Review Finds No Statin-Cancer Link

There's no evidence that popular cholesterol-lowering statins cause cancer, says a review that challenges earlier research raising concerns that the drugs may be associated with an increase in cancer and cancer-related deaths. The findings should reassure the millions of people worldwide who take the drugs, said the researchers at the University of Oxford in the U.K. and the University of Sydney in Australia. They examined data from 170,000 people who took part in 26 randomized and controlled clinical trials. Of those participants, more than 10,000 developed cancer and more than 3,500 died from cancer. The analysis showed that the cancer death rates were the same in people taking statins and in those who took a placebo.

The analysis also found that no difference in cancer risk between a higher statin dose and a standard dose. The study was presented recently at the European Society of Cardiology (ESC) Congress in Stockholm. "Statin therapy had no adverse effect on cancer at any site [in the body] or in any group of individuals, irrespective of their cholesterol levels. There was also no association of cancer with statin dose or duration," noted Dr. Jonathon Emberson, senior statistician at the University of Oxford. The researchers found there was no evidence that statins were linked to particular types of cancer, such as breast cancer, or to particular groups of people, as earlier studies had suggested.

"These findings are extremely reassuring for patients," co-principal investigator Professor Rory Collins, a professor of medicine and epidemiology at the University of Oxford, said in an ESC news release. "Statins are one of the most effective known therapies for the prevention of heart attacks and strokes, and this study should reassure the millions of people who are taking them worldwide." The study was funded by the UK Medical Research Council, the British Heart Foundation and the National Health and Medical Research Council (Australia), and involved collaborators from around the globe.
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Casual Sex Can Lead to Long-Term Relationships: Study
People who "hook up" for casual sex can have as rewarding a long-term relationship as those who take it slowly and establish a meaningful connection before they have sex, says a new study. University of Iowa researchers analyzed relationship surveys and found that average relationship quality was higher for people who took it slowly than for those who became sexually involved in "hook-ups," casual dating, or "friends with benefits" relationships. However, having sex early on wasn't the reason for this disparity, according to UI sociologist Anthony Paik. When he factored out people who weren't interested in getting serious, he found that those who became sexually involved as friends or acquaintances and were open to a serious relationship were just as happy as those who dated but delayed having sex.

The study analyzed a survey of 642 heterosexual adults in Chicago. To measure the quality of the relationships, people answered questions about how much they loved their partner, their level of satisfaction with intimacy in the relationship, the future of the relationship, and how their lives would be different if the relationship ended. "We didn't see much evidence that relationships were lower quality because they started off as hook-ups," Paik, an assistant professor in the College of Liberal Arts and Sciences, said in a UI news release. "The study suggests that rewarding relationships are possible for those who delay sex. But it's also possible for true love to emerge if things start off with a more 'Sex and the City' approach, when people spot each other across the room, become sexually involved and then build a relationship," he added.
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Clues to Heart Attack, Stroke Risk From Fat-Filled Artery
A number of factors put patients with abnormal fatty deposits in an artery at high risk for heart attack, stroke and cardiovascular death, a new study shows. Patients in various stages of this condition atherothrombosis are at increased risk for heart attack and stroke stemming from reduced blood flow from the artery blockage, but some are at greater risk than others. In an analysis of more than 45,000 patients, the researchers found that patients with abnormal fatty deposits in an artery were at highest risk if they had a prior history of heart attack or other emergencies linked to an artery blockage.

Narrowing of the arteries in various locations also substantially increased the risk for patients with atherothrombosis, as did diabetes for all the patients even those with only the risk factors for atherothrombosis.Knowing that these factors boost the risk can help physicians take preventive action, according to the researchers, who are from the VA Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School in Boston. The researchers analyzed data from 45,227 patients enrolled in an international study known as Reduction of Atherothrombosis for Continued Health (REACH) between 2003 and 2004. They collected detailed information from the patients when they enrolled and conducted follow-ups one, two, three and four years later.

They found that 81.3 percent of the patients had hypertension, 70.4 percent had high  cholesterol levels in the blood, and 15.9 percent had polyvascular disease . In addition, 48.4 percent of the patients had "ischemic events" prior heart attacks, unstable angina or other problems related to the artery blockage, with 28.1 percent of those patients having had such an event within the previous year. During the follow-up period, 2,315 patients suffered cardiovascular death, 1,228 had a heart attack, 1,898 had a stroke, and 40 had a heart attack and a stroke on the same day. The researchers found that patients with atherothrombosis with a prior history of heart attacks and other events related to a blood vessel blockage had the highest rate of subsequent cardiac emergencies linked to blood flow problems.
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Smoked Marijuana May Ease Chronic Nerve Pain
Smoking cannabis, also known as marijuana, reduced pain in patients with nerve pain stemming from injuries or surgical complications, new research shows. Twenty-one adults with chronic nerve pain were taught to take a single inhalation of 25 milligrams of cannabis through a pipe, three times a day, for five days. The cannabis contained one of three levels of potency of tetrahydrocannabinol (THC), the active ingredient in marijuana, as well as a placebo dosage containing no THC.All of the patients rotated through each of the four dosages, with nine days of no smoking in between. Patients smoking the highest potency marijuana reported less pain than those smoking samples containing no THC. Patients also reported better sleep and less anxiety, according to the Canadian study.

On an 11-point scale, the average daily pain intensity was 6.1 for those smoking 9.4 percent THC concentration, compared to 5.4 for those smoking cannabis containing no THC."Patients have repeatedly made claims that smoked cannabis helps to treat pain, but the issue for me had always been the lack of clinical research to support that claim," said Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre in Montreal. In this small but randomized, controlled trial, "the pain reductions were modest, but significant," he said. "And it was in people for whom nothing else worked."

The study is published in the Aug. 30 issue of the Canadian Medical Association Journal. Persistent nerve pain, clinically known as neuropathy, can be very difficult to treat, Ware said. These patients had tried other treatments for neuropathy, such as opioids, anticonvulsants, antidepressants and local anesthetics, with little relief, Ware said. In addition, the THC potency levels used in the study were kept at 2.5 percent, 6 percent and 9 percent considerably less than the 12 percent to 15 percent often found in marijuana sold on the street, Ware said. Researchers kept the levels low for two reasons, Ware explained. One was to minimize the psychoactive effects, such as feeling lightheaded, dizzy, detached, nauseous or euphoric.
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Quality of Care After Joint Surgery May Affect Heart Health

The quality of care a patient receives immediately after orthopedic surgery has a major impact on long-term heart health, a new study shows. A team of French researchers checked troponin levels in 378 patients for three days after they had orthopedic surgery, which includes procedures such as joint replacement. Troponin is a protein that's measured to determine whether physiologic stress related to surgery has caused damage to the heart. Dr. Sylvain Ausset, of Percy Military Hospital in Clamart, France, and colleagues focused on troponin levels to detect myocardial ischemia, which correlated with worse long-term cardiac outcomes.

