From Medscape Medical News
by Nick Mulcahy
July 14, 2009 — One in 3 breast cancers detected in publicly organized screening programs is overdiagnosed. And overtreatment inevitably occurs at the same rate, according to a meta-analysis of screening programs in Canada, Australia, Norway, Sweden, and the United Kingdom, published online July 9 in BMJ.
The new analysis is yet another study that adds to the controversy surrounding mammography's benefits and harms, which include overdiagnosis and overtreatment.
"The question is no longer whether overdiagnosis occurs, but how often it occurs," writes Gilbert Welch, MD, in an editorial accompanying the newly published analysis.
Overdiagnosis of cancer refers to cancers that grow so slowly that the patient dies of other causes before it produces symptoms or to cancer that is dormant or even regresses, explained Dr. Welch, who is a professor of medicine at Dartmouth Medical School in Hanover, New Hampshire.
Overdiagnosis is a "widely recognized problem" in prostate cancer screening, said Dr. Welch.
With regard to breast cancer, there is a growing body of evidence about overdiagnosis with which the new study is consistent, he added.
Namely, there are now 5 observational studies that indicate screening mammography is associated with increases in the incidence of breast cancer in women of screening age, but that there is "little or no subsequent decrease in the incidence of older women," notes Dr. Welch.
But is the rate of overdiagnosis really as high as 1 in 3 screen-detected cancers?
Dr. Welch says that that the "most compelling evidence to date" about overdiagnosis comes from an earlier randomized controlled trial of mammography versus observation (BMJ. 2006;332:689-692). In that study, overdiagnosis from screening occurred at a rate of 1 in 6, Dr. Welch notes.
Whatever the rate of overdiagnosis, both the study authors and the editorialist agree, overtreatment is likely to occur at the same rate.
"As it is not possible to distinguish between lethal and harmless cancers, all detected cancers are treated," write the study authors, Karsten Juhl Jørgensen, MD, and Peter C Gøtzsche, MD, from the Nordic Cochrane Center in Copenhagen, Denmark.
Close Call
The balance between the benefits and harms of mammography make it one of medicine's "close calls," adds Dr. Welch. It is a close call that has received a lot of public attention in the past year.
In the United Kingdom, there was public outcry over the lack of information about the harms of mammography in a public-health pamphlet about breast cancer screening. The protest led to a rewrite of the pamphlet, as reported by Medscape Oncology.
Furthermore, The New York Times and other media made front-page news out of a 2008 study from Norway that concluded that about 20% of screen-detected invasive breast cancers spontaneously regress. One of the Norwegian researchers told Medscape Oncology that such lesions are "pseudo-cancers."
In making decisions about whether or not to get screened, women are probably most interested in the "trade-off between the number of deaths from breast cancer avoided and the number of cancers overdiagnosed," suggested Dr. Welsh.
In an effort to provide physicians and their patients with a "balance sheet" of the harms and benefits of mammography, Dr. Welch included a tabular display along with his editorial. The credits and debits are for every 1000 women undergoing annual mammography for 10 years starting at the age of 50 years.
Credits :1 woman will avoid dying from breast cancer
Debits : 2–10 women will be overdiagnosed and treated needlessly
Credit: 10–15 women will be told they have breast cancer earlier than they would otherwise have been told, but this will not affect their prognosis
debit: 100–500 women will have at least 1 "false alarm" (about half these women will undergo biopsy)
New Study Details
To estimate the extent of overdiagnosis in organized screening programs, the Danish investigators compared trends in breast cancer incidence before and after the screening was initiated in the United Kingdom; Manitoba, Canada; New South Wales, Australia; Sweden; and parts of Norway.
The reason for this approach is based on the idea that, if screening was effective and did not produce overdiagnosis, then "the initial increase in cancers in the screened age groups would be fully compensated for by a similar decrease in the older age groups no longer offered screening," write the authors. Why is this so? Because the cancers in the older age groups would have been detected earlier on in life, as a result of screening, explain the authors.
The authors also note that such an approach must take into account changes in the background incidence of breast cancer and other factors.
One set of data offers an example of how the analysis was conducted. In Sweden, nationwide screening began in 1986, and in 1998, "almost all eligible women had been offered screening," the authors write. In 2000, the increase in invasive cancer after screening was implemented was 54% above expected rates for women aged 50 to 59 years and 21% for women aged 60 to 69 years. A drop in the incidence of breast cancer occurred among women aged 70 to 84 years, but the incidence "approached the expected rate," write the authors. In short, 88% of the increase among younger women was not compensated for by any drop in the older women, note the authors.
In summary, the total overdiagnosis of breast cancers, including ductal carcinoma in situ, from these public screening programs in different countries was 52%. The overdiagnosis of invasive breast cancer was 35%, report the authors.
BMJ. 2009;339:b1425 and b2587. Abstract, Abstract
Friday, July 17, 2009
Friday, June 26, 2009
H1N1 Flu - Warning Signs for urgent medical attention
What are the signs and symptoms of H1N1 (swine) flu in people?
The symptoms of H1N1 (swine) flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 (swine) flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions.
