A Toast To Forever - Love Poem

A Toast To Forever

 

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You're the one I can't live without
This fact is true, I have no doubt
I love the way you smile at me
I love the way together we're free

You may be strange and slightly loony
But all this means nothing to me
Because you are who you are
And I can see your beauty
Inside and out
Which is what threw me

When everyday I see you
Till then I cannot wait
To know what we will go through
Are in the hands of fate
The first time that I saw you
I knew I must steal your heart
I hope that it's mine for ever
And that we never do part

You are the one I love the most
And to this here fact I propose a toast;
May we grow old and still have fun
Because I love you and my heart you've won



 - Josh Mertens -

Today's Hair Style Could Cause Tomorrow's Hair Loss

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Black women who like to wear their hair pulled back tightly may be increasing their risk of hair loss, new research suggests.

A team of researchers from Johns Hopkins School of Medicine in Baltimore reviewed 19 studies and found a "strong association" between scalp-pulling hair styles and traction alopecia, which is gradual hair loss from damage to the hair follicle from tension at the hair root.

Traction alopecia is the most common type of hair loss among black American women, affecting about one out of three, the researchers said.

The study did not prove a definitive cause-and-effect connection. But, styles linked with this type of hair loss include braids, tight ponytails, dreadlocks, weaves and extensions, especially if hair has been chemically straightened, the review said.

"Hair is a cornerstone of self-esteem and identity for many people but ironically, some hair styles meant to improve our self-confidence actually lead to hair and scalp damage," Dr. Crystal Aguh, an assistant professor of dermatology at Hopkins, said in a university news release.

The findings show the need for dermatologists to learn more about these potentially damaging forms of hair styles and to advise patients about the risks and alternatives, the researchers suggested.

Traction alopecia is preventable and early intervention can stop or reverse it, the researchers said.

Alternating hair styles, and avoiding those that constantly pull at the hair roots may help, they noted.

"We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe," Aguh said.

The study was published online April 27 in the Journal of the American Academy of Dermatology.


More information
 The American Academy of Family Physicians has more about hair loss.

Seniors' Worsening Depression May Sometimes Predict Dementia

 In some cases, worsening symptoms of depression in seniors might point to early dementia, a new study suggests.

The Dutch study can't prove cause-and-effect, and certainly not every depressed senior is headed for dementia. But experts said the findings are intriguing.

"More research is needed, but the study raises the possibility of an overlap between the pathology of dementia and depression," said Dr. Gisele Wolf-Klein, who reviewed the findings. She directs geriatric education at Northwell Health in New Hyde Park, N.Y.

The study was led by Dr. M Arfan Ikram, an epidemiologist at Erasmus University Medical Center in Rotterdam. His team tracked depression symptoms in more than 3,300 adults, aged 55 and older, in the Netherlands for 11 years. The patients were then monitored for signs of dementia for another 10 years.

During that follow-up, 434 of the participants developed dementia, including 348 cases of Alzheimer's disease. Only those whose symptoms of depression increased over time were at increased risk for dementia, Ikram's team found.

And not everyone in that group developed dementia: Only about 22 percent did so, the researchers said.

Still, that number was higher than for people who had a low level of symptoms of depression -- only 10 percent in that group went on to develop dementia, the study found. That rate was similar for those with remitting (coming and going) symptoms of depression.

According to the research team, the findings suggest that having temporary depression -- even if severe -- does not have a lasting effect on the risk of dementia.

However, Ikram's group believes that increasing symptoms of depression in older adults could be reflective of an early stage of dementia in some cases. They say the finding supports prior research suggesting that dementia and certain types of depression may have a common cause.

Wolf-Klein agreed. "Different courses of depression may reflect different underlying causes, and might be linked to different risks of dementia," she theorized.

Dr. Aaron Pinkhasov is chair of behavioral health at Winthrop-University Hospital in Mineola, N.Y. He called the research "the first robust study looking into the very important association between depression and dementia."

Pinkhasov believes the findings point to a possible common cause between the underpinnings of some cases of depression and dementia.

The study "raises extremely important questions about the role of depression screening and treatment in mitigating the risk of dementia development," he said.
The study was published April 29 in The Lancet Psychiatry.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more on dementia.

Zika Virus Updates

Zika Virus Was in Haiti Long Before Brazil Outbreak: Study

 New research suggests the Zika virus was circulating in Haiti months before Brazil's first cases were reported last spring.

"We know that the virus was present in Haiti in December of 2014," said Dr. Glenn Morris, director of University of Florida's Emerging Pathogens Institute. "And, based on molecular studies, it may have been present in Haiti even before that date."