The researchers then modified postoperative care to reduce events believed to lead to increased episodes of angina based on elevated troponin levels. Doing so lowered the incidence of cardiac problems months, and even years, later, they found.The methods used to improve quality of care included tighter control of oxygen and glucose levels in patients' blood, along with consistency and continuity of care as hospital staff monitored and cared for patients, according to the report published in the October issue of Anesthesiology.

"An improvement of quality of postoperative care results in a twofold decrease of postoperative myocardial ischemia and a fourfold decrease of major cardiac events later on," Ausset said in a news release from the American Society of Anesthesiologists. The findings could lead to new or improved clinical guidelines, according to an accompanying editorial written by Dr. Don Poldermans, of Erasmus Medical Center in Rotterdam, the Netherlands.
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Older Diabetes Patients Still Sexually Active, Study Finds

Most older adults with diabetes are sexually active but the disease does cause some problems with intimacy, a new study found. U.S. researchers surveyed 1,993 people, aged 57 to 85, and found that nearly 70 percent of partnered men with diabetes and 62 percent of partnered women with diabetes had sex two or three times a month, which is comparable to people the same age without diabetes. However, compared with men without diabetes, diabetic men were more likely to lack interest in sex and to experience erectile dysfunction.

Men and women with diabetes reported a higher rate of orgasm problems, such as climaxing too soon (men) or not at all (men and women).The study, published in the September issue of the journal Diabetes Care, also found that 47 percent of men with diabetes had discussed sexual problems with a doctor, compared with only 19 percent of diabetic women. Men were much more likely than women to initiate this type of discussion."Patients and doctors need to know that most middle-age and older adults with partners are still sexually active despite their diabetes.

However, many people with diabetes have sexual problems that are not being addressed," study lead author Dr. Stacy Lindau, an associate professor of obstetrics and gynecology and of medicine at the University of Chicago, said in a university news release. "Failure to recognize and address sexual issues among middle age and older adults with diabetes may impair quality of life and adaptation to the disease," added senior author Dr. Marshall Chin, a professor of medicine at the University of Chicago. "Sexual problems are common in patients with diabetes, and many patients are not discussing these issues with their physicians."
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Black Rice May Be Cheap Source of Antioxidants
Blueberries and blackberries have high levels of antioxidants, which help the body deal with potentially dangerous cellular oxidation, but scientists say they've also found a cheaper source of antioxidants for consumers: black rice. "Just a spoonful of black rice bran contains more health promoting anthocyanin antioxidants than are found in a spoonful of blueberries, but with less sugar and more fiber and antioxidants," study co-author Zhimin Xu said in a news release from the American Chemical Society.

"If berries are used to boost health, why not black rice and black rice bran?" suggested Xu, associate professor at the food science department at Louisiana State University Agricultural Center in Baton Rouge. "Black rice bran would be a unique and economical material to increase consumption of health-promoting antioxidants." The study authors noted that black rice bran could be used to boost the health benefits of breakfast cereals, cakes, cookies and other foods. It could also be added to beverages, and may serve as food coloring, allowing food manufacturers to avoid artificial colorants, the team said in the news release. The scientists explained that pigments in black rice bran extracts range from pink to black.

In the study, the researchers tested black rice bran grown in the Southern United States. Although brown rice is the most common rice variety produced worldwide, Xu said the study results suggest that black rice bran may be healthier than brown rice bran in terms of antioxidants. In Asia, black rice is most commonly used for food decoration, such as in noodles or sushi. One variety of black rice is known as "Forbidden Rice" because in Ancient China, it was only permitted to be eaten by nobles and no one else, according to background information in the news release.The study results were scheduled to be released Thursday at the national meeting of the American Chemical Society in Boston.
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Bird Flu Detection Takes a Novel Turn

Bloodhounds, you've now got some unusual company: Trained mice were able to detect bird flu in ducks, according to novel research. "Based on our results, we believe dogs, as well as mice, could be trained to identify a variety of diseases and health conditions," said Bruce A. Kimball, a U.S. Department of Agriculture scientist who was to present his findings at the national meeting of the American Chemical Society in Boston this week. Kimball and colleagues at the Monell Chemical Senses Center were able to train mice to detect infected duck feces in a maze more than 90 percent of the time when they had the option of heading toward uninfected feces.

The mice were rewarded with water when they correctly identified the infected samples. "We envision two broad, real-world applications of our findings," Kimball said in a news release from the ACS. "First, we anticipate use of trained disease-detector dogs to screen feces, soil or other environmental samples to provide us with an early warning about the emergence and spread of flu viruses. Second, we can identify the specific odor molecules that mice are sensing and develop laboratory instruments and in-the-field detectors to detect them." Bird flu can kill birds, such as chickens, turkeys and ducks. In rare cases, bird flu has spread to humans, and there has been concern that transmission to people could spark worldwide epidemics.
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Short-Term Overeating Could Make Long-Term Weight Loss Tougher
If you think a few weeks of slothful behavior and caloric overindulgence can be easily worked off at the gym, think again. New Swedish research suggests that just a month's worth of unhealthy living changes physiology, making piled-on fat even harder to lose. "A short period of [over-eating] can have later long-term effects," said study co-author Dr. Torbjorn Lindstrom, an associate professor in the department of medical and health sciences within the faculty of health sciences at Linkoping University. "Based on this, it can be recommended to avoid very high food-intake that might occur during shorter periods in normal life."

Lindstrom and his colleagues report their findings in the current issue of Nutrition & Metabolism. They focused on 18 normal-weight healthy participants, averaging 26 years of age. For one month, all 18 were placed on a restricted physical activity regimen that involved the equivalent of no more than 5,000 steps per day. Five thousand steps, the team noted, is the threshold for a "sedentary" lifestyle, whereas a "physically active" lifestyle involved 10,000 steps or more. In addition, participants embarked on diets involving a 70 percent jump in daily caloric intake mainly from fast food amounting to about 5,750 calories ingested per day. The research also included a comparison group who did not change their diet/activity.