In children emergency warning signs that need urgent medical attention include:
•Fast breathing or trouble breathing
•Bluish or gray skin color
•Not drinking enough fluids
•Severe or persistent vomiting
•Not waking up or not interacting
•Being so irritable that the child does not want to be held
•Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
•Difficulty breathing or shortness of breath
•Pain or pressure in the chest or abdomen
•Sudden dizziness
•Confusion
•Severe or persistent vomiting
•Flu-like symptoms improve but then return with fever and worse cough
source - http://www.pandemicflu.gov/faq/swineflu/04.html
The symptoms of H1N1 (swine) flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 (swine) flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions.
In children emergency warning signs that need urgent medical attention include:
•Fast breathing or trouble breathing
•Bluish or gray skin color
•Not drinking enough fluids
•Severe or persistent vomiting
•Not waking up or not interacting
•Being so irritable that the child does not want to be held
•Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
•Difficulty breathing or shortness of breath
•Pain or pressure in the chest or abdomen
•Sudden dizziness
•Confusion
•Severe or persistent vomiting
•Flu-like symptoms improve but then return with fever and worse cough
source - http://www.pandemicflu.gov/faq/swineflu/04.html
Sunday, June 14, 2009
Good Night Sleep reduces BP?
From Heartwire
A Good Night's Sleep Associated With Reduced Blood Pressure
Sue Hughes
June 11, 2009 (Chicago, Illinois) — More evidence that a good night's sleep is associated with better control of blood pressure has come from a new study [1].
The study, published in the June 8, 2009, issue of the Archives of Internal Medicine, was conducted by a group led by Dr Kristen Knutson (University of Chicago, IL).
Knutson explained to heartwire that previous studies have suggested a link between poor sleep and increased blood pressure but that these have had limitations. "They have generally been short-term laboratory tests, but we wanted to look at the real-life situation and study the effects of habitual sleep patterns. In addition, previous studies that have tried to address longer-term sleep issues have relied on self-reporting of sleep quality, but we measured actual sleep duration and quality using a specifically designed wrist band," she said.
The band, known as an Actiwatch-16 (Philips Respironics, Murrysville, PA) wrist-activity monitor, contains sensors that count wrist movements in 30-second time periods, which determine whether the subject is asleep or awake, and has been validated against polysomnography as a good measure of sleep duration and quality, Knutson commented.
"We found that short sleepers had a larger increase in blood pressure over five years than those who slept longer," Knutson said. "Evidence suggests that a certain amount of sleep is necessary for many different functions in the body, including immune function and glucose metabolism, and if we can extend sleep in those who don't sleep well or for long enough, this should translate into many health benefits--one of which may well be lower blood pressure," she added.
Knutson said it was important to acknowledge the need to spend a certain amount of time asleep. "Five or six hours a night is not enough. Seven hours should really be the minimum. In the US, we have a work culture that discourages decent sleeping patterns. There seems to be a sort of badge of honor associated with sleeping only a few hours each night, and someone who sleeps for seven to eight hours may be perceived as not being hard-working enough. We need to change that culture."
She also believes that those individuals who appear to need only three or four hours of sleep each night may be fooling themselves. "People who sleep for short times do not do well in performance tests, even if they think they are well rested. Even these people should try to increase their sleep times," she said.
The current sleep study was ancillary to the large ongoing cohort CARDIA study, which is examining coronary risk in young adults. For the sleep study, 578 early-middle-aged adults participating in the CARDIA study had their blood pressure measured in 2000 and 2001 and in 2005 and 2006 and underwent sleep assessments using wrist actigraphy on two occasions for three consecutive days between 2003 and 2005.
Results showed that after the exclusion of patients who were taking antihypertensive medications, shorter sleep duration and lower sleep quality predicted significantly higher systolic and diastolic blood pressure at baseline as well as more adverse changes in blood-pressure levels over five years.
Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio 1.37; 95% CI 1.05–1.78). Each hour of reduction in sleep duration was associated with a 37% increase in the odds of incident hypertension.
Might Explain Higher Blood Pressure in Men and African Americans
Consistent with other studies, the current results show higher blood pressure in men, particularly African American men, who also slept much less than white women. "These two observations suggest the intriguing possibility that the well-documented higher blood pressure in African Americans and men might be partly related to sleep duration," the researchers write.
The authors note that laboratory studies of short-term sleep deprivation have suggested potential mechanisms for a causal link between sleep loss and hypertension: it is thought that sleep loss may lead to increased sympathetic nervous activity, which could cause high blood pressure if sleep loss were chronic.
They point out that, to their knowledge, the present study is the first to obtain objective measures of sleep duration and quality in a large sample of adults and to reveal associations between poor sleep quality and adverse effect on blood-pressure regulation and risk of hypertension in early-middle-aged adults.
"Because of the major adverse health consequences of high blood pressure, the identification of a new and potentially modifiable risk factor has clinical implications," the authors conclude. "The next step would be intervention studies to try to extend or improve sleep in hypertensive patients and see if we can improve their blood-pressure profile. Such a study is in the works," Knutson told heartwire .
