From Medscape Medical News
Janis C. Kelly
December 30, 2009 — Opiates and other strong analgesics have long been known to numb psychological as well as physical pain, but new evidence suggests that even mild over-the-counter drugs like acetaminophen may relieve psychological discomfort, such as the stress of social rejection.
A research team led by psychologist C. Nathan DeWall, PhD, from the University of Kentucky College of Arts and Sciences, Department of Psychology, Lexington, examined the overlap between neural and psychological pain by randomly assigning healthy volunteers to 3 weeks of either daily acetaminophen or placebo, then comparing self-reports of social pain.
In a second study, the researchers used functional magnetic resonance imaging in an attempt to correlate changes in brain activity in regions believed to be associated with responses to social rejection with subjects' experiences of social pain.
"The idea that a drug designed to alleviate physical pain should reduce the pain of social rejection seemed simple and straightforward based on what we know about neural overlap between social and physical pain systems. To my surprise, I couldn't find anyone who had ever tested this idea," Dr. DeWall said.
He described "social pain" as "a painful affective response to a perceived threat to social belonging. Social rejection is one example of a socially painful event."
The research is due to be published in an upcoming edition of Psychological Science.
Hurt Feelings Measured
The first experiment included 62 healthy volunteers randomly assigned to 1000 mg/day of either acetaminophen or placebo. Each evening, participants used a version of the Hurt Feelings Scale to report how much social pain they experienced that day.
As expected, hurt feelings decreased significantly over time among participants who took acetaminophen (P < .05), but they were unchanged in the placebo group, the researchers report.
"These data provide some of the first evidence that reducing physical pain can reduce the pain of social rejection. They add to our understanding of how seemingly different types of painful experiences are processed through the same neurobiological systems," Dr. DeWall told Medscape Psychiatry.
In the second experiment, the acetaminophen dose was doubled to 2000 mg/day in an attempt to compensate for the lower statistical power associated with the smaller groups (10 participants randomly assigned to acetaminophen, 15 participants randomly assigned to placebo).
After 3 weeks of taking the pills, the subjects participated in a computer game rigged to create feelings of social rejection.
Functional magnetic resonance imaging findings showed that the acetaminophen group had significantly less neural activity than the placebo group during the game in brain regions associated with the distress of social pain and with the affective component of physical pain (the dorsal anterior cingulate cortex and anterior insula).
However, the acetaminophen and control groups "reported equal levels of social distress in response to the exclusion episode," the researchers report.
Potential to Reduce Violent Behavior?
Dr. DeWall said that despite the drug's lack of effect on the experience of social distress, the researchers concluded that acetaminophen reduced the pain of social rejection at the neural level.
The data "suggest that at least temporary mitigation of social pain–related distress may be achieved by means of an over-the-counter painkiller that is normally used for physical aches and pains."
The investigators further suggest that acetaminophen may prevent violent behavior, as "many studies have shown that being rejected can trigger aggressive and antisocial behavior, which could lead to further complications in social life.... If acetaminophen reduces the distress of rejection, the antisocial behavioral consequences of rejection may be reduced as well."
"This research has the potential to change how scientists and laypersons understand physical and social pain. Social pain, such as chronic loneliness, damages health as much as smoking and obesity. We hope our findings can pave the way for interventions designed to reduce the pain of social rejection," said Dr. DeWall.
Kudos
Asked by Medscape Psychiatry to comment on the study, Bruce G. Charlton, MD, applauded the investigators' research efforts.
"It is particularly difficult to get research funding to study old, cheap, unpatented, over-the-counter drugs, so I congratulate the authors on doing this," he said.
Dr. Charlton, who is editor-in-chief of Medical Hypotheses and professor of theoretical medicine at the University of Buckingham, United Kingdom, agreed that different sorts of pain are often related, so there is good reason to assume that acetaminophen or paracetamol may benefit those who suffer any type of pain of unpleasant feelings, including some types of depression.
However, he noted that the same effect would likely apply to aspirin, nonsteroidal anti-inflammatory drugs, and opiates, "about which there is more evidence," he said.
Alternative Interpretation
Magne Arve Flaten, MD, from the department of clinical research at University Hospital of North Norway, Tromso, also commented on the study for Medscape Psychiatry. Dr. Flaten, who recently published a study of cognitive and emotional factors in placebo analgesia, said that alternative interpretations of the data are possible.
"The authors seem to think that rejection induces 'social pain,' but it would probably, in my view, be more correct to say that both pain and social rejection are associated with unpleasantness and other negative emotions.
"Social pain is not pain as we ordinarily think of it, but it shares some of the emotional aspects that pain has, and aspects that probably other negative emotions also have," said Dr. Flaten.
He noted that the investigators' first experiment showed that acetaminophen reduced "hurt feelings," but that the effects, although significant, "seem small." He suspects that the researchers' inability to replicate the psychological effect in the second experiment may have been a result of lack of power because of the small sample size.
"I do not think this research tells us anything about pain, since pain, in a normal sense of the word, was not investigated in these experiments. The research tells us that acetaminophen could reduce some of the negative emotional consequences of social rejection, which is very interesting," Dr. Flaten said.
The study was funded by the National Institute of Mental Health and the Gulf Atlantic Group Incorporated. Dr. DeWall, Dr. Flaten, and Dr. Charlton have disclosed no relevant financial relationships.
Psychol Sci (in press).
note: acetaminophen = paracetamol or panadol
Wednesday, December 30, 2009
Saturday, December 26, 2009
ACP Issues Guidelines for Treatment of Erectile Dysfunction
From MedscapeCME Clinical Briefs
News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD
October 21, 2009 — The American College of Physicians (ACP) has issued recommendations for the treatment of erectile dysfunction (ED), defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. Evaluation and consideration of treatment are indicated when ED persists for at least 3 months.
The new clinical practice guidelines, which are published early release in the October 20 issue of the Annals of Internal Medicine, strongly urge clinicians to begin therapy with an oral phosphodiesterase type 5 (PDE-5) inhibitor in men who seek treatment of ED, unless they are receiving nitrate therapy or have another contraindication to use of PDE-5 inhibitors.