What remains unclear is exactly why there was such a widespread outbreak in Brazil, the study authors said, and more research is needed to reveal why the same did not happen in Haiti.

In Brazil, Zika infections have been linked to more than 5,000 cases of a birth defect known as microcephaly, in which babies are born with abnormally small heads and brains.

To uncover Zika's presence in Haiti, the team of researchers analyzed three "mystery" infections reported in that country in 2014.

The cases involved school-aged children in Haiti's Gressier/Leogane region who developed a fever.
The students were taken to a free clinic where samples of their blood were screened for dengue, chikungunya and malaria.

The blood tests ruled out these three well-known viruses but little thought was given to the Zika virus,
which was not known to be present in the region at the time.

Using an advanced testing method, the University of Florida researchers went back and analyzed the children's blood samples. They found the samples tested positive for the Zika virus.

Their findings, published April 26 in the journal PLOS Neglected Tropical Diseases, suggest the virus was circulating in the Americas long before it swept through Brazil.

The earliest known outbreak of the Zika virus occurred in 2007 in a small group of islands in French Polynesia, known as the Yap Islands. That outbreak affected an estimated 73 percent of people aged 3 and older, the researchers said.

After comparing the viruses, the researchers found the genetic sequences of the slightly older Haitian strains of the virus were more similar to the French Polynesian strains than many of the Brazilian strains.

"There is a possibility that this virus had been moving around the Caribbean before it hit the right combination of conditions in Brazil and took off," Morris said in a university news release.

"By using the sophisticated culturing and sequencing capabilities that we have here at the Emerging
Pathogens Institute, we were able to begin to fill in some of the unknown areas in the history of the
Zika virus, leading us toward a better understanding of what caused this outbreak to suddenly occur at the magnitude that it did in Brazil," Morris said.

As of April 27, there were 1,025 confirmed cases of Zika in U.S. states and territories, according to the federal Centers for Disease Control and Prevention. Nearly all of these infections were acquired by people who had traveled outside the United States.

As mosquito season approaches, U.S. health experts expect to see more infections in Gulf Coast states such as Florida and Texas, as well as Hawaii.

More information
The U.S. Centers for Disease Control and Prevention provides more information on the Zika virus.
To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

FDA Approves First Generic Lipid Controlling Drug

April 29, 2016 -- The U.S. Food and Drug Administration today approved the first generic version of Crestor (rosuvastatin calcium) tablets for the following uses:

• in combination with diet for the treatment of high triglycerides (hypertriglyceridemia) in adults;
• in combination with diet for treatment of patients with primary dysbetalipoproteinemia (Type III Hyperlipoproteinemia), a disorder associated with improper breakdown of cholesterol and triglycerides;
• either alone or in combination with other cholesterol treatment(s) for adult patients with homozygous familial hypercholesterolemia, a disorder associated with high low-density lipoprotein (LDL) cholesterol.

High LDL cholesterol, the so-called “bad cholesterol,” is a known risk factor for heart attacks, strokes, and heart disease. High triglycerides may also increase the risk of heart disease.

“The FDA is working hard to get first-time generic drugs approved as quickly as possible so patients can have increased access to needed treatments,” said Kathleen Uhl, M.D., director of the Office of Generic Drugs in the FDA’s Center for Drug Evaluation and Research. “The FDA requires that generic drugs meet rigorous scientific and quality standards.”

Generic drugs approved by the FDA have the same quality and strength as brand-name drugs. Generic drug manufacturing and packaging sites must pass the same quality standards as those of brand-name drugs.

Watson Pharmaceuticals Inc. of Parsippany, New Jersey has received approval to market generic rosuvastatin calcium in multiple strengths.

Rosuvastatin calcium is in a class of drugs called statins, which work by stopping an enzyme called HMG-CoA reductase from making cholesterol. Statins should be used in addition to a diet restricted in saturated fat and cholesterol.

In the clinical trials for Crestor, the most common side effects reported by participants taking Crestor included headache, pain in muscles (myalgia), abdominal pain, abnormal weakness (asthenia), and nausea.

Rosuvastatin calcium should not be used in women who are pregnant or may become pregnant as it may cause fetal harm. Women who require treatment with rosuvastatin should be advised not to nurse their infants.

Source: FDA

E-Cigarettes 'In' at Some Schools

Teens are more likely to give electronic cigarettes a try if they attend schools where use of the devices is common, a new study suggests.

The researchers found that differences in e-cigarette use between schools increased over time. This finding suggests that certain schools play a larger role in increasing teen use of e-cigarettes than other schools do. The researchers believe that there's something in the culture of those schools that
encourages the use of these devices.

