiple courses of chemotherapy.

Since 2000, patients treated for esophageal, prostate and cervical cancer were also found to be at greater risk for AML, the researchers say. The study also showed that those treated for cancer since the 1990s for cancers of the bones and joints, as well as the endometrium (uterine lining), are also at increased risk for AML.

Meanwhile, patients treated for ovarian cancer, myeloma, and possibly lung cancer may be at reduced risk for AML. The researchers suggested the lower risk among patients with these forms of cancer may be linked to a treatment switch that occurred in the early 1980s from an agent called melphalan to newer, platinum-based chemotherapy.

More research is needed to determine the risks associated with various chemotherapy agents, the researchers said.

For his part, Kolitz said that it is "gratifying to see that the likelihood of developing leukemia from the treatment of several of the studied cancers actually fell over the last decade, very likely because of decreased use of drugs that are most potently [linked to leukemia risk]."

Another expert agreed that the overall risk to any one cancer patient is small.

"This study confirms that a very small number of patients may be at risk for the development of a second cancer due to the effects of chemotherapy," said Dr. William Carroll, a pediatric oncologist at NYU Langone Medical Center, in New York City.

"Patients should always ask their doctor about the risk of serious side effects associated with particular parts of therapy, and whether agents with fewer side effects can be substituted without compromising the best chance for cure," said Carroll, who is also director of the NYU Cancer Institute and a professor at the NYU School of Medicine.

"Finally," he added, "it is increasingly clear that certain patients may be more likely to experience certain side effects based on their own genetic makeup. The ability to determine who is at greatest risk [via genetic testing], thereby allowing therapy to be tapered is one of the fundamental goals of personalized medicine."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Jonathan Kolitz, M.D., associate chief, hematologic oncology, North Shore-LIJ Cancer Institute, Lake Success, N.Y.; William L. Carroll, M.D., pediatric oncologist, NYU Langone Medical Center, and director, NYU Cancer Institute, and professor, NYU School of Medicine, New York City; U.S. National Institutes of Health, news release, Feb. 14, 2013

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FDA Approves 'Bionic Eye' to Help Against Rare Vision Disorder

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 14 (HealthDay News) -- An implanted, sight-enhancing device some are calling a "bionic eye" is the first to gain approval for use in the United States, officials announced Thursday.

According to the U.S. Food and Drug Administration, the new Argus II Retinal Prosthesis System can help patients with a genetic eye disease called retinitis pigmentosa regain some sense of vision. About 100,000 Americans are believed to be affected by the illness, which causes a gradual deterioration of the eyes' photoreceptor cells.

The new device uses a tiny video camera attached to eyeglasses that transmits images to a sheet of electrode sensors that have been sewn into the patient's eye. These sensors then transmit those signals to the brain via the optic nerve. The device helps replace the damaged cells of the retina and helps patients see images or detect movement.

"It's a start, it's a beginning," said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City. "It's going to be exciting for people who get this device who are currently just seeing light or dark, [they] will see shapes and that will be life-altering for them."

An FDA official was similarly enthused.

"For many of the approximately 1,300 individuals who will develop the disease this year, this technology may change their lives," Dr. William Maisel, deputy director for science and chief scientist at FDA's Center for Devices and Radiological Health, said in an agency blog post. "It's the difference between night and day," he added.

Maisel's post also included testimony from people who had tested the device and spoke in favor of its approval at a recent FDA hearing:

"The biggest thing to me was being able to see the crosswalk lines on the street so I can safely cross streets in Manhattan," one user said.

"The most exciting day to me was October 27th, in 2009," another testified. "It was the first time I was able to see letters on the monitor screen [during a test of visual perception]. I had not seen letters since 1994, so that was huge."

A third person said he had a 17-year-old son, "and I don't mind telling you how much -- I mean, how happy that made me, not only to see the silhouette of my son, but to hear that voice coming and saying, 'Yeah, it's me, Dad. I'm here and I love you.'"