References
A Good Night's Sleep Associated With Reduced Blood Pressure
Sue Hughes
June 11, 2009 (Chicago, Illinois) — More evidence that a good night's sleep is associated with better control of blood pressure has come from a new study [1].
The study, published in the June 8, 2009, issue of the Archives of Internal Medicine, was conducted by a group led by Dr Kristen Knutson (University of Chicago, IL).
Knutson explained to heartwire that previous studies have suggested a link between poor sleep and increased blood pressure but that these have had limitations. "They have generally been short-term laboratory tests, but we wanted to look at the real-life situation and study the effects of habitual sleep patterns. In addition, previous studies that have tried to address longer-term sleep issues have relied on self-reporting of sleep quality, but we measured actual sleep duration and quality using a specifically designed wrist band," she said.
The band, known as an Actiwatch-16 (Philips Respironics, Murrysville, PA) wrist-activity monitor, contains sensors that count wrist movements in 30-second time periods, which determine whether the subject is asleep or awake, and has been validated against polysomnography as a good measure of sleep duration and quality, Knutson commented.
"We found that short sleepers had a larger increase in blood pressure over five years than those who slept longer," Knutson said. "Evidence suggests that a certain amount of sleep is necessary for many different functions in the body, including immune function and glucose metabolism, and if we can extend sleep in those who don't sleep well or for long enough, this should translate into many health benefits--one of which may well be lower blood pressure," she added.
Knutson said it was important to acknowledge the need to spend a certain amount of time asleep. "Five or six hours a night is not enough. Seven hours should really be the minimum. In the US, we have a work culture that discourages decent sleeping patterns. There seems to be a sort of badge of honor associated with sleeping only a few hours each night, and someone who sleeps for seven to eight hours may be perceived as not being hard-working enough. We need to change that culture."
She also believes that those individuals who appear to need only three or four hours of sleep each night may be fooling themselves. "People who sleep for short times do not do well in performance tests, even if they think they are well rested. Even these people should try to increase their sleep times," she said.
The current sleep study was ancillary to the large ongoing cohort CARDIA study, which is examining coronary risk in young adults. For the sleep study, 578 early-middle-aged adults participating in the CARDIA study had their blood pressure measured in 2000 and 2001 and in 2005 and 2006 and underwent sleep assessments using wrist actigraphy on two occasions for three consecutive days between 2003 and 2005.
Results showed that after the exclusion of patients who were taking antihypertensive medications, shorter sleep duration and lower sleep quality predicted significantly higher systolic and diastolic blood pressure at baseline as well as more adverse changes in blood-pressure levels over five years.
Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio 1.37; 95% CI 1.05–1.78). Each hour of reduction in sleep duration was associated with a 37% increase in the odds of incident hypertension.
Might Explain Higher Blood Pressure in Men and African Americans
Consistent with other studies, the current results show higher blood pressure in men, particularly African American men, who also slept much less than white women. "These two observations suggest the intriguing possibility that the well-documented higher blood pressure in African Americans and men might be partly related to sleep duration," the researchers write.
The authors note that laboratory studies of short-term sleep deprivation have suggested potential mechanisms for a causal link between sleep loss and hypertension: it is thought that sleep loss may lead to increased sympathetic nervous activity, which could cause high blood pressure if sleep loss were chronic.
They point out that, to their knowledge, the present study is the first to obtain objective measures of sleep duration and quality in a large sample of adults and to reveal associations between poor sleep quality and adverse effect on blood-pressure regulation and risk of hypertension in early-middle-aged adults.
"Because of the major adverse health consequences of high blood pressure, the identification of a new and potentially modifiable risk factor has clinical implications," the authors conclude. "The next step would be intervention studies to try to extend or improve sleep in hypertensive patients and see if we can improve their blood-pressure profile. Such a study is in the works," Knutson told heartwire .
References
Thursday, June 11, 2009
Sodium Intake recommendations in Adults
Application of Lower Sodium Intake Recommendations to Adults -- United States,
1999-2006
Reported by: C Ayala, PhD, EV Kuklina, MD, PhD, J Peralez, MPH, NL Keenan, PhD, DR Labarthe, MD, PhD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.
In 2005--2006, an estimated 29% of U.S. adults had hypertension (i.e., high blood pressure), and another 28% had prehypertension.[1]
Hypertension increases the risk for heart disease and stroke,[2] the first and third leading causes of death in the United States.[3]
Greater consumption of sodium can increase the risk for hypertension.[4]
The main source of sodium in food is salt (sodium chloride [NaCl]); uniodized salt is 40% sodium .
In 2005--2006, the estimated average intake of sodium among persons in the United States aged ≥2 years was 3,436 mg/day.[5]
In 2005, the U.S. Department of Health and Human Services and U.S. Department of Agriculture recommended that adults in the United States should consume no more than 2,300 mg/day of sodium (by equal to approximately 1 tsp of saltweight), but those in specific groups (i.e., all persons with hypertension, all middle-aged and older adults, and all blacks) should consume no more than 1,500 mg/day of sodium.[6]
To estimate the proportion of the adult population for whom the lower sodium recommendation is applicable, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the period 1999--2006. The results indicated that, in 2005--2006, the lower sodium recommendation was applicable to 69.2% of U.S. adults. Consumers and health-care providers should be aware of the lower sodium recommendation, and health-care providers should inform their patients of the evidence linking greater sodium intake to higher blood pressure.