"Our results indicate that there are certain types of schools that facilitate higher rates of e-cigarette use among students," said study leader Adam Lippert, an assistant professor of sociology at University of Colorado Denver.

Data for the study was collected from U.S. middle and high schools between 2011 and 2013 by the U.S. Centers for Disease Control and Prevention. The findings showed that e-cigarette use didn't seem to be affected by whether students smoked regular cigarettes or knew someone who did.

In schools with high rates of e-cigarette use, there may be a widespread belief that the devices are less harmful than regular cigarettes, the researchers said. Educators need to take such beliefs, along with the number of students using e-cigarettes, into account when trying to reduce e-cigarette use, Lippert said in a university news release.

E-cigarette use by American teens has risen dramatically since 2011. In 2015, the devices were used by more than 3 million middle and high school students, according to the CDC.

The study results were published recently in the journal Health and Place.

Kids of Older Moms May Have a Leg Up on Their Peers

Although older women may face more potential pregnancy complications, their children seem to fare better in some ways over the long run, a new study suggests.

Using data on over 1.5 million Swedish adults, researchers found that people born to mothers who were in their late-30s or 40s tended to be taller, fitter and more educated than those born to younger moms.

But, that doesn't guarantee that being born to an older mother means a person will be fitter, taller or more likely to aspire to a higher education. This study can only show an association between those factors.

People are choosing to give birth at later ages, the study authors said. For example, in Germany and the United Kingdom, the average age at first birth is 30 years old. And in Sweden in 2013, more than one-quarter of babies were born to women 35 and older, the report noted.

A woman who gives birth in her 40s rather than her 20s faces higher risks of pregnancy complications and problems for her baby -- including Down syndrome and autism, according to background information in the study.

But, her child is also born 20 years later in time, said researcher Mikko Myrskyla, director of the laboratory for population research at the Max Planck Institute for Demographic Research, in Rostock, Germany.

"Over a period of 20 years, most developed countries have seen strong expansion of education, improvements in health and increases in height," Myrskyla explained.

The potential disadvantages of being born to an older mom, he said, may be more than offset by the advantages of being born in a later time period.

The study results are based on data from Swedish adults born between 1960 and 1991. In general, the investigators found, people who'd been born to older mothers tended to have higher grades in high school and were more likely to go to college, versus those born to moms younger than 30.

But the pattern seemed to be entirely explained by the time period in which a person was born, according to Myrskyla.

Even within families, people born to older mothers were more educated than their older siblings: The
sibling who was born when mom was 45 or older, on average, had more than 1.5 years more education, versus the sibling who was born when mom was in her teens, the study said.

There was a similar pattern when the researchers looked at adulthood height and fitness levels -- which, they say, are "good proxies" for overall health. Based on data from the Swedish military draft, young men born to mothers in their late 30s or early 40s tended to be slightly taller and more fit. But again, that was likely related to being born in a later time period, the study authors explained.

An expert who wasn't involved in the study agreed that being born during "certain times in history" can give people certain advantages -- such as a greater likelihood of going to college.

But that shouldn't drive any woman's family-planning decisions, stressed Brenda Volling, director of the Center for Human Growth and Development at the University of Michigan, in Ann Arbor.

A woman in her 40s is far less likely to have a baby at all, compared with a woman in her 20s, Volling pointed out.

"We know that fertility rates decline significantly once women turn 35," she said. "There are no positive benefits to be had if there is no child to be born."

Volling said the women in this study who were able to give birth in their 40s were "probably a very select group."

These women were likely very healthy and gave birth to "robust" babies, Volling said. "When these two things are in place, then children may have a chance to experience some positive outcomes if the societal resources are in place," she added.

Myrskyla agreed that no one should use this study in their family planning. "We are not making any recommendations on when to have children, or whether to have them at all," he stressed.
Instead, he said, the findings suggest that when older women do have a healthy baby, that child may enjoy certain advantages from being born later.

Findings from the study were published recently in the journal Population and Development Review.

More information
The American College of Obstetricians and Gynecologists has more on having a baby after age 35.

Health Tip: Eczema

 Got Eczema?

Bleach bath therapy may be an effective way to manage eczema, if it's approved by the patient's dermatologist.

The American Academy of Dermatology suggests:

• Carefully measure the amount of bleach to mix with bath water. Use 1/2 cup bleach in a full tub, 1/4 cup in a half-full tub, or one teaspoon of bleach per gallon of water for a baby or toddler.
• Use only regular 6 percent strength bleach, never concentrated.
• Always pour bleach into the tub and never apply directly to skin. Allow the tub to finish filling before the person with eczema climbs in.
• Discuss with the dermatologist the appropriate length of the bleach bath -- usually between five minutes and 10 minutes.
• As soon as the person emerges from the bath, gently pat the skin dry and apply any prescribed eczema medication.