People with retinitis pigmentosa suffer damage to the light-sensitive cells of the retina. As these cells slowly degenerate, patients lose side vision and night vision and later on, central vision. The disease can cause blindness,

The FDA's approval is a limited one, labeled a "humanitarian use device" approval, meaning the Argus II can be used only for fewer than 4,000 patients per year.

The FDA is currently restricting approval to people aged 25 years and older who have severe retinitis pigmentosa and can see light but not identify its source. Eligible patients also include those who cannot see light, but who have some retinal function and a history of being able to see forms.

In addition, patients must be willing and able to get the recommended follow-up, device fitting and visual rehabilitation, the agency said.

Dr. Robert Greenberg, president and CEO of Second Sight Medical Products Inc., the maker of the device, said that "patients with retinitis pigmentosa in the United States for the first time ever will [now] have a treatment option."

Greenberg said the device does not restore full vision, but does give patients what he calls "low vision," meaning it lets them perform visual tasks that they couldn't otherwise do.

This is only the first step, Greenberg added. "One of the great things about the Argus II system is that it is a software-driven system," he said, and "we expect to be producing software upgrades for all the implanted patients."

Current lab work suggests those upgrades will include color vision and sharper images, he said. "We are also working on more advanced implants," Greenberg said.

The device is not cheap -- in Europe, where the device has been approved for use for several years, it typically costs about $100,000, with an additional $16,000 for the operation. The company hasn't set a U.S. price yet, but Greenberg say it is going to exceed $100,000.

Insurance typically covers the cost in several European countries, and the company has started a process to get it covered in the United States, Greenberg said.

To gain FDA approval, the system had to go through a clinical trial to see if the device was both safe and effective. The results showed that most participants could perform basic activities better with the device than without.

Activities tested included locating and touching a square on a white field; detecting the direction of a motion; recognizing large letters, words or sentences; detecting street curbs; walking on a sidewalk without stepping off; and matching black, gray and white socks, according to the FDA.

Among the 30 people in the study, 19 had no adverse events related to the implant surgery.

Eleven patients, however, did experience serious problems. These included erosion of the layer covering the eyeball called the conjunctiva, opening of the wound left by the operation, retinal detachment, inflammation and low pressure in their eyeball, the agency noted.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mark Fromer, MD, ophthalmologist, Lenox Hill Hospital, New York City; Robert Greenberg, M.D., Ph.D., president, CEO, Second Sight Medical Products, Inc.; FDA Blog post, William Maisel, M.D., M.P.H., Deputy Director, Science and Chief Scientist, Center for Devices and Radiological Health, U.S. Food and Drug Administration

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'Bilingual Babies' Can Tell Languages Apart

THURSDAY, Feb. 14 (HealthDay News) -- Babies as young as 7 months can tell one language from another and begin to learn them even if they have very different rules of grammar, a new study suggests.

The authors discovered that babies use pitch and the duration of spoken words to figure out that languages are different.

"By as early as 7 months, babies are sensitive to these differences and use these as cues to tell the languages apart," study co-author Janet Werker, a University of British Columbia psychologist, said in a university news release. "If you speak two languages at home, don't be afraid, it's not a zero-sum game. Your baby is very equipped to keep these languages separate, and they do so in remarkable ways."

"Babies growing up bilingual... develop new strategies that monolingual babies don't necessarily need to use," added study co-author Judit Gervain, a linguist at the Paris Descartes University.

The study appears Feb. 14 in the journal Nature Communications, and will be presented at the American Association for the Advancement of Science annual meeting, in Boston.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of British Columbia, news release, Feb. 14, 2013

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Health Tip: Use Focused Imagery to Relax

(HealthDay News) -- Focused imagery is a relaxation exercise that can help you relax and deflect stress.