NHANES is an ongoing series of cross-sectional surveys on health and nutrition designed to be nationally representative of the noninstitutionalized, U.S. civilian population by using a complex, multistage probability design. All NHANES surveys include a household interview followed by a detailed physical examination, including blood pressure tests.* Data from four NHANES survey periods (1999--2000, 2001--2002, 2003--2004, and 2005--2006) were used to estimate the percentages of U.S. adults in the three risk groups for whom lower sodium intake of ≤1,500 mg/per day was recommended in 2005.† To represent the three risk groups, three nonoverlapping populations were defined for the analysis: all adults aged ≥20 years with hypertension, all adults aged ≥40 years without hypertension, and blacks aged 20--39 years without hypertension.[6] Participants first were categorized as having hypertension or not having hypertension, using an average of two or more blood pressure measurements (87% of the sample had three or more measurements). Hypertension was defined as having systolic blood pressure of ≥140 mm Hg, or diastolic blood pressure of ≥90 mm Hg, or taking antihypertension medication; prehypertension was defined as systolic blood pressure of 120--139 mm Hg or diastolic blood pressure of 80--89 mm Hg, and not taking antihypertension medication. Overall for the four survey periods, 22% of participants with hypertension had normal blood pressure readings but were categorized with hypertension because they self-reported taking antihypertension medication. Percentage estimates and 95% confidence intervals (CIs) were calculated using statistical software to account for nonresponse and complex sampling design. The significance of linear trend across survey periods was determined by using orthogonal polynomial coefficients calculated recursively.
Overall in 2005--2006, 69.2% of U.S. adults aged ≥20 years (approximately 145.5 million persons) met the criteria for the risk groups recommended for lower sodium consumption of ≤1,500 mg/day. Among adults aged ≥20 years, 30.6% were found to have hypertension; 34.4% did not have hypertension but were aged ≥40 years, and 4.2% did not have hypertension but were black and aged 20--39 years (Table). The overall percentage of persons in these risk groups increased significantly over the four NHANES study periods: 64.4% in 1999--2000, 67.4% in 2001--2002, 69.0% in 2003--2004, and 69.2% in 2005--2006 (p for linear trend = 0.05) (Table).
* Additional information available at http://www.cdc.gov/nchs/data/nhanes/databriefs/calories.pdf.
1999-2006
Reported by: C Ayala, PhD, EV Kuklina, MD, PhD, J Peralez, MPH, NL Keenan, PhD, DR Labarthe, MD, PhD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.
In 2005--2006, an estimated 29% of U.S. adults had hypertension (i.e., high blood pressure), and another 28% had prehypertension.[1]
Hypertension increases the risk for heart disease and stroke,[2] the first and third leading causes of death in the United States.[3]
Greater consumption of sodium can increase the risk for hypertension.[4]
The main source of sodium in food is salt (sodium chloride [NaCl]); uniodized salt is 40% sodium .
In 2005--2006, the estimated average intake of sodium among persons in the United States aged ≥2 years was 3,436 mg/day.[5]
In 2005, the U.S. Department of Health and Human Services and U.S. Department of Agriculture recommended that adults in the United States should consume no more than 2,300 mg/day of sodium (by equal to approximately 1 tsp of saltweight), but those in specific groups (i.e., all persons with hypertension, all middle-aged and older adults, and all blacks) should consume no more than 1,500 mg/day of sodium.[6]
To estimate the proportion of the adult population for whom the lower sodium recommendation is applicable, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the period 1999--2006. The results indicated that, in 2005--2006, the lower sodium recommendation was applicable to 69.2% of U.S. adults. Consumers and health-care providers should be aware of the lower sodium recommendation, and health-care providers should inform their patients of the evidence linking greater sodium intake to higher blood pressure.
NHANES is an ongoing series of cross-sectional surveys on health and nutrition designed to be nationally representative of the noninstitutionalized, U.S. civilian population by using a complex, multistage probability design. All NHANES surveys include a household interview followed by a detailed physical examination, including blood pressure tests.* Data from four NHANES survey periods (1999--2000, 2001--2002, 2003--2004, and 2005--2006) were used to estimate the percentages of U.S. adults in the three risk groups for whom lower sodium intake of ≤1,500 mg/per day was recommended in 2005.† To represent the three risk groups, three nonoverlapping populations were defined for the analysis: all adults aged ≥20 years with hypertension, all adults aged ≥40 years without hypertension, and blacks aged 20--39 years without hypertension.[6] Participants first were categorized as having hypertension or not having hypertension, using an average of two or more blood pressure measurements (87% of the sample had three or more measurements). Hypertension was defined as having systolic blood pressure of ≥140 mm Hg, or diastolic blood pressure of ≥90 mm Hg, or taking antihypertension medication; prehypertension was defined as systolic blood pressure of 120--139 mm Hg or diastolic blood pressure of 80--89 mm Hg, and not taking antihypertension medication. Overall for the four survey periods, 22% of participants with hypertension had normal blood pressure readings but were categorized with hypertension because they self-reported taking antihypertension medication. Percentage estimates and 95% confidence intervals (CIs) were calculated using statistical software to account for nonresponse and complex sampling design. The significance of linear trend across survey periods was determined by using orthogonal polynomial coefficients calculated recursively.