By the end of the month, the feasting group gained an average of 14 pounds. Their fat mass, specifically, was found to have gone up from about 20 percent of total body weight, to nearly 24 percent after the month-long intervention. Participants lost most of that new weight over the ensuing six months. However, one year after the study's end, participants still registered a noticeable gain in fat mass compared with their pre-study status. This fat stuck around despite the fact that the participants had returned to their lower-calorie pre-study diet and more active routines. Two-and-a-half years after the study, fat mass gains were even greater, registering just under 7 pounds on average, the researchers found. There was no such long-term change among the control group who had stuck to their usual diet.
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U.S. Child Abuse Cases Falling, Despite Recession

Child abuse rates in the United States declined between 2007 and 2008 despite the onset of the economic recession, a new study has found. Cases of child sexual abuse decreased 6 percent, physical abuse declined 3 percent and child neglect fell 2 percent, according to researchers at the Crimes Against Children Research Center at the University of New Hampshire. Researchers led by center director and professor of sociology David Finkelhor said the decreases are especially noteworthy because 2008 was the first full year of the current recession and tough economic times are believed to be associated with increased family stress and child abuse.

"This is good news, but we need to be very cautious. It could be that discouragement and despair in families about their deteriorating economic situation take longer than a year to show their effects," Finkelhor said in a university news release. However, the study did note that the recent decrease is part of a downward trend in physical and sexual abuse that's continued for more than 15 years. "The long-term improvement for sexual and physical abuse may be related to a generation-long effort to educate and respond more effectively and aggressively to the problem," Finkelhor said. "If successful prevention efforts are behind the declines, then the improvements may persist even in the face of social stressors like the recession."
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Vitamin D May Influence Genes for Cancer, Autoimmune Disease
Scientists have discovered a link between vitamin D and genes related to autoimmune diseases and cancer. The finding may explain why vitamin D deficiency is a risk factor for a number of serious illnesses, including multiple sclerosis, type 1 diabetes and rheumatoid arthritis, according to researchers from the United Kingdom and Canada. In the study, Sreeram Ramagopalan of Oxford University and colleagues noted there is a growing amount of evidence that vitamin D deficiency is a risk factor for a wide range of diseases, but it's not known exactly how vitamin D is involved. It has been suspected that genetics may contribute to this connection. Vitamin D has an effect on genes through the vitamin D receptor, which binds to specific locations on the human genome to influence gene expression.

In this study, the researchers mapped sites of vitamin D receptor binding information that can be used to identify disease-related genes that might be influenced by vitamin D. The investigators found that vitamin D receptor binding is significantly enhanced in regions of the human genome associated with several common autoimmune diseases, such as multiple sclerosis, type 1 diabetes and Crohn's disease, and in regions associated with cancers such as leukemia and colorectal cancer.The findings, published in the Aug. 23 online edition of the journal Genome Research, highlight the serious risks associated with vitamin D deficiency, especially for people who may be genetically predisposed to be sensitive to vitamin D deficiency, the study authors explained in a news release from Cold Spring Harbor Laboratory.

"Considerations of vitamin D supplementation as a preventative measure for these diseases are strongly warranted," Ramagopalan stated in the news release. People should consume between 200 and 600 international units of vitamin D daily, according to a U.S. Institute of Medicine guideline, and the American Academy of Pediatrics recommends 400 international units daily. The U.S. guideline is currently under review, and many experts have called for an increase in the recommended intake levels. Exposure to sunlight triggers the body to naturally produce vitamin D, although it can be hard to get enough in some regions during certain parts of the year. Vitamin D is also found in certain foods, such as fish, cheese, egg yolks and fortified milk and breakfast cereals.
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Slowed Reflexes in Aging Could Be Due to Brain Changes

Breakdowns in brain connections may be the reason why your physical response times slow as you age, a new study has found. The decline occurs in an area of the brain called the corpus callosum, which helps regulate "cross-talk" between the two sides of the brain, said lead author Rachael Seidler, an associate professor in the School of Kinesiology and psychology department at the University of Michigan. Normally, one side of the brain controls movement on the opposite side of the body. For example, the left side of the brain controls movement on the right side of the body.

But when regulation of cross-talk between the two sides of the brain starts to break down with age, both sides of the brain talk simultaneously while one side of the body tries to move, resulting in slower response times, the researchers explained. Seidler and colleagues studied the response times and brain activity of adults aged 65 to 75 as they used computer joysticks, and compared them to a group of 20-25 year olds. They also used a functional MRI to image the blood oxygen levels in different parts of the brain, as a measurement of brain activity in the older group. "The more they recruited the other side of the brain, the slower they responded," Seidler said in a University of Michigan news release.
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Scientists Create Fertile Ground for Growing Stem Cells

A team of researchers at the Massachusetts Institute of Technology say they've developed a synthetic surface that makes it easier to grow stem cells. There are two sources of human stem cells: embryonic cells or pluripotent cells. Pluripotent stem cells are body cells that have been reprogrammed to an immature state so that they can develop into any kind of specialized body cells.While it's believed that pluripotent stem cells hold great potential for treating a wide range of diseases, scientists have found it difficult to grow them in large enough quantities to be used in human studies. "For therapeutics, you need millions and millions of cells.

If we can make it easier for the cells to divide and grow, that will really help to get the number of cells you need to do all of the disease studies that people are excited about," Krishanu Saha, a postdoctoral associate at MIT and co-first author of the paper, said in an MIT news release. The newly developed surface, which contains no foreign animal material, allows human pluripotent stem cells to remain alive and continue reproducing themselves for at least three months, the researchers reported. This is the first synthetic material that allows single cells to form colonies of identical cells, something that is necessary in order to identify cells with desired traits, according to the MIT team of chemical engineers, materials scientists and biologists.
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Rectal Cancer Rates on the Rise in Younger Adults

While the number of actual cases is still extremely small, U.S. researchers report that the incidence of rectal cancer among people under the age of 40 is on the rise. A young person's chance of developing the disease remains tiny, but doctors should be aware of the risk, said study co-author Dr. David L. Sherr, an assistant professor of radiation oncology at Weill Cornell Medical College in New York City. "If patients under 40 have rectal bleeding, that should be taken as seriously as in a 0-year-old," Sherr said. "Some kind of investigation could be warranted."