The Cleveland Clinic suggests how to practice focused imagery:

Visualize a peaceful, relaxing image to help you tune out stress.Go to a quiet spot where you can relax without interruption.Get into a comfortable position, either sitting or lying down.Close your eyes and breathe deeply a few times.Imagine paradise in your mind, whether it's relaxing on a beach or fishing on a lake. Imagine all of the sights, sounds and smells.Frequently imagine this paradise, especially when you feel stressed. Perhaps play an audio tape that reminds you of your image.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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'Bilingual Babies' Can Tell Languages Apart

THURSDAY, Feb. 14 (HealthDay News) -- Babies as young as 7 months can tell one language from another and begin to learn them even if they have very different rules of grammar, a new study suggests.

The authors discovered that babies use pitch and the duration of spoken words to figure out that languages are different.

"By as early as 7 months, babies are sensitive to these differences and use these as cues to tell the languages apart," study co-author Janet Werker, a University of British Columbia psychologist, said in a university news release. "If you speak two languages at home, don't be afraid, it's not a zero-sum game. Your baby is very equipped to keep these languages separate, and they do so in remarkable ways."

"Babies growing up bilingual... develop new strategies that monolingual babies don't necessarily need to use," added study co-author Judit Gervain, a linguist at the Paris Descartes University.

The study appears Feb. 14 in the journal Nature Communications, and will be presented at the American Association for the Advancement of Science annual meeting, in Boston.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of British Columbia, news release, Feb. 14, 2013

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#5: Pampers Baby Dry Diapers Economy Pack Plus Size 4, 192 Count

Safety Information
Keep away from any source of flame. Pampers diapers, like almost any article of clothing, will burn if exposed to flame. To avoid risk of choking on plastic, padding, or other materials, do not allow your child to tear the diaper. Discard any torn or unsealed diaper, or any loose pieces of the diaper. To avoid suffocation, keep all plastic bags away from babies and children. If you notice gel-like material on your baby’s skin, don’t be alarmed. This comes from the diaper padding and can be easily removed by wiping your baby’s skin with a soft, dry cloth.

Ingredients
Pampers Baby Dry contain these mild ingredients which are gentle to the skin: Petrolatum, Stearyl Alcohol, Aloe Barbadensis Leaf Extract.

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#3: Quilted Northern, Ultra Plush, Double Rolls, [6 Rolls*8 Pack] = 48 Total Count

Your comments can help make our site better for everyone. Please note that we are unable to respond directly to all feedback submitted via this form, but we'll ask you to sign in so we can contact you if needed. Feedback is limited to 1000 characters.

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#1: Playtex Diaper Genie Refill (810 count total - 3 pack of 270 each) Amazon Frustration-Free Packaging

Your comments can help make our site better for everyone. Please note that we are unable to respond directly to all feedback submitted via this form, but we'll ask you to sign in so we can contact you if needed. Feedback is limited to 1000 characters.

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#7: Pampers Swaddlers Diapers Economy Pack Plus Size 3, 174 Count (Packaging May Vary)

New parent here. I have been using Swaddlers since my baby was born (newborn size). Great diapers in my opinion.

I had read that some Pampers diapers had Dry-Max in them and that it could irritate sensitive skin. However, as much reading I did online I never got a good concrete answer on which Pampers Swaddlers had dry-max in them.

To convolute things even more, go to a local store that sells diapers and you will probably find that some Pampers Swaddlers packages say "with Dry Max" on them and some dont (I'm not talking about the Sensitive version - Just regular Swaddlers). So Pampers makes two versions of Swaddlers, one with Dry max and one without? WRONG! (well, at least according to Pampers themselves that is wrong). Straight from Pampers customer service:

1. Any regular Pampers Swaddlers (non-Sensiitive versions) diapers have Dry-Max (regardless of whether it says Dry-max on the packing or not)

2. Pampers Swaddlers SENSITIVE do NOT have Dry-Max

I confirmed this by sending them the product codes of various diapers I had bought online and in actual stores, and they confirmed that each one had dry-max in it (even though some of the packaging did not explicitly say dry-max on it).