Overall in 2005--2006, 69.2% of U.S. adults aged ≥20 years (approximately 145.5 million persons) met the criteria for the risk groups recommended for lower sodium consumption of ≤1,500 mg/day. Among adults aged ≥20 years, 30.6% were found to have hypertension; 34.4% did not have hypertension but were aged ≥40 years, and 4.2% did not have hypertension but were black and aged 20--39 years (Table). The overall percentage of persons in these risk groups increased significantly over the four NHANES study periods: 64.4% in 1999--2000, 67.4% in 2001--2002, 69.0% in 2003--2004, and 69.2% in 2005--2006 (p for linear trend = 0.05) (Table).
* Additional information available at http://www.cdc.gov/nchs/data/nhanes/databriefs/calories.pdf.
contact dermatitis
Guidelines for the Management of Contact Dermatitis: An Update: Intervention and Treatment
J. Bourke,¹ I. Coulson* and J. English †
http://www.medscape.com/viewarticle/703348_6
Intervention and Treatment of Irritant Contact Dermatitis
The management of irritant contact dermatitis principally involves the protection of the skin from irritants. The most common irritants are soaps and detergents, although water itself is also an irritant. In occupational settings other irritants such as oils and coolants, alkalis, acids and solvents may be important. The principles of management involve avoidance, protection and substitution, as follows.
Avoidance. In general, this is self-evident. However, a visit to the workplace may be necessary to identify all potential skin hazards.
Protection. Most irritant contact dermatitis involves the hands. Gloves are therefore the mainstay of protection. For general purposes and household tasks, rubber or polyvinyl chloride household gloves, possibly with a cotton liner or worn over cotton gloves, should suffice. It is important to take off the gloves on a regular basis as sweating may aggravate existing dermatitis. There is also some evidence that occlusion by gloves may impair the stratum corneum barrier function[45] (Quality of evidence I). In an occupational setting, the type of glove used will depend upon the nature of the chemicals involved. Health and safety information for handling the chemical should stipulate which gloves ought to be used[46] (Appendix 5). Exposure time is an important factor in determining the most appropriate glove as so-called 'impervious' gloves have a finite permeation time for any particular substance; a glove may be protective for a few minutes but not for prolonged contact, e.g. NRL gloves and methacrylate bone cement.
Substitution. It may be possible to substitute nonirritating agents. The most common example of this is the use of a soap substitute. Correct recycling of oils in heavy industry and reduction of, or changing, the biocide additives may help.
Allergic Contact Dermatitis
Detection and avoidance of the allergen is often easier said than done. Again, a site visit may be necessary to identify the source of allergen contact and methods of avoidance. It may be necessary to contact manufacturers of products to determine if the allergen is present. It may also be necessary to contact a number of manufacturers to identify suitable substitutes.
Visiting the Workplace
Visiting the workplace has an important place in the management of contact dermatitis. Apart from identifying potential allergens and irritants, it may be essential in the effective treatment and prevention of contact dermatitis (Quality of evidence III) (Strength of recommendation B). More information about the indications for visiting a patient's workplace and how to go about it are given elsewhere.[47]
Barrier Creams and After-work Creams?
Barrier creams by themselves are of questionable value in protecting against contact with irritants[48,49] (Quality of evidence I) (Strength of recommendation E). Their use should not be overpromoted as this may confer on workers a false sense of security and encourage them to be complacent in implementing the appropriate preventive measures.
After-work creams appear to confer some degree of protection against developing irritant contact dermatitis. There are controlled clinical trials showing benefit in the use of soap substitutes[50] and after-work creams[51] in reducing the incidence and prevalence of contact dermatitis (Quality of evidence I) (Strength of recommendation A). They should be encouraged and made readily available in the workplace.
Topical Corticosteroids
Topical corticosteroids, soap substitutes and emollients are widely accepted as the treatment of established contact dermatitis. There is one study demonstrating a marginal benefit of the use of a combined topical corticosteroid/antibiotic combination[52] in infected or potentially infected eczema (Quality of evidence IV) (Strength of recommendation C). There is an open prospective randomized trial demonstrating the long-term intermittent use of mometasone furoate in chronic hand eczema[53] (Quality of evidence I) (Strength of recommendation B).
Topical tacrolimus has been shown to be effective in a nickel model of allergic contact dermatitis.[54]
Second-line Treatments
Second-line treatments such as psoralen plus UVA, azathioprine and ciclosporin are used for steroid-resistant chronic hand dermatitis. There are several prospective clinical trials to support these treatments[55-57] (Quality of evidence I) (Strength of recommendation A). A randomized controlled trial of Grenz rays for chronic hand dermatitis showed a significantly better response with this therapy compared with use of topical corticosteroids[58] (Quality of evidence I) (Strength of recommendation B). Oral retinoids have been used in the treatment of chronic hand eczema with a recently published trial of alitretinoin showing promise[59] (Quality of evidence I) (Strength of recommendation B).
