Building Healthy Adults Starts in Childhood

From Medscape Medical News > Psychiatry Megan Brooks December 28, 2011 — Extensive evidence indicates that early childhood adversity and “toxic stress” have harmful effects on mental and physical health that can last a lifetime, warns a new technical report from the American Academy of Pediatrics (AAP). In an accompanying policy statement, the AAP advocates incorporating the growing scientific knowledge base that links childhood adversity to lifelong harm into the training of all current and future physicians. The report and policy statement were published online December 26 and will appear in the January 2012 print issue of Pediatrics. "Potentially Transformational" Drawing on multiple lines of investigation in biological, behavioral, and social sciences, the authors of the technical report present an ecobiodevelopmental (EBD) framework that illustrates how early childhood experiences and environmental influences can shape lifelong learning, behavior, and health. The authors summarize what they call “extensive evidence” linking early adversity to later impairments in learning, behavior, and physical and mental well-being. The implications of this EBD framework for the practice of medicine are “potentially transformational,” Jack P. Shonkoff, MD, director of the Center on the Developing Child at Harvard University, Boston, Massachusetts, and colleagues note in the report. It suggests that many adult diseases “should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood,” they write. In the accompanying policy statement, the AAP says, “All health care professionals should adopt the proposed EBD framework as a means of understanding the social, behavioral, and economic determinants of lifelong disparities in physical and mental health.” Pediatrics. 2012;129: Published online December 26, 2011. Report, Policy Statement

Does the Cranberry Beat Antibiotics for Recurrent UTIs?

From Medscape Internal Medicine > Medicine Matters Medicine Matters , Medscape Sandra A. Fryhofer, MD Posted: 12/22/2011 Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic? Relief for recurrent urinary tract infections (UTIs): cranberries or antibiotics? A new study in the Archives of Internal Medicine explores which approach is best. Urinary tract infections are common. About half of all women have had at least one. For those who have had at least 2 or more UTIs per year, low-dose antibiotics are often prescribed for prevention, but this can create strains -- usually Escherichia coli -- that are resistant to most antibiotics. So, is a more organic treatment, such as cranberries, preferable? Cranberries have been used as the alternative treatment of choice for UTI prevention for years. Exactly how they work isn't totally clear. Cranberries contain both fructose and Type A proanthocyanadins (PACs) that prevent bacteria from attaching to the urinary tract lining. A combined look at 2 randomized control trials found that cranberry products do work better than placebo. They reduced risk of UTI recurrence by 39%. However, unlike these studies, the one discussed in this commentary compared cranberries to an antibiotic -- trimethoprim sulfa (Bactrim®). This was a year-long, double-blind, double-dummy, randomized, noninferiority trial of more than 200 premenopausal women with recurrent UTIs. Patients received either trimethoprim sulfa, 480 mg once a day, or cranberry capsules, 500 mg twice a day. The PAC dose in the cranberries was 9.1 mg. Antibiotics were better at preventing urinary tract infections in the women. However, bacteria did become more resistant to trimethoprim sulfa as well as amoxicillin and ciprofloxacin. Increased resistance was not seen in the cranberry group. There is a caveat. Research published in the journal BMC Infectious Diseases finds that 72 mg of PACs prevent bacteria from adhering to the urinary tract lining. This is much higher than the 9.1 milligrams used in this study. Does more cranberry equal more prevention? It might be worth another study.

DHEA Hormone May Help Women Through Menopause

From Reuters Health Information By Kate Kelland LONDON (Reuters) Dec 20 - A hormone called DHEA and mostly secreted by the adrenal glands might be able to help women who are going through menopause and could also give them better sex lives, according to a preliminary study out Tuesday. Italian researchers writing in the journal of the International Menopause Society, Climacteric, said they had found the first robust evidence that low doses of DHEA can help sexual function and menopausal symptoms, suggesting it may one day become an alternative to hormone replacement therapy (HRT). But they stressed that the trial was small, so far larger studies are needed to confirm the results. "We must bear in mind that this is a pilot study with a small sample," Dr. Anna Fenton, co-editor of Climacteric, said in commentary on the work. "We can't yet say that this study means that DHEA is a viable alternative to HRT, but ... we should be looking to do larger studies to confirm these initial results." DHEA, or dehydroepiandrosterone, is a natural steroid hormone mostly made in the adrenal glands and has a variety of therapeutic uses. Sales of HRT drugs have fallen sharply since the Women's Health Initiative study in 2002 found higher rates of ovarian cancer, breast cancer and strokes in women who took the pills, and the search has since been on for alternatives. American researchers said in January that the antidepressant Lexapro, made by drugmaker Forest Laboratories, significantly cut the number and severity of hot flushes in menopausal women, and other antidepressants including GlaxoSmithKline's Paxil and the Pfizer drugs Prozac and Effexor also have been found to be effective. For this trial, a team of researchers led by Dr. Andrea Genazzani of the University of Pisa followed a group of 48 post-menopausal women with troubling symptoms. Over a year, 12 women took vitamin D and calcium, 12 took DHEA 10 mg daily, 12 took standard HRT (1 mg estradiol plus 5 mg dihydrogesterone daily), and 12 took a synthetic steroid called tibolone (2.5 mg daily) which is used to alleviate menopausal symptoms. The women's menopausal symptoms, sexual interest and activity were measured using a standard questionnaire that explores factors such as satisfaction with frequency of sex, vaginal lubrication, orgasm, and sexual partner. After 12 months, all the women on hormone replacements had improvements in menopausal symptoms, but those taking vitamin D and calcium did not show any significant improvement. At the start of the trial, all groups had similar sexual activity, but after the year, those taking calcium and vitamin D scored an average of 34.9 on the questionnaire scale, while those taking DHEA had a score of 48.6, showing that those on DHEA had more sexual interest and activity. The results for the HRT group were similar, and both the HRT and DHEA groups showed a higher level of sexual intercourse in comparison to the control group, the researchers said. Dr. Genazzani said the results showed DHEA has potential, especially for those women who may have problems in taking more conventional HRT. "But this is a small study, a proof of concept," she cautioned. "What we need to do now is to look at a larger study, to confirm that these initial results are valid," she added. SOURCE: http://bit.ly/vuMZnp