While colon and rectal (or colorectal) cancers often strike older people and are responsible for the second-highest number of cancer deaths in the United States after lung cancer, these cancers are fairly rare in younger people, the study authors noted in the report published online Aug. 23 and in the Sept. 15 print issue of Cancer. Sherr estimated that only 300 annual cases of rectal cancer, on average, were diagnosed in people under the age of 40 in the entire country between 1973 and 2005. He said the risk of a person younger than age 40 being diagnosed with the disease during that time period was about four in a million.

However, an analysis of U.S. statistics shows that rectal cancer has been increasing by an average of 2.5 percent a year. While that amounts to fewer than 10 extra cases each year compared to the previous year, it's still a "real and significant increase," he said. It's not clear why cases are on the rise, but Dr. Jerald D. Wishner, a cancer specialist, said he's seeing more colorectal cancer cases among young people than a decade or two ago. "At any given time, I'm taking care of two to three patients in their 20s and 30s with colon and rectal cancer," said Wishner, co-director of minimally invasive and robotic surgery at Northern Westchester Hospital in Mount Kisco, N.Y.
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Cyberbullying, 'Sexting' Major Problems for Schoolkids
Being bullied in cyberspace and "sexting" are major problems for school-age children, and parents need to be aware of this to protect them, says an expert. Research suggests that as many as 25 percent of children in the United States report being subjected to cyberbullying, which the use of technological devices to deliberately harass or harm other people through e-mail, text messaging, instant messaging, cell phones and online networking sites."With the increase technological devices, children are now using to harass and harm other children," Bridget Roberts, an professor of counseling at Indiana State University, said in a university news release.

"Many children have personal cell phones, making it very easy to use these devices in that way. Communication in cyberspace also seems more anonymous and seems to require less responsibility on the part of the child committing the behavior." And at least 20 percent of teens say they've engaged in sexting, which is the sending of sexually explicit photos via cell phones. "Teens and their parents are not aware of the serious nature of such an act and the potentially life-long consequences" of sexting, Roberts-Pittman warned. For example, teens arrested for sexting can be charged with the possession or distribution of child pornography and be required to register as a sex offender for up to 20 years in some states.

She said worrisome changes in a child's behavior may be an indication of cyberbullying or sexting. "Behavior change is a part of adolescence. However, a significant change could mean the child is dealing with a serious issue such as cyberbullying. Parents should be aware of signs such as anxiety, depression, their child not wanting to attend school or making a drastic decision such as quitting a sports team," Roberts-Pittman said. In addition, parents need to monitor their children's phone and Internet use and can do so using software packages such as Spectorsoft or I Am Big Brother.
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Study Finds Even a Little Cigarette Smoke Harms Airway

A drag from a cigarette now and then can't hurt, right? Wrong, according to a new study that finds even low levels of smoke exposure can cause irreparable damage to cells essential to breathing. The damage occurred among "casual" smokers and even after exposure to secondhand smoke. The initial damage, while not usually severe, can be cumulative and prolonged exposure to tobacco smoke could lead to chronic obstructive pulmonary disease (COPD) and even lung cancer, the researchers reported. "It has been known for a long time that secondhand smoke or smoking occasionally can be risky for your health," said study author Dr. Ronald Crystal.

Just how much a little exposure might damage airway cells hasn't been clear, however. "We found that if we could detect nicotine in the urine we could also detect changes in the genes in the cells lining the airways," said Crystal, who is also chair of the department of genetic medicine at Weill Cornell Medical College. The bottom line: "There is no level of cigarette smoking or exposure to cigarette smoke that does not make the cells in your lungs sick," he said. "If you are an occasional smoker you are still at risk. Don't think that smoking one or two cigarettes a week means you are home free."

As for secondhand smoke, "if you are working in a place where people smoke, either get them to stop or go get another job," Crystal advised. "If you have somebody at home who smokes, send them outside to smoke. Don't be exposed to secondhand smoke." The report is published in the Aug. 20 issue of American Journal of Respiratory and Critical Care Medicine. For the study, Crystal's team recruited 121 people who were nonsmokers, active smokers or low-exposure smokers. To determine who belonged in which group, all participants had their urine tested for levels of nicotine.
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Kids Seem More Likely to Reject Those Whose Eyes Cross
Children with a condition called strabismus, in which their eyes aren't straight or don't line up with each other, may be less likely to be invited to birthday parties than other children, researchers have found.Swiss researchers digitally altered photographs of six children from six identical twin pairs to create inward and outward types of strabismus. They asked 118 children, aged 3 to 12 years, photos are unaltered pictures of the children with aligned eyes and select whom they would invite to their birthday party.

Children under 6 years of age didn't have any preference between the photos of the kids with strabismus or normally aligned eyes. But children 6 and older were much less likely to select the photos of the children with strabismus, Dr. Daniel Mojon, of the department of strabismology and neuro-ophthalmology at Kantonsspital in St. Gallen, Switzerland, and colleagues found. There were 48 children aged 6 to 8 in the study, and among that group 18 did not select any child with a strabismus, 17 selected this type of child once, 11 did so twice and two did so three times, according to the report published online Aug. 18 in the British Journal of Ophthalmology.

The researchers found that among the 31 children in the 4- to 6-year age group, only one did not select a child with strabismus, 21 selected a child with strabismus once or twice, and nine selected a child with strabismus three or four times. "Our results show that schoolchildren with strabismus seem less likely to be accepted by their peers, so corrective surgery for strabismus should be performed before the age of 6 years, when negative social implications may arise," Mojon and colleagues concluded.
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Teen Survey Finds Gangs, Drugs Common in U.S. Schools

Drugs and gangs are common problems at public schools in the United States, a new teen survey shows.Among public school students aged 12 to 17, 27 percent (5.7 million) report that their schools are both "gang- and drug-infected." Drug-infected means that drugs are used, kept or sold on school grounds.The 15th annual teen survey by the National Center on Addiction and Substance Abuse at Columbia University also found that 46 percent of teens in public schools say there are gangs in their schools and 47 percent of teens say that drugs are used, kept or sold on school grounds.