"The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials," lead author Amir Qaseem, MD, PhD, MHA, FACP, senior medical associate at the ACP, said in a news release.
Therefore, the guideline recommends that physicians decide on a specific PDE-5 inhibitor to prescribe based on individual patient preferences, taking into account convenience and ease of use, medication costs, and safety and adverse effects profile. Available PDE-5 inhibitors include sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil.
Because available evidence is inconclusive about the efficacy of hormonal therapy for ED in patients with low testosterone levels, the ACP does not recommend for or against routine hormonal blood tests or treatment in patients with ED. Measurement of hormone levels may be appropriate in specific patients.
Clinicians should consider the presence or absence of symptoms of hormonal dysfunction, such as decreased libido, premature ejaculation, or fatigue, and of physical findings such as testicular or muscle atrophy, when considering whether to measure hormone levels in individual patients.
Risk factors for ED include advanced age, diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism. Worldwide prevalence of ED exceeded 152 million in 1995, and with the graying of the population, it is estimated that it will be approximately 322 million by the year 2025.
The accompanying review of evidence included an analysis of information from 130 randomized controlled trials of oral PDE-5 inhibitors used for ED as monotherapy or in combination. The study authors identified these trials by searching English-language publications in MEDLINE (from 1966 - May 2007), EMBASE (from 1980 - week 22 of 2007), the Cochrane Central Register of Controlled Trials (second quarter of 2007), PsycINFO (from 1985 - June 2007), AMED (from 1985 - June 2007), and SCOPUS (in 2006). The investigators further updated this search by searching for articles in MEDLINE and EMBASE published between May 2007 and April 2009.
Regardless of the specific cause of ED, such as diabetes, depression, or prostate cancer, or baseline severity, treatment with a PDE-5 inhibitor was associated with statistically significant and clinically meaningful improvements in sexual intercourse and in erectile function. For sildenafil and vardenafil, improvement in erectile functioning was related to higher doses, but this was not true for tadalafil. Higher doses were also linked to a higher risk for adverse effects.
The evidence review also showed a relatively good tolerability profile of PDE-5 inhibitors. Adverse effects were mostly mild or moderate, including headaches, flushing, dyspepsia, and rhinorrhea. Less common adverse effects were visual disturbances, myalgia, nausea, diarrhea, vomiting, dizziness, and chest pain.
Although trials reviewed as part of the evidence base for this guideline did not report priapism, this adverse effect was reported infrequently during postmarketing surveillance.
Various PDE-5 inhibitors did not differ significantly in the incidence of adverse events. There was high-quality evidence that men treated with a PDE-5 inhibitor are more likely to have at least 1 adverse event vs placebo. The incidence for more serious adverse events was less than 2%, and incidence did not differ between PDE-5 inhibitors and placebo.
Available testosterone formulations include oral, injection, gel, patch, and cream. Evidence regarding the efficacy of hormonal therapy for ED was inconclusive because trials comparing testosterone vs placebo in hypogonadal men with ED were small, of low quality, or showed inconsistent effects on erectile function.
"The evidence regarding the incidence of adverse events was limited and inconclusive, and more high-quality head-to-head trials are needed to explore differences in adverse events, especially severe adverse events," the guidelines authors write. "The evidence regarding the utility of routine hormonal blood tests was inconclusive given the limited number of studies and various methodological issues and needs to be further developed."
Specific recommendations in this clinical practice guideline, and their accompanying level of evidence rating, are as follows:
The ACP recommends that clinicians begin treatment with a PDE-5 inhibitor in men who seek treatment of ED and who have no contraindication to use of PDE-5 inhibitors (grade: strong recommendation; high-quality evidence).
The ACP recommends that clinicians choose a specific PDE-5 inhibitor based on the individual preferences of men with ED, considering ease of use, cost of medication, and adverse effects profile (grade: weak recommendation; low-quality evidence).
The ACP does not recommend for or against routine use of hormonal blood tests or hormonal therapy for patients with ED (grade: insufficient evidence to determine net benefits and harms).
Financial support for the development of this guideline was provided exclusively from the ACP operating budget. The recommendations are not intended to represent an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. Some of the guidelines authors have disclosed various financial relationships with Bristol-Myers Squibb, the Centers for Disease Control and Prevention, Novo Nordisk, Merck Vaccines, Boehringer Ingelheim, Wyeth, Sanofi Pasteur, Pfizer, and/or Up-to-Date.
Ann Intern Med. Published online October 20, 2009.
Clinical Context
ED is one of the most common medical conditions among men, occurring in approximately half of subjects of 1 study of men between the ages of 40 and 70 years. Multiple chronic diseases are associated with a higher risk for ED, and the worldwide prevalence of ED is expected to be 322 million by the year 2025. The annual cost of treatment of ED could reach $15 billion in the United States alone if all men with ED sought care.
Given the widespread prevalence of ED, evidence-based care is critically important to improve outcomes and control costs. The current guidelines provide recommendations from the ACP regarding the evaluation and management of ED.
News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD
October 21, 2009 — The American College of Physicians (ACP) has issued recommendations for the treatment of erectile dysfunction (ED), defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. Evaluation and consideration of treatment are indicated when ED persists for at least 3 months.
The new clinical practice guidelines, which are published early release in the October 20 issue of the Annals of Internal Medicine, strongly urge clinicians to begin therapy with an oral phosphodiesterase type 5 (PDE-5) inhibitor in men who seek treatment of ED, unless they are receiving nitrate therapy or have another contraindication to use of PDE-5 inhibitors.
"The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials," lead author Amir Qaseem, MD, PhD, MHA, FACP, senior medical associate at the ACP, said in a news release.
Therefore, the guideline recommends that physicians decide on a specific PDE-5 inhibitor to prescribe based on individual patient preferences, taking into account convenience and ease of use, medication costs, and safety and adverse effects profile. Available PDE-5 inhibitors include sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil.
Because available evidence is inconclusive about the efficacy of hormonal therapy for ED in patients with low testosterone levels, the ACP does not recommend for or against routine hormonal blood tests or treatment in patients with ED. Measurement of hormone levels may be appropriate in specific patients.