For the really confusing part, there is a non-sensitive Pampers Swaddlers Newborn diaper that does NOT have dry-max in it, even though it is packaged like a "regular" Swaddler (i.e. non-sensitive). Look closely and you will see on each of these newborn packages that it has a special little symbol on it that reads "SPECIALIZED HOSPITAL PRODUCT". What's that all about? I contacted Pampers again:

"Thanks for writing!

There is some packaging that is normally not offered at the retail level. These Swaddlers are going to be plain white for the hopsitals, and the make up of the diaper is like Swaddlers Sensitive. "

So at least for some newborn Swaddlers, they are made like Sensitive Swaddlers and do not have dry-max. Those diapers can be found here (see sellers Trend Marketing or Planet Stuff):
Pampers Swaddlers Newborn 240 Diapers (12 packs of 20)

whew...that was confusing right? So in summary, according to Pampers themselves:
ANY "regular" Swaddlers have Dry-max, UNLESS the packaging says "SPECIALIZED HOSPITAL PRODUCT" on the outside.
ANY "sensitive" Swaddlers do NOT have dry-max.

I hope this helps someone!!

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#6: Nature's Way Organic Extra Virgin Coconut Oil, 16 Ounce

Ships with any qualifying order over $25, or as a monthly Subscribe & Save delivery. Details Sorry, I could not read the content fromt this page.

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#2: Pampers Sensitive Wipes 12x Box With Tub 768 Count (Packaging May Vary)

Safety Information
To avoid danger of suffocation, keep all plastic bags away from babies and children. Do not place in cribs, beds, carriages or playpens. This is not a toy. Do not allow children to push fingers or hand through opening. To avoid danger of suffocation, keep plastic away from babies and children. Dispose of plastic wrap immediately.

Ingredients
Our Gentle Wipe

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#9: Optimum Nutrition Opti-Men Multivitamins, 180-Count

Vitamins, minerals, and other essential nutrients are the body's fundamental building blocks. They support a strong foundation and are responsible for our energy levels, performance, and vitality. Optimum Nutrition designed Opti-Men as a complete nutrient optimization system. By packing over 75 active ingredients into one pill, ON has created much more than a multivitamin.

Quality Counts: GMP Certified Products
Optimum Nutrition's commitment to quality is evident throughout the entire product development process. As a continued measure of quality, all vendors must provide a Certificate of Analysis for each raw material supplied. The certified analyses are also verified through random in-house and independent laboratory testing. To further diminish any chance of physical, chemical, and microbiological contaminants, ON has established and implemented a Hazard Analysis Critical Control Point (HACCP) program. Quality assurance professionals make routine checks on all storage, blending, and production areas and conduct daily inspections.

About Optimum Nutrition: True Strength
Since 1986, Optimum Nutrition has been supporting the nutrition goals of elite athletes and goal-driven individuals around the world. Building on a foundation of company owned and operated production facilities, unparalleled manufacturing expertise, and uncompromising quality standards, ON continually strives to bring athletes and active individuals sports nutrition solutions designed to make a real difference in performance. Whether your goals involve strength, speed, power, endurance - or any combination - ON supplements work as hard as you do. Realize your True Strength with the quality and innovation leader.

What's in the Box
Optimum Nutrition Opti-Men Men's Multivitamins, 180 count.

Opti-Men is a complete Nutrient Optimization System, providing the ultimate in performance supplementation. With more than 75 distinct ingredients, Opti-Men lays a solid foundation for everyday health, performance, and vitality.Five Performance Blends: Amino-Blend Contains 8 key free-form acids (including Arginine, Glutamine, and BCAAs), the building blocks of lean muscle growth and development. Viri-Blend Contains 8 exotic botanicals and marine concentrates designed to enhance your male edge. Phyto-Blend Contains over 20 antioxidant-rich fruit and vegetable concentrates to help combat free radicals. Enzy-Blend Contains 4 specific enzymes for enhanced nutrition digestion and absorption. Opti-Blend Comprehensive nutritional coverage with 25 vitamins and essential minerals with an emphasis on antioxidants and B-vitamins.