Compared with teens who go to drug-free and gang-free schools, those at schools infected with both drugs and gangs are: five times more likely to smoke marijuana; three times more likely drink alcohol; 12 times more likely to smoke tobacco; three times more likely to have access to marijuana within an hour and five times more likely to have access to it within a day; and nearly five times more likely to know a peer who uses illegal drugs (such as acid, ecstasy, methamphetamine, cocaine or heroin). The complete survey findings were scheduled for release Thursday at a press conference at the Kaiser Family Foundation Building in Washington, D.C.
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Novel Ovarian Cancer Test Shows Promise
A new method for screening for ovarian cancer appears to be 100 percent effective in early testing, researchers say. The approach relies on just a single drop of blood, the molecules of which are vaporized and electrified before being subjected to a high-tech analysis called mass spectrometry. The Georgia Institute of Technology researchers said they found the approach to be foolproof in identifying cases of ovarian cancer in initial trials involving 94 subjects. Forty-four had ovarian cancer and 50 had benign conditions. 

"Because ovarian cancer is a disease of relatively low prevalence, it's essential that tests for it be extremely accurate," John F. McDonald, chief research scientist at the Ovarian Cancer Institute in Atlanta and a professor of biology at Georgia Tech, said in a news release from the school. "We believe we may have developed such a test." McDonald and his colleagues report their finding online in the current issue of Cancer Epidemiology, Biomarkers & Prevention Research. The researchers pointed out that ovarian cancer is asymptomatic in its early stages, prompting a need for a screening approach that can identify the onset of this "silent killer." Last spring, British researchers speaking at the American Society of Clinical Oncology meeting discussed another potential ovarian cancer screening method. 

That one uses mathematical models to better pinpoint risk for the disease among postmenopausal women. While that method also demonstrated very high (99.7 percent) accuracy, studies assessing its effectiveness are still underway. The Georgia Tech method, which appeared to register no false positive or negative results, was developed by Facundo Fernandez, an associate professor in the school of chemistry and biochemistry. The Georgia team is now testing the approach among 500 patients. "The caveat is we don't currently have 500 patients with the same type of ovarian cancer, so we're going to look at other types of ovarian cancer," Fernandez said in the news release. "It's possible that there are also signatures for other cancers, not just ovarian, so we're also going to be using the same approach to look at other types of cancers. We'll be working with collaborators in Atlanta and elsewhere." Dr. Robert J. Morgan, director of the gynecologic oncology program at the City of Hope Cancer Center in Duarte, Calif., said that if the new screening method holds up upon further investigation, it could prove to be "earth-shatteringly important."
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Long-Term Type 1 Diabetes 'Survivors' Give Clues to the Disease

Although it's long been thought that people with type 1 diabetes cease to produce any insulin after they've had the disease for a while, new research suggests that the insulin-producing beta cells destroyed by type 1 diabetes may actually be in a constant state of turnover, even in people who've had diabetes for decades. This new research stems from a study of people who've had type 1 diabetes for at least 50 years and have been awarded the Joslin Diabetes Center's "50-Year Medal." In fact, the impetus for the study came from one of the medalists who mentioned to her doctor that she believed her body was still making some insulin.

"I knew I still produced insulin. I don't do it all the time, but sometimes I need a lot less insulin, and the doctors proved on one test that I still did make some insulin," said medalist Elizabeth Saalfeld from Springfield, Va., who was diagnosed with type 1 diabetes in 1945 at age 9. "In our study, we made the unexpected finding that about two-thirds of the medalists still retained the ability to have positive C-peptide results, which is an indication that they could still be making insulin," said the study's senior author, Dr. George L. King, chief scientific officer at the Joslin Diabetes Center in Boston. "It was a surprise because they've had diabetes for so long."

Results of the study were released online Aug. 10 in advance of publication in an upcoming print issue of the journal Diabetes. Type 1 diabetes is believed to be an autoimmune disease in which the body's immune system mistakenly attacks the beta cells in the pancreas. When enough beta cells have been destroyed, the body is no longer able to produce sufficient enough amounts of insulin to properly metabolize the carbohydrates in food. Someone with type 1 diabetes must replace that lost insulin through daily injections.The current study included 411 living diabetes medalists, and a post-mortem pancreas analysis from another nine medalists.
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Many Depressed People Have Mild, Brief Episodes of Mania

Nearly 40 percent of Americans with major depression also have brief but recurring episodes of manic behavior, a new study suggests. Researchers at the U.S. National Institute of Mental Health (NIMH) reported that these patients have what's called "subthreshold hypomania"  meaning a milder form of mania that lasts fewer than four days, and is therefore below the threshold for bipolar disorder. "With hypomania, people may be more active and energetic than usual, and they may sleep less and become agitated more easily," said the study's senior author, Kathleen Merikangas, a senior investigator at the NIMH in Bethesda, Md. "The behavior is definitely different than their usual state, but it doesn't cause impairment in their lives." The findings were published Aug. 16 in the online advance edition of the American Journal of Psychiatry.

Merikangas and her colleagues analyzed data from a survey of more than 5,000 U.S. households. They found that people with subthreshold hypomania have higher rates of anxiety and substance abuse and more depressive episodes than depressed people who don't exhibit manic behavior. What's more, they were just as likely to have a family history of mania as people with bipolar disorder, which suggests that they may be at a higher risk of developing full-blown bipolar disorder down the road.Although these mild episodes of mania last only two or three days, they recur frequently, Merikangas said. She stressed that some periods of high energy are entirely natural. "If someone has one instance where she feels really good for a few days because of something that happened in her life, like falling in love, that's not subthreshold hypomania," Merikangas said.

A true manic episode lasts for one week or more, often includes psychotic symptoms and sometimes requires hospitalization. However, the researchers noted that most people with bipolar disorder experience hypomania rather than mania."This study really helps consolidate an idea that's been around for a while, which is that there's a broad continuum ranging from pure unipolar depression to classic bipolar depression," said Dr. Gregory Simon, a psychiatrist and mental health researcher at the Group Health Research Institute in Seattle. Simon added that the findings raise questions about treatment implications, which need to be addressed in future studies. "Does it mean that these people may get greater benefit from some treatments rather than others? There's a way to answer that question, but we haven't done that yet."
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Cosmetic Surgery Not a Help for Body Dysmorphic Disorder

One in five people with a condition known as body dysmorphic disorder (BDD) undergo cosmetic procedures, but only 2 percent of them experience a reduction in the severity of their condition after their treatment, researchers say. "BDD is a psychiatric disorder characterized by preoccupation with an imagined or slight defect in appearance, which causes clinically significant distress or functional impairment. A majority of these individuals believe they have an actual deformity that can be corrected by `cosmetic treatments to fix these perceived defects rather than seeking psychiatric interventions," study co-author Dr. Katharine A. Phillips, director of the body image program at Rhode Island Hospital, said in a hospital news release.