Clinicians should consider the presence or absence of symptoms of hormonal dysfunction, such as decreased libido, premature ejaculation, or fatigue, and of physical findings such as testicular or muscle atrophy, when considering whether to measure hormone levels in individual patients.
Risk factors for ED include advanced age, diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism. Worldwide prevalence of ED exceeded 152 million in 1995, and with the graying of the population, it is estimated that it will be approximately 322 million by the year 2025.
The accompanying review of evidence included an analysis of information from 130 randomized controlled trials of oral PDE-5 inhibitors used for ED as monotherapy or in combination. The study authors identified these trials by searching English-language publications in MEDLINE (from 1966 - May 2007), EMBASE (from 1980 - week 22 of 2007), the Cochrane Central Register of Controlled Trials (second quarter of 2007), PsycINFO (from 1985 - June 2007), AMED (from 1985 - June 2007), and SCOPUS (in 2006). The investigators further updated this search by searching for articles in MEDLINE and EMBASE published between May 2007 and April 2009.
Regardless of the specific cause of ED, such as diabetes, depression, or prostate cancer, or baseline severity, treatment with a PDE-5 inhibitor was associated with statistically significant and clinically meaningful improvements in sexual intercourse and in erectile function. For sildenafil and vardenafil, improvement in erectile functioning was related to higher doses, but this was not true for tadalafil. Higher doses were also linked to a higher risk for adverse effects.
The evidence review also showed a relatively good tolerability profile of PDE-5 inhibitors. Adverse effects were mostly mild or moderate, including headaches, flushing, dyspepsia, and rhinorrhea. Less common adverse effects were visual disturbances, myalgia, nausea, diarrhea, vomiting, dizziness, and chest pain.
Although trials reviewed as part of the evidence base for this guideline did not report priapism, this adverse effect was reported infrequently during postmarketing surveillance.
Various PDE-5 inhibitors did not differ significantly in the incidence of adverse events. There was high-quality evidence that men treated with a PDE-5 inhibitor are more likely to have at least 1 adverse event vs placebo. The incidence for more serious adverse events was less than 2%, and incidence did not differ between PDE-5 inhibitors and placebo.
Available testosterone formulations include oral, injection, gel, patch, and cream. Evidence regarding the efficacy of hormonal therapy for ED was inconclusive because trials comparing testosterone vs placebo in hypogonadal men with ED were small, of low quality, or showed inconsistent effects on erectile function.
"The evidence regarding the incidence of adverse events was limited and inconclusive, and more high-quality head-to-head trials are needed to explore differences in adverse events, especially severe adverse events," the guidelines authors write. "The evidence regarding the utility of routine hormonal blood tests was inconclusive given the limited number of studies and various methodological issues and needs to be further developed."
Specific recommendations in this clinical practice guideline, and their accompanying level of evidence rating, are as follows:
The ACP recommends that clinicians begin treatment with a PDE-5 inhibitor in men who seek treatment of ED and who have no contraindication to use of PDE-5 inhibitors (grade: strong recommendation; high-quality evidence).
The ACP recommends that clinicians choose a specific PDE-5 inhibitor based on the individual preferences of men with ED, considering ease of use, cost of medication, and adverse effects profile (grade: weak recommendation; low-quality evidence).
The ACP does not recommend for or against routine use of hormonal blood tests or hormonal therapy for patients with ED (grade: insufficient evidence to determine net benefits and harms).
Financial support for the development of this guideline was provided exclusively from the ACP operating budget. The recommendations are not intended to represent an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. Some of the guidelines authors have disclosed various financial relationships with Bristol-Myers Squibb, the Centers for Disease Control and Prevention, Novo Nordisk, Merck Vaccines, Boehringer Ingelheim, Wyeth, Sanofi Pasteur, Pfizer, and/or Up-to-Date.
Ann Intern Med. Published online October 20, 2009.
Clinical Context
ED is one of the most common medical conditions among men, occurring in approximately half of subjects of 1 study of men between the ages of 40 and 70 years. Multiple chronic diseases are associated with a higher risk for ED, and the worldwide prevalence of ED is expected to be 322 million by the year 2025. The annual cost of treatment of ED could reach $15 billion in the United States alone if all men with ED sought care.
Given the widespread prevalence of ED, evidence-based care is critically important to improve outcomes and control costs. The current guidelines provide recommendations from the ACP regarding the evaluation and management of ED.
Depression, Anxiety Major Factors in Neck Pain
From Reuters Health Information
News Author: Megan Rauscher
CME Author: Désirée Lie, MD, MSEd
February 13, 2009 — Psychosocial distress, specifically depression and anxiety, are closely linked to recurrent or persistent neck pain, clinicians from Germany report in the journal BMC Musculoskeletal Disorders posted online January 26.
"For successful long term results, it is essential to consider psychosocial factors and to include them into therapeutic strategies" for neck pain, Dr. Martin Scherer from the University of Gottingen noted in comments to Reuters Health.
The study involved 448 patients from a general practice setting in Germany with at least one episode of neck pain between March 2005 and April 2006. These patients completed a comprehensive questionnaire including the Neck Pain and Disability Scale and the Hospital Anxiety and Depression Scale (HADS).
Forty-four percent of the study subjects were 50 years or older and nearly 80% were female. About one third had basic education and a similar proportion was unemployed or retired. More than half of the subjects (56%) reported neck pain on the day they completed the questionnaire and 26% had constant neck pain during the past year.
Based on their HADS response, 20% of subjects were classified as having depressive mood, and 28% reported being anxious.
According to Dr. Scherer and colleagues, in both crude and adjusted regression analyses, depression and anxiety were highly significantly correlated with increasing levels of neck pain.
When levels of depression and anxiety were classified by quartiles of the Neck Pain and Disability Scale, subjects with depressive mood or anxiety were highly likely to be in the group with the highest levels of neck pain.
The results, the researchers say, suggest that the degree of neck pain is related to the degree of psychological distress. "To put it in other words," they write, "the higher the pain level in patients with cervical problems, the more attention should be paid to psychosocial distress as an additional burden."