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#4: #1 Garcinia Cambogia Extract - Garcinia Cambogia GOLD - 500 mg, 180 Veggie Capsules (Featuring Clinically-Proven, Multi-Patented 60% HCA Extract for Weight-Loss) 1,500 mg per Serving

Ingredients
100% Pure Garcinia Cambogia Extract with 60% HCA (Naturally occurring Hydroxycitric Acid) ~ 500 mg per Capsule ~ 180 Vegetarian Capsules per Bottle. Our clinically-proven Garcinia Cambogia extract is bound to naturally occurring 70 mg of Potassium and 50 mg of Calcium in a patented ratio that has been clinically shown to be more soluble and better absorbed than other HCA extracts. If taking the clinically-proven "Weight-loss Dosage" of 9 capsules per day, each bottle will last 20 days. If taking the "Satiety Dosage" of 3 capsules per day, each bottle will last 60 days. If you follow Dr. Oz recommended dosage of 3000 mg per day, each bottle will last 30 days. We recommend that you take Garcinia Cambogia Gold at least for 60 days to be able to reach your goals.

Directions
Two different dosages are suggested for Garcinia Cambogia extract depending on the purpose it is taken for. The "Satiety Dosage" helps to curb appetite and reduce caloric intake whereas the "Weight-loss Dosage" helps to curb appetite, reduce caloric intake, burn fat, reduce body weight 3 times more than diet and exercise alone, and promote normal cholesterol and seratonin levels. SATIETY DOSAGE: As a dietary supplement, take 1 vegetarian capsule ? hour to 2 hours before meals three times daily, or as directed by a healthcare professional (that's 1,500 mg per day). WEIGHT-LOSS DOSAGE: As a dietary supplement, take 3 vegetarian capsules ? to 2 hours before meals three times daily, or as directed by a healthcare professional (that's 4,500 mg per day). To avoid late night snacking, please take 2 or 3 capsules after dinner. For Dr. Oz followers, we have also provided the recommendation from his website for reference: "Take 500 mg to 1000 mg before each meal, and make sure to take no more than 3000 mg total per day."

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#8: Philips Sonicare HX7022/30 Eseries Standard Replacement Brush Heads, 2 Pack, Frustration Free Packaging

HX7022/66
HX7023/66 HX7012/66 HX7053/64 HX6053/66 HX6013/66 HX6023/66 HX6062/66
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Obese Black Women at Higher Risk for Having Very Large Babies

THURSDAY, Feb. 14 (HealthDay News) -- Black women who are obese before they become pregnant or gain an excessive amount of weight during pregnancy are at greater risk for having an abnormally large baby, according to a new study.

Macrosomia -- when an infant is born weighing more than 8.8 pounds -- could result in a number of complications, such as hemorrhage, infection, the need for a C-section, preeclampsia and infant death near birth, the researchers said.

Preeclampsia is a pregnancy-related condition marked by high blood pressure and protein in the urine.

Using data on 59,000 black women from the Black Women's Health Study, the researchers compared information on the mothers of 691 full-term infants who weighed more than 8.8 pounds at birth to similar women whose babies weighed less.

Mothers who had a body-mass index (BMI) of more than 31 were twice as likely to have a baby with macrosomia, the study found. BMI is a measure of height versus weight, and 30 and over is considered obese. In addition, the risk for macrosomia was also much higher for women with a pre-pregnancy waist circumference wider than 35 inches compared to women with a waistline smaller than 27 inches.

Women who gained more weight than is recommended in the 2009 Institute of Medicine (IOM) guidelines were also at greater risk for having an abnormally large baby. The researchers noted this was true for all categories of pre-pregnancy BMI.

"In addition to maintaining a healthy weight and waistline before pregnancy, our data suggest that it is especially important for obese women to adhere to the IOM guidelines for pregnancy weight gain to reduce their risk of macrosomia," senior study author Lauren Wise, an associate professor of epidemiology at the Boston University School of Public Health, said in a university news release.