Phillips and her colleagues looked at 200 people with BDD and found that 31 percent sought and 21 percent underwent surgical or minimally invasive cosmetic treatment. Among those who actually had a cosmetic procedure, most continued to have BDD symptoms afterwards, and in some cases they developed new preoccupations with their appearance, the researchers noted. The investigators also surveyed 265 cosmetic surgeonsand found that 178 (65 percent) reported treating patients with BDD. But among those cases, only 1 percent of the treatments resulted in symptom improvement for patients with BDD, the study authors reported.

"These findings, coupled with reports of lawsuits and occasionally violence perpetrated by persons with BDD towards physicians, have led some to believe that BDD is a contraindication for cosmetic treatment," Phillips said. The most common surgical procedures sought by BDD patients are rhinoplasty (nose jobs) and breast enlargements, while the most common minimally invasive treatments are collagen injections and skin treatments known as microdermabrasion, the study authors noted. The researchers also found that three-quarters of procedures requested by BDD patients involved facial features and that more than one-third of patients received multiple procedures.
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Students Warned to Beware of 'Laptop-itis'

The very design of laptop computers encourages bad posture among college students and other heavy users, which can lead to headaches, muscle strain and debilitating neck, shoulder and hand injuries, researchers caution.The issue stems from the unified body construction that defines laptops, researchers at the University of North Carolina (UNC) at Chapel Hill School of Medicine, explained in a university news release. With an inseparable keyboard and monitor, users are not free to configure their equipment in a way that minimizes risk. "When you use a laptop, you have to make some sort of sacrifice," Dr. Kevin Carneiro, a physician in the UNC School of Medicine's department of physical medicine and rehabilitation, stated in the news release.

Such a sacrifice to convenience comes at a price, Carneiro noted. Awkward positioning of the fingers and body can cause nerve injury to the wrist and prompt the onset of carpal tunnel syndrome, while poor neck position and shoulder posture can cause muscle strain and soreness in those areas. Signs of trouble typically come in the form of headaches, wrist pain, tingling in the fingers or thumb, and neck and shoulder pain, he added. Concern about such laptop health issues is driven by their rising popularity, as worldwide sales now exceed those of standard desktop computers. Students are particularly vulnerable, since laptops are a common feature of campus life. That said, Carneiro and his colleagues point out that laptop users can take specific steps to minimize their risk.

* If you are working at a computer, your body should form 90-degree angles at the elbows, knees and hips.
* Use a docking station and cables to hook up to an external monitor and/or separate keyboard that are      moveable to encourage better posture.
* With the help of a docking station, position the computer so you can read the screen without bending your neck.
* Pay attention to the chair you sit in look for one that is adjustable and comes with back support.
* Tilt the screen so you don't need to bend your neck, and place the mouse so that your wrists are in a neutral position .
* Take frequent short breaks every 20 minutes or so this can help rest muscles and encourage position shifting. Do some shoulder shrugs, gentle forward head rolls, and shoulder scrunches to stretch your muscles.
* Stay hydrated drinking plenty of water can help keep discs in your back lubricated.

In addition, watch out for warning signs, including pain and tingling. Carneiro said these may mean you need to use better posture, take more breaks, or see a doctor.
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Being an Only Child Won't Harm Social Skills: Study

Boys and girls who grow up without siblings are no less capable of developing good social skills than those raised with brothers and sisters, new research indicates. The observations stem from an analysis involving more than 13,000 middle school and high school students conducted by a team of researchers at Ohio State University. "I don't think anyone has to be concerned that if you don't have siblings, you won't learn the social skills you need to get along with other students in high school," study co-author Donna Bobbitt-Zeher, an assistant professor of sociology on OSU's Marion campus, said in a news release from the American Sociological Association (ASA).

Together with OSU colleague Douglas Downey, Bobbit-Zeher is slated to present the findings Monday at the ASA annual meeting in Atlanta. Interest in the question of how siblings might affect socialization skills has been growing in recent years, the authors noted, with an earlier study by Downey suggesting that kindergarten aged kids fare better if they grow up with siblings. "As family sizes get smaller in industrialized countries, there is concern about what it might mean for society as more children grow up without brothers and sisters," Bobbit-Zeher said. "The fear is that they may be losing something by not learning social skills through interacting with siblings."

The current effort used interview data collected by the National Study of Adolescent Health (ADD Health) that concerned children in grades 7 through 12 who were enrolled at more than 100 schools across the United States between 1994 and 1995. The interviews were used to assess popularity by asking the kids to list up to five male and five female friends, and then tallying the number of "votes" each participant got overall. The authors found that students were "nominated" an average of five times by their peers, and that voting was not influenced by the presence of siblings, irrespective of gender or whether sibling status (full, step, half, or adopted). Parental age, race and socio-economic status also appeared to have no impact on the question of siblings and social skill development.
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Anger Focuses Attention on Rewards, Not Threats: Study

Even though anger is a negative emotion, angry people tend to pay more attention to rewards than threats, a new study finds. Previous research has found that people with other types of negative emotions, such as fea or anxiety, tend to focus more on threat than reward. For example, they'll spend more time looking at a picture of a person holding a knife threateningly than a picture of a sexy couple. On the other hand, people experiencing a positive emotion such as excitement are drawn to rewards, explained Brett Q. Ford, of Boston College, and colleagues. "Emotions can vary in what they make you want to do. Fear is associated with a motivation to avoid, whereas excitement is associated with a motivation to approach.

It can make you want to seek out certain things, like rewards," Ford said in an Association for Psychological Science news release. In the study, volunteers were asked to write for 15 minutes about one of four personal memories, and were assigned to write about a time when they were angry, afraid, excited/happy, or felt little or no emotion. Depending on the emotion the participant had been assigned, a five-minute piece of music was played to reinforce the feeling.After completing the writing task, the volunteers were asked to look at two side-by-side pictures. The investigators used a device that monitors eye movement to determine how much time the volunteers spent focusing on each picture.