Dr. Scherer and colleagues also note that their findings are consistent with a recent systematic review, which investigated determinants and risk factors for neck pain in the general population and found "consistent evidence only for psychological health factors and for other health problems like musculoskeletal complaints and poorer self-rated health."
"Findings of our study," Dr. Scherer told Reuters Health, "underline that neck pain therapies are more likely to be efficient if care for chronic patients is not only symptom-oriented but focuses on psychosocial factors that have been proved to be central for development and prognosis of neck pain."
BMC Musculoskelet Disord. Published online January 26, 2009.
Reuters Health Information 2009. © 2009 Reuters Ltd.
Clinical Context
Neck pain is highly prevalent, with two thirds of the adult population affected during their lifetime. However, only 10% of neck pain recurs or is persistent. Although many therapeutic approaches have been advocated, recommendations for management do not integrate all knowledge about psychosocial factors as prognostic factors to determine the outcomes and course of neck pain.
This is a cross-sectional survey of patients with neck pain seen in a general-practice setting to examine lifestyle and psychosocial factors associated with neck pain.
News Author: Megan Rauscher
CME Author: Désirée Lie, MD, MSEd
February 13, 2009 — Psychosocial distress, specifically depression and anxiety, are closely linked to recurrent or persistent neck pain, clinicians from Germany report in the journal BMC Musculoskeletal Disorders posted online January 26.
"For successful long term results, it is essential to consider psychosocial factors and to include them into therapeutic strategies" for neck pain, Dr. Martin Scherer from the University of Gottingen noted in comments to Reuters Health.
The study involved 448 patients from a general practice setting in Germany with at least one episode of neck pain between March 2005 and April 2006. These patients completed a comprehensive questionnaire including the Neck Pain and Disability Scale and the Hospital Anxiety and Depression Scale (HADS).
Forty-four percent of the study subjects were 50 years or older and nearly 80% were female. About one third had basic education and a similar proportion was unemployed or retired. More than half of the subjects (56%) reported neck pain on the day they completed the questionnaire and 26% had constant neck pain during the past year.
Based on their HADS response, 20% of subjects were classified as having depressive mood, and 28% reported being anxious.
According to Dr. Scherer and colleagues, in both crude and adjusted regression analyses, depression and anxiety were highly significantly correlated with increasing levels of neck pain.
When levels of depression and anxiety were classified by quartiles of the Neck Pain and Disability Scale, subjects with depressive mood or anxiety were highly likely to be in the group with the highest levels of neck pain.
The results, the researchers say, suggest that the degree of neck pain is related to the degree of psychological distress. "To put it in other words," they write, "the higher the pain level in patients with cervical problems, the more attention should be paid to psychosocial distress as an additional burden."
Dr. Scherer and colleagues also note that their findings are consistent with a recent systematic review, which investigated determinants and risk factors for neck pain in the general population and found "consistent evidence only for psychological health factors and for other health problems like musculoskeletal complaints and poorer self-rated health."
"Findings of our study," Dr. Scherer told Reuters Health, "underline that neck pain therapies are more likely to be efficient if care for chronic patients is not only symptom-oriented but focuses on psychosocial factors that have been proved to be central for development and prognosis of neck pain."
BMC Musculoskelet Disord. Published online January 26, 2009.
Reuters Health Information 2009. © 2009 Reuters Ltd.
Clinical Context
Neck pain is highly prevalent, with two thirds of the adult population affected during their lifetime. However, only 10% of neck pain recurs or is persistent. Although many therapeutic approaches have been advocated, recommendations for management do not integrate all knowledge about psychosocial factors as prognostic factors to determine the outcomes and course of neck pain.
This is a cross-sectional survey of patients with neck pain seen in a general-practice setting to examine lifestyle and psychosocial factors associated with neck pain.
Stop Using Tamiflu for Healthy Flu Patients
Mark Reiter, MD, Emergency Medicine, Dec 14, 2009
Emergency Physician, Bethlehem, PA
Last week, The Cochrane Review, concluded that the existing literature (they looked at 5 higher quality studies out of 20 studies of antivirals for influenza) did not support the use of neuramidase inhibitors for healthy patients for treatment of influenza. They could not detect a statistically significant clinical impact, and did not an increase in side effects, particularly nausea. (www.medscape.com/viewarticle/713604) Many physicians had come to a similar conclusion, but Cochrane's findings certainly adds significant weight.
A few days ago, the World Health Organization endorsed The Cochrane Review's findings, and recommends that antivirals only be used in influenza at high risk for complications. (www.medscape.com/viewarticle/713775) The CDC has been offering similar advice for several months.
In the week ending October 31st, 587,960 prescriptions for antiviral flu medicines were filled in the U.S. (98% for Tamiflu), according to the LA Times.
Do we really think we are helping people? Are we hurting people? Are we trying to make satisfied patients what they think they want? Are we trying to avoid complaints or lawsuits? We need to do better....
Emergency Physician, Bethlehem, PA
Last week, The Cochrane Review, concluded that the existing literature (they looked at 5 higher quality studies out of 20 studies of antivirals for influenza) did not support the use of neuramidase inhibitors for healthy patients for treatment of influenza. They could not detect a statistically significant clinical impact, and did not an increase in side effects, particularly nausea. (www.medscape.com/viewarticle/713604) Many physicians had come to a similar conclusion, but Cochrane's findings certainly adds significant weight.
A few days ago, the World Health Organization endorsed The Cochrane Review's findings, and recommends that antivirals only be used in influenza at high risk for complications. (www.medscape.com/viewarticle/713775) The CDC has been offering similar advice for several months.
In the week ending October 31st, 587,960 prescriptions for antiviral flu medicines were filled in the U.S. (98% for Tamiflu), according to the LA Times.
Do we really think we are helping people? Are we hurting people? Are we trying to make satisfied patients what they think they want? Are we trying to avoid complaints or lawsuits? We need to do better....