Nickel Elimination Diets
There is some evidence[60,61] to support the benefit of low nickel diets in some nickel-sensitive patients (Quality of evidence IV) (Strength of recommendation C).
J. Bourke,¹ I. Coulson* and J. English †
http://www.medscape.com/viewarticle/703348_6
Intervention and Treatment of Irritant Contact Dermatitis
The management of irritant contact dermatitis principally involves the protection of the skin from irritants. The most common irritants are soaps and detergents, although water itself is also an irritant. In occupational settings other irritants such as oils and coolants, alkalis, acids and solvents may be important. The principles of management involve avoidance, protection and substitution, as follows.
Avoidance. In general, this is self-evident. However, a visit to the workplace may be necessary to identify all potential skin hazards.
Protection. Most irritant contact dermatitis involves the hands. Gloves are therefore the mainstay of protection. For general purposes and household tasks, rubber or polyvinyl chloride household gloves, possibly with a cotton liner or worn over cotton gloves, should suffice. It is important to take off the gloves on a regular basis as sweating may aggravate existing dermatitis. There is also some evidence that occlusion by gloves may impair the stratum corneum barrier function[45] (Quality of evidence I). In an occupational setting, the type of glove used will depend upon the nature of the chemicals involved. Health and safety information for handling the chemical should stipulate which gloves ought to be used[46] (Appendix 5). Exposure time is an important factor in determining the most appropriate glove as so-called 'impervious' gloves have a finite permeation time for any particular substance; a glove may be protective for a few minutes but not for prolonged contact, e.g. NRL gloves and methacrylate bone cement.
Substitution. It may be possible to substitute nonirritating agents. The most common example of this is the use of a soap substitute. Correct recycling of oils in heavy industry and reduction of, or changing, the biocide additives may help.
Allergic Contact Dermatitis
Detection and avoidance of the allergen is often easier said than done. Again, a site visit may be necessary to identify the source of allergen contact and methods of avoidance. It may be necessary to contact manufacturers of products to determine if the allergen is present. It may also be necessary to contact a number of manufacturers to identify suitable substitutes.
Visiting the Workplace
Visiting the workplace has an important place in the management of contact dermatitis. Apart from identifying potential allergens and irritants, it may be essential in the effective treatment and prevention of contact dermatitis (Quality of evidence III) (Strength of recommendation B). More information about the indications for visiting a patient's workplace and how to go about it are given elsewhere.[47]
Barrier Creams and After-work Creams?
Barrier creams by themselves are of questionable value in protecting against contact with irritants[48,49] (Quality of evidence I) (Strength of recommendation E). Their use should not be overpromoted as this may confer on workers a false sense of security and encourage them to be complacent in implementing the appropriate preventive measures.
After-work creams appear to confer some degree of protection against developing irritant contact dermatitis. There are controlled clinical trials showing benefit in the use of soap substitutes[50] and after-work creams[51] in reducing the incidence and prevalence of contact dermatitis (Quality of evidence I) (Strength of recommendation A). They should be encouraged and made readily available in the workplace.
Topical Corticosteroids
Topical corticosteroids, soap substitutes and emollients are widely accepted as the treatment of established contact dermatitis. There is one study demonstrating a marginal benefit of the use of a combined topical corticosteroid/antibiotic combination[52] in infected or potentially infected eczema (Quality of evidence IV) (Strength of recommendation C). There is an open prospective randomized trial demonstrating the long-term intermittent use of mometasone furoate in chronic hand eczema[53] (Quality of evidence I) (Strength of recommendation B).
Topical tacrolimus has been shown to be effective in a nickel model of allergic contact dermatitis.[54]
Second-line Treatments
Second-line treatments such as psoralen plus UVA, azathioprine and ciclosporin are used for steroid-resistant chronic hand dermatitis. There are several prospective clinical trials to support these treatments[55-57] (Quality of evidence I) (Strength of recommendation A). A randomized controlled trial of Grenz rays for chronic hand dermatitis showed a significantly better response with this therapy compared with use of topical corticosteroids[58] (Quality of evidence I) (Strength of recommendation B). Oral retinoids have been used in the treatment of chronic hand eczema with a recently published trial of alitretinoin showing promise[59] (Quality of evidence I) (Strength of recommendation B).
Nickel Elimination Diets
There is some evidence[60,61] to support the benefit of low nickel diets in some nickel-sensitive patients (Quality of evidence IV) (Strength of recommendation C).
Aspirin not as effective for primary prevention?
Meta-Analysis Questions Use of Aspirin in Primary Prevention CME
News Author: Sue Hughes
CME Author: Désirée Lie, MD, MSEd
June 9, 2009 — The authors of a new meta-analysis of aspirin use in primary prevention say their results "do not seem to justify general guidelines advocating the routine use of aspirin in all healthy individuals above a moderate level of risk for coronary heart disease. "
The meta-analysis, published in the May 30, 2009 issue of the Lancet, was conducted by the Antithrombotic Trialists' (ATT) Collaboration, led by Dr Colin Baigent (Clinical Trial Service Unit, Oxford University, UK).