They found that volunteers who had been assigned to recall an angry memory spent more time looking at rewarding pictures, as did the people who recalled feeling happy and excited. The findings suggest that visual attention may not be related to negative versus positive emotions, but instead related to how a person's emotions motivate them. For example, anger might motivate someone to approach something in an aggressive way, while happiness might cause someone to want to approach things in a social or friendly way, the study authors noted in the news release. "Attention kicks off an entire string of events that can end up influencing behavior," the authors concluded in the news release. The study findings were released online in advance of publication in an upcoming issue of Psychological Science.
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Generics As Good As Costly Blood Pressure Meds, Study Finds

Costly, brand-name blood pressure-lowering drugs are no better at preventing cardiovascular disease than older, generic diuretics, reveals long-term data from a large study. It included more than 33,000 patients with high blood pressure who were randomly selected to take either a diuretic or one of two newer drugs a calcium blocker or an ACE inhibitor. Data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial released in 2002 showed that after four to eight years of follow-up, the diuretic was better than the calcium blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.

Differences between the drugs narrowed after eight to 13 years of follow-up, the findings show. However, the diuretic was still better in two areas. Compared with patients taking the diuretic, those in the ACE inhibitor group had a 20 percent higher death rate from stroke, and those in the calcium channel blocker group had a 12 percent higher rate of hospitalization and death because of heart failure. The results were to be presented Friday at the China Heart Congress and International Heart Forum in Beijing. "We are continuing to mine data that we collected during the trial," Dr. Paul Whelton, president and CEO of Loyola University Health System and chairman of ALLHAT, said in a university news release. ALLHAT is sponsored by the U.S. National Heart, Lung and Blood Institute.
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Many Patients Say 'No' to Chocolate As Medicine

It sounds like a great prescription, but a new study finds that many heart patients aren't all that sweet on using chocolate as medicine. Researchers in Australia discovered that patients more often preferred boring pills over antioxidant-rich chocolate to help control their blood pressure. "Fifty grams of dark chocolate containing 70 percent of cocoa daily was less acceptable than a pill of tomato extract or placebo," said Karin Ried, co-author of a letter appearing Aug. 12 in the BMJ.So, because patients didn't stick with the regimen, "chocolate might not be practical to be recommended as long-term treatment for blood pressure," she added. "However, eating chocolate occasionally or regularly might have health-benefiting properties."

Several trials have found that the antioxidants in dark chocolate can help lower blood pressure, including one that found that even 30 calories of chocolate a day could help. "We know that flavonoids and polyphenols have been able to decrease blood pressure, so we've said that having a square of chocolate that's 70 percent cocoa part of a healthy diet," said Dr. Suzanne Steinbaum, a preventive cardiologist with Lenox Hill Hospital in New York City. In the new trial, originally published in 2009, Ried and colleagues randomized 36 people to receive 50 milligrams of "commercially available" dark chocolate , a tomato extract capsule , or a placebo daily for eight weeks.

The tomato extract contained levels of antioxidants "equivalent to four or five medium-size tomatoes," Ried said, while the placebo capsules "contained mainly soy oil." Although the dark chocolate did have a more salutary effect on blood pressure than either the tomato extract or the placebo, many participants just didn't find this treat palatable. About half of those in the chocolate group "found it hard" to eat this amount of chocolate every day, while 20 percent "considered it an unacceptable long-term treatment option." Participants had no problem with a daily pill, however. The findings seem counterintuitive to the growing waistlines seen around the world, but Ried thinks she may have a reason for the reactions.
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College Campuses See Rise in Cases of Severe Mental Illness

More cases of severe mental illness are being reported among college students than a decade ago, as more young people with mental health issues tackle a post secondary education and are open to getting help when they need it, a new U.S. study shows. The use of prescription medications by students to treat psychiatric illness has also risen significantly over the past decade, the research team noted. "If we look at the average college student and their level of psychological and emotional functioning and distress, on the whole they are not necessarily worse off than they were 10 years ago," explained study author John C. Guthman, director of student counseling at Hofstra University's division of student affairs.

"However, there are some students who are outliers and they have some difficulty in some areas. And these relatively few students that present in significant distress seem to have increased to a greater percentage than they were a decade ago." Guthman and his colleagues are to report their findings Thursday at the American Psychological Association annual meeting, in San Diego. The authors noted that their observations appear to be in line with what mental health professionals have observed and reported anecdotally in recent years.

To get a handle on the current state of affairs, Guthman and his team analyzed diagnostic records concerning nearly 3,300 undergraduate and graduate students who had sought college counseling at some point in the 10 years between 1997 and 2009. After examining intake information concerning mental disorders, suicidal tendencies and behavioral reports, the team determined that over the years most students had been diagnosed with mood and anxiety disorders and that, on average, the nature of these cases had remained relatively mild over time.
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Travel for Surgery May Help Spread New Superbug

A gene that makes bacteria resistant to almost all antibiotics has appeared in Pakistan, Bangladesh and India, researchers have found. The so-called NDM-1 gene has also been identified in the United Kingdom in patients who underwent surgery in India. Researchers warn that the appearance of the antibiotic-resistant strain of bacteria is worrisome because it could spread around the world due to the fact that people in Europe and the United States often travel internationally for medical procedures. The researchers, led by Timothy Walsh of Cardiff University in the United Kingdom, first discovered the gene in 2009 in samples of pneumonia and E. coli bacteria taken from a Swedish patient in India.

The bacteria with the gene resist various types of antibiotics, including those specifically designed to treat infections caused by drug resistant germs.The researchers found signs of the bacteria in Bangladesh, India, Pakistan and the United Kingdom. It was most commonly found in a pneumonia strain and an E. coli strain that commonly causes urinary tract infections. In some cases, the germs resisted all antibiotics, according to the report released online Aug. 11 in advance of publication in the September print edition of The Lancet Infectious Diseases.