Wednesday, December 23, 2009
Ten Minor Steps To Develop Your Wellbeing
By: Jayden Shemayah
Countless of us make wellbeing-related resolutions, such as to lose weight, to stop smoking or sign up for the neighborhood fitness center. While it is common to set excessive goals, trainers say that making lesser goals might do more for our health.
"Lesser steps are reachable and are easier to squeeze into your daily routine," says James O. Hill, Ph.D., Director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. "They are less overpowering than a big, rapid conversion."
Here are 10 Steps to try:
1. Stop gaining weight. Even if you acquire only a pound or two each year, the extra weight adds up rapidly.
2. Walk more. Use a pedometer to add up your daily steps; after that add 2,000 extra steps into your day, the equivalent of one additional mile. Keep adding steps, 1,000 to 2,000 each month or so, until you take 10,000 steps on most days.
3. Eat breakfast. Breakfast eaters tend to have healthier diets and weigh less too. For a filling and nutrition-packed breakfast, top Whole Grain Total® with fresh fruit slices and low-fat or fat-free milk.
4. Replace three grain servings each day to whole grain. If you're like the average American, you eat fewer than one whole grain serving daily.
5. Have a minimum of one healthy green salad per day. Eating a salad (with low-fat or fat-free dressing) is filling and may help you eat a smaller amount during the meal. It also counts toward your five daily cups of fruits and vegetables.
6. Eliminate Fat. Fat has a lot of calories, and calories are a significant factor in weight loss. Purchase lean meats, eat poultry skinless, switch over to lower-fat cheeses, invest in a nonstick pan with just a dab of oil or butter.
7. Consider calcium by eating' two or three daily servings of low-fat or fat-free milk or yogurt. Dairy calcium is healthy for bones and may well also help you drop weight.
8. Downsize. If the package is small, the serving size will be smaller as well.
9. Aim to drop just 5 to 10 percent of your present weight. The benefits to losing weight are great-lower blood pressure, blood sugar, cholesterol and triglycerides.
10. Keep track of your eating. Jot down everything you eat over the next couple of days and be on the lookout for problem spots. Often, just writing things down can help you consume a reduced amount.
For more information on how to lose fat, gain muscle, and to find out how to get abs check out this site - How To Get A Six Pack Fast
Smart Articles @ http://www.articlebrain.com
Countless of us make wellbeing-related resolutions, such as to lose weight, to stop smoking or sign up for the neighborhood fitness center. While it is common to set excessive goals, trainers say that making lesser goals might do more for our health.
"Lesser steps are reachable and are easier to squeeze into your daily routine," says James O. Hill, Ph.D., Director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. "They are less overpowering than a big, rapid conversion."
Here are 10 Steps to try:
1. Stop gaining weight. Even if you acquire only a pound or two each year, the extra weight adds up rapidly.
2. Walk more. Use a pedometer to add up your daily steps; after that add 2,000 extra steps into your day, the equivalent of one additional mile. Keep adding steps, 1,000 to 2,000 each month or so, until you take 10,000 steps on most days.
3. Eat breakfast. Breakfast eaters tend to have healthier diets and weigh less too. For a filling and nutrition-packed breakfast, top Whole Grain Total® with fresh fruit slices and low-fat or fat-free milk.
4. Replace three grain servings each day to whole grain. If you're like the average American, you eat fewer than one whole grain serving daily.
5. Have a minimum of one healthy green salad per day. Eating a salad (with low-fat or fat-free dressing) is filling and may help you eat a smaller amount during the meal. It also counts toward your five daily cups of fruits and vegetables.
6. Eliminate Fat. Fat has a lot of calories, and calories are a significant factor in weight loss. Purchase lean meats, eat poultry skinless, switch over to lower-fat cheeses, invest in a nonstick pan with just a dab of oil or butter.
7. Consider calcium by eating' two or three daily servings of low-fat or fat-free milk or yogurt. Dairy calcium is healthy for bones and may well also help you drop weight.
8. Downsize. If the package is small, the serving size will be smaller as well.
9. Aim to drop just 5 to 10 percent of your present weight. The benefits to losing weight are great-lower blood pressure, blood sugar, cholesterol and triglycerides.
10. Keep track of your eating. Jot down everything you eat over the next couple of days and be on the lookout for problem spots. Often, just writing things down can help you consume a reduced amount.
For more information on how to lose fat, gain muscle, and to find out how to get abs check out this site - How To Get A Six Pack Fast
Smart Articles @ http://www.articlebrain.com
Friday, December 18, 2009
Thousands of New Cancers Predicted Due to Increased Use of CT
From Medscape Medical News
Roxanne Nelson
December 17, 2009 — Computed tomography (CT) scans are widely used and are an invaluable tool for medical imaging. However, the possible overuse of CT scans and the variability in radiation doses might subsequently lead to thousands of cases of cancer, according to findings from 2 new studies published in the December 14/28 issue of the Archives of Internal Medicine.
In the first study, researchers found that radiation doses from common CT procedures are higher and more variable than what is typically cited. For example, the authors note that the median effective dose of an abdomen and pelvis CT scan is often cited as 8 to 10 mSv, but they found that the median dose of this type of scan was actually 66% higher, and the median dose of a multiphase CT scan of the abdomen and pelvis was nearly 4 times higher.
The authors also found a considerable range in doses within and across the institutions included in their study, with a mean 13-fold variation between the highest and lowest dose for each CT type studied.
In the second study, researchers estimated future cancer risks from current CT scan use in the United States, and projected that 29,000 future cancers will be directly attributable to CT scans that were performed in 2007. It is expected that the majority of these projected cancers will be caused by scans of the abdomen and pelvis (n = 14,000), chest (n = 4100), and head (n = 4000), and by CT coronary angiography (n = 2700).
What is becoming clear . . . is that the large doses of radiation from such scans will translate, statistically, into additional cancers.
More than 19,500 CT scans are performed every day in the United States; these expose each patient to the equivalent of 30 to 442 chest radiographs per scan, notes Rita F. Redberg, MD, MSc, professor of medicine at the University of California, San Francisco School of Medicine and editor of the Archives of Internal Medicine, in an accompanying editorial.