Baigent commented to heartwire : "The present data that we have reported here have not been previously available. The current guidelines are based on previous meta-analyses, which have limitations. We have shown for the first time that the very same people at higher risk of heart disease are also at higher bleeding risk with aspirin, which is a very important piece of information and should influence the way in which aspirin is used."
He added: "Medicine has moved on in recent years, and we now know that we can safely reduce risk of heart disease by lowering cholesterol and blood pressure, and the drugs used to lower these risk factors are probably safer than aspirin. A person wanting to lower their risk might well consider taking a statin or an antihypertensive first and only after that add in a less safe drug like aspirin."
Baigent pointed out that the present guidelines, recommending aspirin for primary prevention in all people above a certain risk, are not supported by this new meta-analysis. "It is not for us to recommend changes in guidelines, but I would think the guidelines committees would now want to review their recommendations in light of these new findings," he said. "I'm not saying you should never use aspirin for primary prevention, and certain individuals may wish to still take it after discussing the risks and benefits with their doctor, which I think is fine. But our data suggest there is not good evidence of substantial benefit that outweighs risk enough to justify a public policy recommending routine use above a moderate CHD risk in primary prevention."
He added that this advice does not affect recommendations for secondary prevention, where the absolute benefit of aspirin is much greater and vastly outweighs the risk of bleeding.
source: http://cme.medscape.com/viewarticle/704102?sssdmh=dm1.483760&src=nldne
News Author: Sue Hughes
CME Author: Désirée Lie, MD, MSEd
June 9, 2009 — The authors of a new meta-analysis of aspirin use in primary prevention say their results "do not seem to justify general guidelines advocating the routine use of aspirin in all healthy individuals above a moderate level of risk for coronary heart disease. "
The meta-analysis, published in the May 30, 2009 issue of the Lancet, was conducted by the Antithrombotic Trialists' (ATT) Collaboration, led by Dr Colin Baigent (Clinical Trial Service Unit, Oxford University, UK).
Baigent commented to heartwire : "The present data that we have reported here have not been previously available. The current guidelines are based on previous meta-analyses, which have limitations. We have shown for the first time that the very same people at higher risk of heart disease are also at higher bleeding risk with aspirin, which is a very important piece of information and should influence the way in which aspirin is used."
He added: "Medicine has moved on in recent years, and we now know that we can safely reduce risk of heart disease by lowering cholesterol and blood pressure, and the drugs used to lower these risk factors are probably safer than aspirin. A person wanting to lower their risk might well consider taking a statin or an antihypertensive first and only after that add in a less safe drug like aspirin."
Baigent pointed out that the present guidelines, recommending aspirin for primary prevention in all people above a certain risk, are not supported by this new meta-analysis. "It is not for us to recommend changes in guidelines, but I would think the guidelines committees would now want to review their recommendations in light of these new findings," he said. "I'm not saying you should never use aspirin for primary prevention, and certain individuals may wish to still take it after discussing the risks and benefits with their doctor, which I think is fine. But our data suggest there is not good evidence of substantial benefit that outweighs risk enough to justify a public policy recommending routine use above a moderate CHD risk in primary prevention."
He added that this advice does not affect recommendations for secondary prevention, where the absolute benefit of aspirin is much greater and vastly outweighs the risk of bleeding.
source: http://cme.medscape.com/viewarticle/704102?sssdmh=dm1.483760&src=nldne
Saturday, May 30, 2009
10 Great Reasons to Strength Train For the Rest of Your Life
By: Gen Wright
Are you looking to be strong and fit for life, strong enough to take off for the slopes at a moment's notice, continue playing a sport, or spend holidays tramping in out of the way locations around the world? The simple answer to achieve any of these levels of fitness is two words: Strength Training. When it comes to building and maintaining strength, no other form of exercise offers a better bang for your buck and here's what it can do for you:
1. Avoid Muscle Tissue Loss
Through inactivity adults lose between 2.2 kg and 3.2 kg of lean muscle tissue every decade. Only strength training exercise will stop this happening throughout our lives. Although endurance exercise such as running, swimming etc improves our cardiovascular fitness, it does not prevent the loss of muscle tissue.
2. Avoid Metabolic Rate Reduction
Because muscle tissue is a very active tissue, muscle loss is accompanied by a reduction in our resting metabolism (the rate the body burns fuel) by 2 to 5 percent every decade. Strength training prevents muscle tissue loss preventing the accompanying decrease in resting metabolic rate.
3. Increase Metabolic Rate
Research reveals that simply adding 1.4kg of muscle tissue increases our resting metabolism by 7% and our daily calorie requirements by 15% reducing the likelihood of body fat accumulation.
4. Reduce Body Fat
Muscle tissue is metabolically active, meaning it burns calories. The more of it we have the more calories we burn while we are sleeping, working, and through exercise. For example, think of your metabolism like a car, the more muscle you have, the larger your engine and the more calories (fuel) you burn. If we neglect strength training, our metabolism might be closer to that of a scooter instead of a grunty V8!