The study authors noted that the U.K. patients with NDM-1-producing antibiotic-resistant bacteria had traveled to India or Pakistan for surgery, including cosmetic surgery. Because it is common for people from Europe and the United States to travel internationally for such surgeries, NDM-1 "will likely spread worldwide," Walsh and colleagues concluded.Whether the bacteria will actually become a major threat is "difficult to really tell at this moment in time, but the potential is there for it to become a worrisome issue," Dr. Johann Pitout, a University of Calgary microbiologist, said in an interview. If the germs do spread, their existence will have "serious future implications" on how hospitals deal with infections, noted Pitout, who also authored a commentary accompanying the study.
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Brain Research May Help Predict Anxiety, Depression in Young

Brain regions that may play a role in the development of childhood anxiety have been pinpointed by U.S. researchers.The findings could lead to new methods of early detection and treatment for at-risk children, according to study leader Ned. H. Kalin, chair of psychiatry at the University of Wisconsin-Madison School of Medicine and Public Health. "Children with anxious temperaments suffer from extreme shyness, persistent worry and increased bodily responses to stress. It has long been known that these children are at increased risk of developing anxiety, depression and associated substance abuse disorders," Kalin said in a university news release. He and his colleagues scanned the brains of 238 young rhesus monkeys and found that increased activity in brain regions called the amygdala and the anterior hippocampus predicted anxious temperament.

Previous research led by Kalin found that anxious young monkeys are similar to anxious children. "We believe that young children who have higher activity in these brain regions are more likely to develop anxiety and depression as adolescents and adults, and are also more likely to develop drug and alcohol problems in an attempt to treat their distress," he said. The findings, published in the Aug. 12 issue of Nature, suggest it may be possible to prevent children from developing full-blown anxiety. "My feeling is that the earlier we intervene with children, the more likely they will be able to lead a happy life in which they aren't as controlled by anxiety and depression. We think we can train vulnerable kids to settle their brains down," Kalin said.
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Competing For a Mate May Shorten Men's Lives, Study Suggests

In certain situations, competing for a mate may shorten a man's life.U.S. researchers found that when men reach sexual maturity in settings where they far outnumber women, they live an average of three months less than males from areas with a more equitable gender ratio.While previous studies have examined gender ratios and longevity in animals, this is the first time it's been studied in humans, according to senior author Nicholas Christakis, a professor of medicine and medical sociology at Harvard Medical School, and a professor of sociology at Harvard University's Faculty of Arts and Sciences.

"At first blush, a quarter of a year may not seem like much, but it is comparable to the effects of, say, taking a daily aspirin, or engaging in moderate exercise. A 65-year-old man is typically expected to live another 15.4 years. Removing three months from this block of time is significant," Christakis said in a Harvard news release. For this study, he and his colleagues analyzed data from the long-term Wisconsin Longitudinal Study, which followed people who graduated from Wisconsin high schools in 1957. The researchers calculated the gender ratios of each high-school graduating class and then looked at the life spans of the graduates.

As of 2007, men from classes with more boys than girls didn't live as long as those from classes that had a more even gender balance. For 65-year-old men, the difference in lifespan was 1.6 percent. The study appears in the August issue of the journal Demography.While the researchers didn't look into the reasons for their finding or prove that it was related to the struggle to find a mate they believe a number of social and biological factors play a role. Trying to find a mate is stressful, and stress is a known contributor to health problems, Christakis noted.
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Cholesterol Levels Fluctuate With Menstrual Cycle
Women's cholesterol levels vary throughout their menstrual cycle as their levels of estrogen rise and fall, a new study reveals. This means that to get a clear picture of a woman's cholesterol levels, doctors may need to take readings over several months before deciding whether the patient needs to have her levels lowered, the researchers noted. "Doctors who are looking at women high cholesterol have to take into account the phase of the menstrual cycle they are at when they take the measurement," said study co-author Enrique F. Schisterman, chief of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

"Practically, it's easier to recognize the beginning of a cycle," he said. "So if you do it consistently at the beginning of the cycle then you will get consistent measures over time." The report is published in the current online edition of the Journal of Clinical Endocrinology and Metabolism.For the study, Schisterman's group compared levels of estrogen with cholesterol and triglyceride levels in 259 healthy women, aged 18 to 44. Most of the women, had 14 or more measurements taken over two menstrual cycles. The women also charted the phases of their cycles using at-home fertility monitors that detect hormone levels indicating ovulation. Most of the women were physically active and did not smoke.

Only 5 percent had cholesterol levels higher than 200 mg/dL, which is borderline high-risk for heart disease. But, cholesterol levels among 19.7 percent of the women reached 200 mg/dL at least once. To make cholesterol readings more consistent and reliable, measurements should be taken at the same time each month for a couple of cycles, Schisterman added. "Practically, it's easier to recognize the beginning of a cycle," he said. "So if you do it consistently at the beginning of the cycle then you will get consistent measures over time."The report is published in the current online edition of the Journal of Clinical Endocrinology and Metabolism.
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Many Girls Now Begin Puberty at Age 7, 8

The onset of puberty is continuing to drop among American girls, with many girls as young as 7 and 8 now showing the beginnings of breast development, new research shows. Rising rates of childhood obesity long linked to earlier sexual development may be to blame, experts say. In the study, more than 1,200 girls ages 6 to 8 from Cincinnati, East Harlem, N.Y. and San Francisco were examined on two occasions between 2004 and 2006 by two different female pediatricians or nurse practitioners who felt for the presence of breast tissue. "We wanted to be careful not to mistake fatty deposits for actual breast tissue," explained study author Dr. Frank Biro, director of adolescent medicine at Cincinnati's Children's Hospital.

Among 7-year-olds, about 10.4 percent of white girls, 23.4 percent of black girls and almost 15 percent of Hispanic girls had started developing breasts, the team report in the September issue of Pediatrics. Among 8-year-olds, 18.3 percent of white girls, about 43 percent of black girls and just under 31 percent of Hispanic girls showed evidence of breast development.The figures suggest a rise in early-onset puberty compared to similar studies conducted earlier. For 7-year-old white girls, especially, they show a doubling of the rate from as recently as a decade ago, Biro said. One study found that about 5 percent of white 7-year-old girls and 10.5 percent of 8-year-olds were showing breast development.

For black girls, the rate of breast development in that study was 15.4 percent for 7-year-olds and 36.6 percent for 8-year-olds. The earlier data did not include information on Hispanic girls. Experts called the findings alarming. In terms of women's health, early puberty, including younger ages at menarche, or first menstrual cycle, is associated with a higher risk of breast cancer throughout the life span, Biro said. In addition, developing early is associated with psychological and social pressures that young girls may be ill-equipped to handle, including sexual advances from older boys and men, said Dr. Marcia Herman-Giddens, adjunct professor of public health at the University of North Carolina, Chapel Hill.
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