IOM guidelines for weight gain during pregnancy are as follows:

Normal-weight women with a BMI of 18.5 to 24.9 should gain 25 to 35 pounds. Overweight women with a BMI of 25 to 29.9 should gain 15 to 25 pounds. Obese women with a BMI of 30 or more should gain 11 to 20 pounds.

It may be that excess weight gain before or during pregnancy leads to greater maternal glucose concentrations and insulin resistance, which can increase the risk for large babies, according to the release. Weight gain around the waist is also linked to glucose and insulin metabolic changes.

The study was published online in the journal Obesity. While it found a link between obesity in black women and abnormally large babies, it did not show a cause-and-effect relationship.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Boston Medical Center, news release, Feb. 11, 2013

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Open Windows, Lower Risk for Preterm Birth: Study

THURSDAY, Feb. 14 (HealthDay News) --Opening the windows at home may help pregnant women reduce their risk for preterm birth or low birth weight, a new study indicates.

Researchers suggested the increase in fresh air could help protect expectant mothers from exposure to secondhand smoke and other volatile organic compounds that can be found indoors.

For the study, published online and in the April issue of the American Journal of Public Health, researchers questioned more than 1,760 mothers in Los Angeles about the quality of air in their home while they were pregnant. They were asked about their exposure to secondhand smoke, how often they opened the windows and how often they used hairspray, insect spray and nail polish at home.

Although the researchers did not link the use of hairspray or other household products with preterm birth or low birth weight, they did find that opening the windows at home reduced the women's risk for these complications of pregnancy.

The study showed that women exposed to secondhand smoke at home who opened their windows for less than half the day were three times more likely to experience low birth weight and were 92 percent more likely to have a preterm birth.

Even if they were not exposed to secondhand smoke, women who didn't open their windows very often were 49 percent more likely to have a baby with low birth weight and 25 percent more likely to have a preterm delivery than women in homes with better ventilation.

"As there is no risk-free level of secondhand smoke, pregnant women should be advised to avoid secondhand smoke exposure whenever possible, or mitigate secondhand smoke exposure by limiting smoking by household members to outdoor spaces or ventilating their home," the authors wrote.

While the study found an association between opening windows and preterm birth, it did not establish a cause-and-effect link.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Public Health Association, news release, Feb. 14, 2013

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Open Windows, Lower Risk for Preterm Birth: Study

THURSDAY, Feb. 14 (HealthDay News) --Opening the windows at home may help pregnant women reduce their risk for preterm birth or low birth weight, a new study indicates.

Researchers suggested the increase in fresh air could help protect expectant mothers from exposure to secondhand smoke and other volatile organic compounds that can be found indoors.

For the study, published online and in the April issue of the American Journal of Public Health, researchers questioned more than 1,760 mothers in Los Angeles about the quality of air in their home while they were pregnant. They were asked about their exposure to secondhand smoke, how often they opened the windows and how often they used hairspray, insect spray and nail polish at home.

Although the researchers did not link the use of hairspray or other household products with preterm birth or low birth weight, they did find that opening the windows at home reduced the women's risk for these complications of pregnancy.

The study showed that women exposed to secondhand smoke at home who opened their windows for less than half the day were three times more likely to experience low birth weight and were 92 percent more likely to have a preterm birth.

Even if they were not exposed to secondhand smoke, women who didn't open their windows very often were 49 percent more likely to have a baby with low birth weight and 25 percent more likely to have a preterm delivery than women in homes with better ventilation.

"As there is no risk-free level of secondhand smoke, pregnant women should be advised to avoid secondhand smoke exposure whenever possible, or mitigate secondhand smoke exposure by limiting smoking by household members to outdoor spaces or ventilating their home," the authors wrote.

While the study found an association between opening windows and preterm birth, it did not establish a cause-and-effect link.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Public Health Association, news release, Feb. 14, 2013

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Use of Morning-After Pill on the Rise: CDC

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 14 (HealthDay News) -- The number of U.S. women using the "morning-after" contraception pill has risen dramatically in the last decade, federal health officials report.