French Breast Implant Fears Spread Around World

From Reuters Health Information By Kate Kelland and Daniel Flynn LONDON/PARIS (Reuters) Dec 22 - Fears over the safety of silicone breast implants made by a now defunct French firm spread to Australia, South America and across Europe on Thursday as French officials prepared to decide if thousands of women should have their implants surgically removed. The silicone gel implants, made by a company called Poly Implant Prosthese (PIP) which was shut down in 2010, appear to have an unusually high rupture rate and have sparked an investigation in France into possible links to cancer. Some 300,000 PIP implants, which are used in cosmetic surgery to enhance breast size or replace lost breast tissue, were sold worldwide before PIP went bust last year. "It's not just France that's concerned. We're looking at 300,000 to 400,000 potential victims in the world," said Alexandra Blachere, the leader of a French PIP implant patient group. She said women from Italy and Spain had been in touch with her with worries about their implants, and she'd seen reports of problems in Venezuela, Brazil and elsewhere. Britain's drugs watchdog the Medicines and Healthcare products Regulatory Agency (MHRA) said, however, that there was no reason for patients to be alarmed and stressed as there is currently no scientific evidence to suggest increased health risks. MHRA officials said they had talked to other health or regulatory experts from France, the Netherlands, Portugal, Italy, Ireland, Hungary, Austria, Denmark and Malta. "They all agreed that there was no evidence of any increase in incidents of cancer associated with PIP breast implants and no evidence of any disproportionate rupture rates other than in France," it said in a statement. Founded in 1991, Poly Implants Prosthese was based in southern France and for a while ranked as the world's number three maker of implants, supplying around 100,000 a year. Some 80% were exported abroad, and health authorities around the world said they were watching closely for the results on Friday of an inquiry by France's National Cancer Institute into whether the implants can be linked to cancer. France has had reports of eight cases of cancer in women with breast implants made by PIP, which is accused of using industrial-grade silicone normally used in anything from computers to cookware. MHRA said there were also French reports of a woman with PIP implants who died from anaplastic large cell lymphoma (ALCL). France's drug and medical device regulatory authority, AFSSAPS, ruled last year that the state would pay for the removal of all the PIP implants but only fund replacements for victims of breast cancer, not those who used them for aesthetic purposes. A French victims association is pushing for the state to pay for replacements for all women with PIP implants. France's Health Ministry is expected to make an announcement on Friday following the National Cancer Institute's findings. BRITAIN MONITORING FRENCH DECISION Australia's healthcare watchdog, the Therapeutic Goods Administration (TGA), said around 8,900 of the PIP implants had been used in Australian women, some of whom had complained about the devices splitting and leaking. "The TGA has received 45 reports relating to PIP implants, 39 of which relate to rupture," it said in a statement. It has had no reports of ALCL in Australian women with the implants. The TGA said women with PIP implants should continue to monitor them and consult their surgeons if they have any concerns. Brain's MHRA said the same, adding that it would be "looking carefully at the French safety statement when it comes out as a matter of priority." PIP was placed into liquidation in March 2010 with losses of 9 million euros after AFSSAPS recalled its implants when surgeons reported abnormally high rupture rates. During a subsequent inspection of its manufacturing site, officials found PIP had started using a type of silicone gel that was not approved by health authorities, but was around 10 times cheaper. A subsequent investigation found that a majority of implants made by PIP since 2001 contained the unapproved gel. A solicitor acting for at least 250 British women taking legal action over their PIP implants said the liquidation of the French company had limited the scope for patients' legal action. "We're suing about half a dozen clinics that have been involved in implanting the PIP breast implants," Mark Harvey, a partner at legal firm Hugh James, told Reuters. "We would have preferred to sue PIP, obviously, but they are bankrupt so they have no money and no assets."