5. Increase Bone Mineral Density
Not only does strength training exercise stimulate muscle growth; it also stimulates the growth of bone tissue. Bone mineral density peaks at age 20 then gradually declines for the rest of our lives. This makes us very susceptible to fractures, "shrinking" and diseases such as sarcopenia (muscle loss) and osteoporosis bone loss) as we age.
6. Improve Glucose Metabolism.
Strength training increases the use of blood sugars into the muscles, helping reduce the chance of developing diabetes. Researchers have reported a 23 percent increase in glucose uptake after four months of strength training.
7. Reduce Resting Blood Pressure
Strength training alone has been shown to reduce resting blood pressure significantly reducing risk of heart disease. If our muscles are stronger, less stress is placed on our cardiovascular (heart/lung) system while performing day to day activities.
8. Improve Joint Strength and Stability
Increasing the strength of muscles, also greatly enhances the strength and stability of the our joints. This decreases the stress put on them in day to day activities reducing degeneration of our joints. Arthritis is prevented or symptoms reduced with stronger muscles.
9. Improve Vitality and Quality of Life
The condition of our muscles is responsible for our energy, vigor and our ability to perform everyday activities with ease. Muscles are like an engine of a car, if they are well looked after, you can drive it regularly without fear of it breaking down and strength training is the means to keep them in top condition.
10. Improve Sporting Performance
All forms of power, speed, coordination and explosiveness come from having a good base of strength. Strength training is an effective means of increasing our physical capacity, improving our athletic performance, reducing our injury risk and increasing our enjoyment of our chosen sport.
So as you can see strength training should be performed by everyone. Men, women, children and older people can all benefit from strength training. It prevents our body from deteriorating enabling us to live longer and enjoy more of life as we age.
Strength training really is anti-aging and can match our health span with our life span.
Smart Articles @ http://www.articlebrain.com
Are you looking to be strong and fit for life, strong enough to take off for the slopes at a moment's notice, continue playing a sport, or spend holidays tramping in out of the way locations around the world? The simple answer to achieve any of these levels of fitness is two words: Strength Training. When it comes to building and maintaining strength, no other form of exercise offers a better bang for your buck and here's what it can do for you:
1. Avoid Muscle Tissue Loss
Through inactivity adults lose between 2.2 kg and 3.2 kg of lean muscle tissue every decade. Only strength training exercise will stop this happening throughout our lives. Although endurance exercise such as running, swimming etc improves our cardiovascular fitness, it does not prevent the loss of muscle tissue.
2. Avoid Metabolic Rate Reduction
Because muscle tissue is a very active tissue, muscle loss is accompanied by a reduction in our resting metabolism (the rate the body burns fuel) by 2 to 5 percent every decade. Strength training prevents muscle tissue loss preventing the accompanying decrease in resting metabolic rate.
3. Increase Metabolic Rate
Research reveals that simply adding 1.4kg of muscle tissue increases our resting metabolism by 7% and our daily calorie requirements by 15% reducing the likelihood of body fat accumulation.
4. Reduce Body Fat
Muscle tissue is metabolically active, meaning it burns calories. The more of it we have the more calories we burn while we are sleeping, working, and through exercise. For example, think of your metabolism like a car, the more muscle you have, the larger your engine and the more calories (fuel) you burn. If we neglect strength training, our metabolism might be closer to that of a scooter instead of a grunty V8!
5. Increase Bone Mineral Density
Not only does strength training exercise stimulate muscle growth; it also stimulates the growth of bone tissue. Bone mineral density peaks at age 20 then gradually declines for the rest of our lives. This makes us very susceptible to fractures, "shrinking" and diseases such as sarcopenia (muscle loss) and osteoporosis bone loss) as we age.
6. Improve Glucose Metabolism.
Strength training increases the use of blood sugars into the muscles, helping reduce the chance of developing diabetes. Researchers have reported a 23 percent increase in glucose uptake after four months of strength training.
7. Reduce Resting Blood Pressure
Strength training alone has been shown to reduce resting blood pressure significantly reducing risk of heart disease. If our muscles are stronger, less stress is placed on our cardiovascular (heart/lung) system while performing day to day activities.
8. Improve Joint Strength and Stability
Increasing the strength of muscles, also greatly enhances the strength and stability of the our joints. This decreases the stress put on them in day to day activities reducing degeneration of our joints. Arthritis is prevented or symptoms reduced with stronger muscles.
9. Improve Vitality and Quality of Life
The condition of our muscles is responsible for our energy, vigor and our ability to perform everyday activities with ease. Muscles are like an engine of a car, if they are well looked after, you can drive it regularly without fear of it breaking down and strength training is the means to keep them in top condition.
10. Improve Sporting Performance
All forms of power, speed, coordination and explosiveness come from having a good base of strength. Strength training is an effective means of increasing our physical capacity, improving our athletic performance, reducing our injury risk and increasing our enjoyment of our chosen sport.
So as you can see strength training should be performed by everyone. Men, women, children and older people can all benefit from strength training. It prevents our body from deteriorating enabling us to live longer and enjoy more of life as we age.
Strength training really is anti-aging and can match our health span with our life span.
Smart Articles @ http://www.articlebrain.com
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