According to the Centers for Disease Control and Prevention, about 4.2 percent of women in 2002 said they had used the pill, but between 2006 and 2010 that figure had jumped to 11 percent, which translates to 5.8 million women who were between 15 and 44 years old.

The pill, considered emergency contraception to prevent unwanted pregnancy, was particularly popular among young women between 20 and 24 years old, who accounted for 23 percent of users, the government report found.

The report, released Wednesday by the CDC's National Center for Health Statistics using data from the 2006-2010 National Survey of Family Growth, also found:

Non-Hispanic white and Hispanic women were more likely to have used emergency contraception, 11 percent, compared with non-Hispanic black women, 7.9 percent.16 percent of users were between the ages of 25 to 29, 14 percent were teens 15 to 19 years old, and only 5 percent were 30 or older.19 percent of the women who used the pill weren't married, and 14 percent lived with a partner.The most common reasons for using the pill were a woman's fear that the contraceptive she was using might not work, or because she had unprotected sex.Most of the women who took the morning-after pill had used it only once; 24 percent used it twice, and 17 percent had used it at least three times.

Emergency contraception is a high dose of progestin that prevents pregnancy by delaying ovulation (when the egg leaves the ovary and travels into the fallopian tube where it's available for fertilization by sperm). Some research suggests emergency contraception may make it more difficult for sperm to get past the cervix and into the uterus, and may make the uterus less hospitable to sperm.

Although the morning-after pill can be taken up to five days after unprotected sex, it becomes less effective the longer women wait.

The new report is likely to buttress the Obama administration's goal of providing contraception to all women, which has pitted the administration against religious and conservative groups that oppose any form of birth control.

Dr. Jill Rabin, chief of ambulatory care obstetrics and gynecology and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., believes the increased use of the morning-after pill has to do with its longevity and because it has been proven safe and effective.

"It's safer than aspirin," she said.

She also disputes the claim by some conservative groups who see the pill as an abortion pill. "It is definitely not an abortion pill. Once an egg is fertilized, the pill has no power," she said.

"It is far better to prevent an unintended pregnancy if a woman is not ready to conceive," Rabin added.

Planned Parenthood also applauded the new findings, saying the morning-after pill is key to providing women with a choice.

"These data underscores what we see at Planned Parenthood health centers every day -- that birth control is central to women's health and that they must have access to a full range of methods," Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America, said in a statement.

"Previous studies also show that emergency contraception is safe for women of all ages and that rates of unprotected sex do not increase when teens have easier access to emergency contraception," she added.

According to Planned Parenthood, the morning-after pill is available in drug stores without a prescription for those 17 and older. For women under 17, a doctor's prescription is needed.

The cost of emergency contraception varies, running anywhere from $10 to $70. For women who need a prescription, the cost of the pill and the doctor visit can be as high a $250, according to Planned Parenthood.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jill Rabin, M.D., chief, ambulatory care, obstetrics and gynecology, and head, urogynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Deborah Nucatola, senior director of medical services, Planned Parenthood Federation of America; U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, report, Use of Emergency Contraception Among Women Aged 15-44," February 2013

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Health Tip: Use Focused Imagery to Relax

(HealthDay News) -- Focused imagery is a relaxation exercise that can help you relax and deflect stress.

The Cleveland Clinic suggests how to practice focused imagery:

Visualize a peaceful, relaxing image to help you tune out stress.Go to a quiet spot where you can relax without interruption.Get into a comfortable position, either sitting or lying down.Close your eyes and breathe deeply a few times.Imagine paradise in your mind, whether it's relaxing on a beach or fishing on a lake. Imagine all of the sights, sounds and smells.Frequently imagine this paradise, especially when you feel stressed. Perhaps play an audio tape that reminds you of your image.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Use of Morning-After Pill on the Rise: CDC

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 14 (HealthDay News) -- The number of U.S. women using the "morning-after" contraception pill has risen dramatically in the last decade, federal health officials report.