However, there is a question of benefit — whether these scans will lead to "demonstrable benefits through improvements in longevity or quality of life are hotly debated," she writes. "What is becoming clear, however, is that the large doses of radiation from such scans will translate, statistically, into additional cancers."
"We need to do something now, not wait 10 or 20 years to see the effects. It's not like radiation exposure can be undone after we find out that it does cause cancer," Dr. Redberg told Medscape Oncology.
Roxanne Nelson
December 17, 2009 — Computed tomography (CT) scans are widely used and are an invaluable tool for medical imaging. However, the possible overuse of CT scans and the variability in radiation doses might subsequently lead to thousands of cases of cancer, according to findings from 2 new studies published in the December 14/28 issue of the Archives of Internal Medicine.
In the first study, researchers found that radiation doses from common CT procedures are higher and more variable than what is typically cited. For example, the authors note that the median effective dose of an abdomen and pelvis CT scan is often cited as 8 to 10 mSv, but they found that the median dose of this type of scan was actually 66% higher, and the median dose of a multiphase CT scan of the abdomen and pelvis was nearly 4 times higher.
The authors also found a considerable range in doses within and across the institutions included in their study, with a mean 13-fold variation between the highest and lowest dose for each CT type studied.
In the second study, researchers estimated future cancer risks from current CT scan use in the United States, and projected that 29,000 future cancers will be directly attributable to CT scans that were performed in 2007. It is expected that the majority of these projected cancers will be caused by scans of the abdomen and pelvis (n = 14,000), chest (n = 4100), and head (n = 4000), and by CT coronary angiography (n = 2700).
What is becoming clear . . . is that the large doses of radiation from such scans will translate, statistically, into additional cancers.
More than 19,500 CT scans are performed every day in the United States; these expose each patient to the equivalent of 30 to 442 chest radiographs per scan, notes Rita F. Redberg, MD, MSc, professor of medicine at the University of California, San Francisco School of Medicine and editor of the Archives of Internal Medicine, in an accompanying editorial.
However, there is a question of benefit — whether these scans will lead to "demonstrable benefits through improvements in longevity or quality of life are hotly debated," she writes. "What is becoming clear, however, is that the large doses of radiation from such scans will translate, statistically, into additional cancers."
"We need to do something now, not wait 10 or 20 years to see the effects. It's not like radiation exposure can be undone after we find out that it does cause cancer," Dr. Redberg told Medscape Oncology.
Tuesday, December 1, 2009
Brain Care 101
Jan 11, 2008
It is Not Only Cars That Deserve Good Maintenance:
By: Alvaro Fernandez
Last week, the US Car Care Council released a list of tips on how to take care of your car and “save big money at the pump in 2008.”
You may not have paid much attention to this announcement. Yes, it’s important to save gas these days; but, it’s not big news that good maintenance habits will improve the performance of a car, and extend its life.
If we can all agree on the importance of maintaining our cars that get us around town, what about maintaining our brains sitting behind the wheel?
A spate of recent news coverage on brain fitness and “brain training” has missed an important constituency: younger people. Recent advancements in brain science have as tremendous implications for teenagers and adults of all ages as they do for seniors.
In a recent conversation with neuroscientist Yaakov Stern of Columbia University, he related how surprised he was when, years ago, a reporter from Seventeen magazine requested an interview. The reporter told Dr. Stern that he wanted to write an article to motivate kids to stay in school and not to drop out, in order to start building their Cognitive Reserve early and age more gracefully.
What is the Cognitive Reserve?
Emerging research since the 90s from the past decade shows that individuals who lead mentally stimulating lives, through their education, their jobs, and also their hobbies, build a “Cognitive Reserve” in their brains. Only a few weeks ago another study reinforced the value of intellectualy demanding jobs.
Stimulating the brain can literally generate new neurons and strengthen their connections which results in better brain performance and in having a lower risk of developing Alzheimer’s symptoms. Studies suggest that people who exercise their mental muscles throughout their lives have a 35-40% less risk of manifesting Alzheimer’s.
As astounding as these insights may be, most Americans still devote more time to changing the oil, taking a car to a mechanic, or washing it, than thinking about how to maintain, if not improve, their brain performance.
Further, better brain scanning techniques like fMRI (glossary) are allowing scientists to investigate healthy live brains for the first time in history. Two of the most important findings from this research are that our brains are plastic (meaning they not only create new neurons but also can change their structure) throughout a lifetime and that frontal lobes are the most plastic area. Frontal lobes, the part of our brains right behind the forehead, controls “executive functions” — which determine our ability to pay attention, plan for the future and direct behavior toward achieving goals. They are critical for adapting to new situations. We exercise them best by learning and mastering new skills.
This part of the brain is delicate: our frontal lobes wait until our mid to late 20s to fully mature. They are also the first part of our brain to start to decline, usually by middle age.
In my view, not enough young and middle-aged people are benefiting from this emerging research, since it has been perceived as something “for seniors.” Granted, there are still many unknowns in the world of brain fitness and cognitive training, we need more research, better assessments and tools. But, this does not mean we cannot start caring for our brains today.
Recent studies have shown a tremendous variability in how well people age and how, to a large extent, our actions influence our rate of brain improvement and/or decline. The earlier we begin the better. And it is never too late.
What can we do to maintain our brain, especially the frontal lobes? Focus on four pillars of brain health: physical exercise, a balanced diet, stress management, and brain exercise.
Stress management is important since stress has been shown to actually kill neurons and reduce the rate of creation of new ones.
Brain exercises range from low-tech (i.e. meditation, mastering new complex skills, lifelong learning and engagement) to high-tech (i.e. using the growing number of brain fitness software programs).
I know, this is starting to sound like those lists we all know are good for us but we actually don’t do. Let me make it easier by proposing a new New Year Resolution for 2008: every time you wash your car or have it washed in 2008, ask yourself, “What have I done lately to maintain my brain?”
It is Not Only Cars That Deserve Good Maintenance:
By: Alvaro Fernandez
Last week, the US Car Care Council released a list of tips on how to take care of your car and “save big money at the pump in 2008.”