According to the Centers for Disease Control and Prevention, about 4.2 percent of women in 2002 said they had used the pill, but between 2006 and 2010 that figure had jumped to 11 percent, which translates to 5.8 million women who were between 15 and 44 years old.

The pill, considered emergency contraception to prevent unwanted pregnancy, was particularly popular among young women between 20 and 24 years old, who accounted for 23 percent of users, the government report found.

The report, released Wednesday by the CDC's National Center for Health Statistics using data from the 2006-2010 National Survey of Family Growth, also found:

Non-Hispanic white and Hispanic women were more likely to have used emergency contraception, 11 percent, compared with non-Hispanic black women, 7.9 percent.16 percent of users were between the ages of 25 to 29, 14 percent were teens 15 to 19 years old, and only 5 percent were 30 or older.19 percent of the women who used the pill weren't married, and 14 percent lived with a partner.The most common reasons for using the pill were a woman's fear that the contraceptive she was using might not work, or because she had unprotected sex.Most of the women who took the morning-after pill had used it only once; 24 percent used it twice, and 17 percent had used it at least three times.

Emergency contraception is a high dose of progestin that prevents pregnancy by delaying ovulation (when the egg leaves the ovary and travels into the fallopian tube where it's available for fertilization by sperm). Some research suggests emergency contraception may make it more difficult for sperm to get past the cervix and into the uterus, and may make the uterus less hospitable to sperm.

Although the morning-after pill can be taken up to five days after unprotected sex, it becomes less effective the longer women wait.

The new report is likely to buttress the Obama administration's goal of providing contraception to all women, which has pitted the administration against religious and conservative groups that oppose any form of birth control.

Dr. Jill Rabin, chief of ambulatory care obstetrics and gynecology and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., believes the increased use of the morning-after pill has to do with its longevity and because it has been proven safe and effective.

"It's safer than aspirin," she said.

She also disputes the claim by some conservative groups who see the pill as an abortion pill. "It is definitely not an abortion pill. Once an egg is fertilized, the pill has no power," she said.

"It is far better to prevent an unintended pregnancy if a woman is not ready to conceive," Rabin added.

Planned Parenthood also applauded the new findings, saying the morning-after pill is key to providing women with a choice.

"These data underscores what we see at Planned Parenthood health centers every day -- that birth control is central to women's health and that they must have access to a full range of methods," Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America, said in a statement.

"Previous studies also show that emergency contraception is safe for women of all ages and that rates of unprotected sex do not increase when teens have easier access to emergency contraception," she added.

According to Planned Parenthood, the morning-after pill is available in drug stores without a prescription for those 17 and older. For women under 17, a doctor's prescription is needed.

The cost of emergency contraception varies, running anywhere from $10 to $70. For women who need a prescription, the cost of the pill and the doctor visit can be as high a $250, according to Planned Parenthood.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jill Rabin, M.D., chief, ambulatory care, obstetrics and gynecology, and head, urogynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Deborah Nucatola, senior director of medical services, Planned Parenthood Federation of America; U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, report, Use of Emergency Contraception Among Women Aged 15-44," February 2013

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'Bilingual Babies' Can Tell Languages Apart

THURSDAY, Feb. 14 (HealthDay News) -- Babies as young as 7 months can tell one language from another and begin to learn them even if they have very different rules of grammar, a new study suggests.

The authors discovered that babies use pitch and the duration of spoken words to figure out that languages are different.

"By as early as 7 months, babies are sensitive to these differences and use these as cues to tell the languages apart," study co-author Janet Werker, a University of British Columbia psychologist, said in a university news release. "If you speak two languages at home, don't be afraid, it's not a zero-sum game. Your baby is very equipped to keep these languages separate, and they do so in remarkable ways."

"Babies growing up bilingual... develop new strategies that monolingual babies don't necessarily need to use," added study co-author Judit Gervain, a linguist at the Paris Descartes University.

The study appears Feb. 14 in the journal Nature Communications, and will be presented at the American Association for the Advancement of Science annual meeting, in Boston.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of British Columbia, news release, Feb. 14, 2013

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