You may not have paid much attention to this announcement. Yes, it’s important to save gas these days; but, it’s not big news that good maintenance habits will improve the performance of a car, and extend its life.
If we can all agree on the importance of maintaining our cars that get us around town, what about maintaining our brains sitting behind the wheel?
A spate of recent news coverage on brain fitness and “brain training” has missed an important constituency: younger people. Recent advancements in brain science have as tremendous implications for teenagers and adults of all ages as they do for seniors.
In a recent conversation with neuroscientist Yaakov Stern of Columbia University, he related how surprised he was when, years ago, a reporter from Seventeen magazine requested an interview. The reporter told Dr. Stern that he wanted to write an article to motivate kids to stay in school and not to drop out, in order to start building their Cognitive Reserve early and age more gracefully.
What is the Cognitive Reserve?
Emerging research since the 90s from the past decade shows that individuals who lead mentally stimulating lives, through their education, their jobs, and also their hobbies, build a “Cognitive Reserve” in their brains. Only a few weeks ago another study reinforced the value of intellectualy demanding jobs.
Stimulating the brain can literally generate new neurons and strengthen their connections which results in better brain performance and in having a lower risk of developing Alzheimer’s symptoms. Studies suggest that people who exercise their mental muscles throughout their lives have a 35-40% less risk of manifesting Alzheimer’s.
As astounding as these insights may be, most Americans still devote more time to changing the oil, taking a car to a mechanic, or washing it, than thinking about how to maintain, if not improve, their brain performance.
Further, better brain scanning techniques like fMRI (glossary) are allowing scientists to investigate healthy live brains for the first time in history. Two of the most important findings from this research are that our brains are plastic (meaning they not only create new neurons but also can change their structure) throughout a lifetime and that frontal lobes are the most plastic area. Frontal lobes, the part of our brains right behind the forehead, controls “executive functions” — which determine our ability to pay attention, plan for the future and direct behavior toward achieving goals. They are critical for adapting to new situations. We exercise them best by learning and mastering new skills.
This part of the brain is delicate: our frontal lobes wait until our mid to late 20s to fully mature. They are also the first part of our brain to start to decline, usually by middle age.
In my view, not enough young and middle-aged people are benefiting from this emerging research, since it has been perceived as something “for seniors.” Granted, there are still many unknowns in the world of brain fitness and cognitive training, we need more research, better assessments and tools. But, this does not mean we cannot start caring for our brains today.
Recent studies have shown a tremendous variability in how well people age and how, to a large extent, our actions influence our rate of brain improvement and/or decline. The earlier we begin the better. And it is never too late.
What can we do to maintain our brain, especially the frontal lobes? Focus on four pillars of brain health: physical exercise, a balanced diet, stress management, and brain exercise.
Stress management is important since stress has been shown to actually kill neurons and reduce the rate of creation of new ones.
Brain exercises range from low-tech (i.e. meditation, mastering new complex skills, lifelong learning and engagement) to high-tech (i.e. using the growing number of brain fitness software programs).
I know, this is starting to sound like those lists we all know are good for us but we actually don’t do. Let me make it easier by proposing a new New Year Resolution for 2008: every time you wash your car or have it washed in 2008, ask yourself, “What have I done lately to maintain my brain?”
Why Smart Brains Make Stupid Decisions
Jun 20, 2008
By: Alvaro Fernandez
It happens. Often.
Why?
We just secured an interview with Ori Brafman, co-author of Sway: The Irresistible Pull of Irrational Behavior (Doubleday Business, 2008), to discuss our Dark Side (well, he calls it “different hidden forces” and “psychological undercurrents”).
While reading some reviews about his book, I particularly enjoyed finding, after the usual impressive long collection of endorsements, this “disclaimer”:
*DISCLAIMER: If you decide to buy this book because of these endorsements, you just got swayed. One of the psychological forces you’ll read about in Sway is our tendency to place a higher value on opinions from people in positions of prominence, power, or authority. (But you should still buy the book.)
Alvaro Fernandez (AF): Ori, what is SWAY? can you give us a couple quick examples?
Ori Brafman (OB): Sway is about why perfectly rational people make irrational choices. We interviewed business executives, airline pilots, doctors, and even a Supreme Court Justice to uncover the psychological forces that affect our decision-making. What was especially interesting was to find out that we all get swayed, and that these psychological forces are much more ubiquitous than we thought.
Take, for instance, the story of Jacob Van Zanten who was the head of safety for KLM. One foggy afternoon, Van Zanten took off without getting tower clearance, causing the biggest airline accident in history. Why would this man, who’s the head of safety make such an irrational choice?
Or look at the story of Harvard Business School students who paid $204 for a twenty-dollar bill.
Â
AF: Happy to have attended Stanford… Now, how did that happen?
OB: The professor set up an auction for a $20 bill. But there was a twist. The winner would get the $20 bill. But the second place bidder, would still have to honor his bid, but would get nothing. At first there are lots of bidders, but then as the bidding approaches $20 people start pulling out. Inevitably, though two people stay in. As the bidding continued to rise, the second-place person became determined to not be the sucker who pays good money for nothing in return. The amazing thing is that time after time the auction continues well past the $20 point. People are just so determined not to lose, that they keep on bidding up.
AF: Why do people get Swayed?
OB: Without realizing it, we get swept up by a host of different hidden forces. I think of it like being in a boat in the middle of the ocean. It may look like we’re standing still, but underneath the surface, undercurrents move us without us realizing it. The same thing happens with psychological undercurrents. In Sway, we look at some of the major undercurrents and explore how they intersect triggering so many different irrational behaviors. The thing is that we’re prone to psychological sways all of the time–whether we’re conducting a job interview, going out on a first date, or deciding whether to sell a stock.
AF: Let’s be practical for a minute… what can people do to Sway other people?
OB: We’re constantly engaged in a hidden dance of sorts where we sway people around us and are swayed by others. One of the most unusual studies we encountered has to do with what we call the chameleon effect. In the study, a group of men and women–who had never met each other–were told to have a short phone conversation. Now, before the conversation, each man was shown a picture of the woman he’d be talking to. Unbeknownst to the men, the pictures were fake. And half the men were shown a picture of a beautiful woman, while the other half were shown a picture of a less attractive woman. The pictures had nothing to do with how the real women looked like, and the real women had no idea that there were any pictures shown. The kicker is that the women who the men thought were pretty ended up sounding beautiful on the phone. And the women who the men thought were less attractive ended up sounding less beautiful. We take on the roles others ascribe to us. Think about that with employees or even with your kids. If we think someone is smart, there’s a good chance they’ll live up to that role.
AF: And what can people do to prevent being Swayed?
OB: The biggest step is to recognize how often we get swayed. We have a tendency to think that our decisions are rational, when in fact, different sways may have informed the decision. Once we realize that we’re prone to get swayed, the second step is figuring out specific strategies to counter the sway.
It ranges from taking a long-term perspective to using empirical models for job interviews.
AF: For example?
OB: We have a propensity to “diagnose” a job candidate from the first moment we meet him or her. We assign a diagnosis, and are unable to see things in a different light despite objective evidence to the contrary. It’s for this reason that job interviews are terrible predictors of actual performance. A much more effective approach is to conduct very structured interviews that don’t allow managers to get swayed. In these interviews, the questions are pre-scripted and focus on experience and ability rather than vague things like “what’s your biggest strength?” We call these the Joe Friday interview (just the facts…) These interviews may seem less personal, but they’re actually much more effective for actually selecting a good candidate.
AF: Ori, thank you very much for your time.
OB: My pleasure!
http://www.sharpbrains.com/blog/2008/06/20/why-smart-brains-make-stupid-decisions/
By: Alvaro Fernandez
It happens. Often.
Why?
We just secured an interview with Ori Brafman, co-author of Sway: The Irresistible Pull of Irrational Behavior (Doubleday Business, 2008), to discuss our Dark Side (well, he calls it “different hidden forces” and “psychological undercurrents”).
While reading some reviews about his book, I particularly enjoyed finding, after the usual impressive long collection of endorsements, this “disclaimer”:
*DISCLAIMER: If you decide to buy this book because of these endorsements, you just got swayed. One of the psychological forces you’ll read about in Sway is our tendency to place a higher value on opinions from people in positions of prominence, power, or authority. (But you should still buy the book.)
Alvaro Fernandez (AF): Ori, what is SWAY? can you give us a couple quick examples?
Ori Brafman (OB): Sway is about why perfectly rational people make irrational choices. We interviewed business executives, airline pilots, doctors, and even a Supreme Court Justice to uncover the psychological forces that affect our decision-making. What was especially interesting was to find out that we all get swayed, and that these psychological forces are much more ubiquitous than we thought.
Take, for instance, the story of Jacob Van Zanten who was the head of safety for KLM. One foggy afternoon, Van Zanten took off without getting tower clearance, causing the biggest airline accident in history. Why would this man, who’s the head of safety make such an irrational choice?
Or look at the story of Harvard Business School students who paid $204 for a twenty-dollar bill.
Â
AF: Happy to have attended Stanford… Now, how did that happen?
OB: The professor set up an auction for a $20 bill. But there was a twist. The winner would get the $20 bill. But the second place bidder, would still have to honor his bid, but would get nothing. At first there are lots of bidders, but then as the bidding approaches $20 people start pulling out. Inevitably, though two people stay in. As the bidding continued to rise, the second-place person became determined to not be the sucker who pays good money for nothing in return. The amazing thing is that time after time the auction continues well past the $20 point. People are just so determined not to lose, that they keep on bidding up.
AF: Why do people get Swayed?
OB: Without realizing it, we get swept up by a host of different hidden forces. I think of it like being in a boat in the middle of the ocean. It may look like we’re standing still, but underneath the surface, undercurrents move us without us realizing it. The same thing happens with psychological undercurrents. In Sway, we look at some of the major undercurrents and explore how they intersect triggering so many different irrational behaviors. The thing is that we’re prone to psychological sways all of the time–whether we’re conducting a job interview, going out on a first date, or deciding whether to sell a stock.
AF: Let’s be practical for a minute… what can people do to Sway other people?
OB: We’re constantly engaged in a hidden dance of sorts where we sway people around us and are swayed by others. One of the most unusual studies we encountered has to do with what we call the chameleon effect. In the study, a group of men and women–who had never met each other–were told to have a short phone conversation. Now, before the conversation, each man was shown a picture of the woman he’d be talking to. Unbeknownst to the men, the pictures were fake. And half the men were shown a picture of a beautiful woman, while the other half were shown a picture of a less attractive woman. The pictures had nothing to do with how the real women looked like, and the real women had no idea that there were any pictures shown. The kicker is that the women who the men thought were pretty ended up sounding beautiful on the phone. And the women who the men thought were less attractive ended up sounding less beautiful. We take on the roles others ascribe to us. Think about that with employees or even with your kids. If we think someone is smart, there’s a good chance they’ll live up to that role.
AF: And what can people do to prevent being Swayed?
OB: The biggest step is to recognize how often we get swayed. We have a tendency to think that our decisions are rational, when in fact, different sways may have informed the decision. Once we realize that we’re prone to get swayed, the second step is figuring out specific strategies to counter the sway.
It ranges from taking a long-term perspective to using empirical models for job interviews.
AF: For example?
OB: We have a propensity to “diagnose” a job candidate from the first moment we meet him or her. We assign a diagnosis, and are unable to see things in a different light despite objective evidence to the contrary. It’s for this reason that job interviews are terrible predictors of actual performance. A much more effective approach is to conduct very structured interviews that don’t allow managers to get swayed. In these interviews, the questions are pre-scripted and focus on experience and ability rather than vague things like “what’s your biggest strength?” We call these the Joe Friday interview (just the facts…) These interviews may seem less personal, but they’re actually much more effective for actually selecting a good candidate.
AF: Ori, thank you very much for your time.
OB: My pleasure!
http://www.sharpbrains.com/blog/2008/06/20/why-smart-brains-make-stupid-decisions/
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