Air Pollution And Pregnancy - The Concern

Mild Air Pollution of Concern in Pregnancy

Being exposed to just a small amount of air pollution during pregnancy ups the risk of a pregnancy
 complication that can cause long-term health problems in children, a new study warns.
"
This study raises the concern that even current standards for air pollution may not be strict enough to protect the fetus, which may be particularly sensitive to environmental factors," said study author Rebecca Massa Nachman. She is a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"We found biological effects in women exposed to air pollution levels below the EPA standard," she added in a school news release.

The researchers found that the greater a pregnant woman's exposure to air pollution, the more likely she was to develop a condition called intrauterine inflammation. This condition is a leading cause of premature birth. It also boosts the risk of health problems for a woman's child from the fetal stage well into childhood, the researchers explained.

However, the study doesn't prove a cause-and-effect link. It only shows an association between exposure to air pollution and the pregnancy complication.

"Twenty years ago, we showed that high levels of air pollution led to poor pregnancy outcomes, including premature births. Now we are showing that even small amounts of air pollution appear to have biological effects at the cellular level in pregnant women," senior study author Dr. Xiaobin Wang said in the news release. Wang is director of the Center on the Early Life Origins of Disease at Bloomberg.

The study authors looked at data from more than 5,000 mostly low-income mother-child pairs in Boston. About two-thirds of the women in the study were exposed to air pollution levels considered acceptable by the EPA. One-third were exposed to levels at or above the agency's standard, the researchers said.

Women exposed to the highest levels of air pollution were nearly twice as likely as those exposed to the lowest levels to develop intrauterine inflammation. The first trimester appeared to the time of highest risk for the condition, the research revealed.

Most women with intrauterine inflammation have few obvious signs of the condition. But, the placenta -- which is typically discarded after birth -- offers crucial clues to the condition and could offer other important health information as well, according to the researchers.

"The placenta may be a window into what is going on in terms of early life exposure and what it means for future health problems," Wang said.

"This organ is discarded, but testing it is noninvasive and could be a valuable source of all kinds of environmental information," she added.

The study was published online April 27 in the journal Environmental Health Perspectives.

More information
The March of Dimes has more on air pollution and pregnancy.
Posted: April 2016

Some Smart Yet Easy Ways to Shield Yourself From Skin Cancer

One in five Americans will develop skin cancer at some point in their life, but it can be treated and cured if detected early, a dermatologist says.

"Knowing your own skin is the key to discovering skin cancer early on. See a dermatologist for a skin check if you notice a spot, mole or lump on your body that is changing, growing or bleeding," said Dr.
Mark Lebwohl. He is chair of the dermatology department at the Icahn School of Medicine at Mount
Sinai in New York City.

May is Skin Cancer Awareness Month and May 2 is Melanoma Monday. Melanoma is the most deadly form of skin cancer.

Lebwohl described in a school news release how to prevent and detect skin cancer.

• Apply a sunblock with an SPF of 30 or higher to all exposed skin whenever you're outdoors. Do this throughout the year and even on cloudy days. Reapply about every two hours.
• Wear long-sleeved shirts, pants, a wide-brimmed hat and sunglasses.
• Never sunbathe and never use tanning beds.
• Have a doctor look for changes to your skin during annual checkups, and check your skin every month. If you have a lot of brown spots, it might be a good idea to ask about total body photography -- to create a photographic record of your moles and monitor for changes.

You should also follow the ABCDEs, Lebwohl added, and tell your doctor if you see any of the following in your moles:

•  Asymmetry -- where one side of a mole is different from the other.
• Borders that are irregular, scalloped or poorly defined.
• Color that varies from one area to another, with shades of tan and brown, black and sometimes white, red or blue.
• Diameters that are the size of a pencil eraser (6 millimeters) or larger. However, some melanomas can be smaller, Lebwohl noted.
• Evolving, which means a mole or other skin feature looks different from the rest or is changing in size, shape and color.

More information
The U.S. National Cancer Institute has more on skin cancer prevention.

Coffee, Wine Good for Healthy Gut, Sodas May Be Bad

The food you eat and the medicines you take can alter your gut bacteria in ways that either help or harm your health, two new studies suggest.

Foods like fruits, vegetables, coffee, tea, wine, yogurt and buttermilk can increase the diversity of bacteria in a person's intestines. And that diversity can help ward off illness, said Dr. Jingyuan Fu, senior author of one of the studies.

"It is believed that higher diversity and richness [in gut bacteria] is beneficial," explained Fu. She is an associate professor of genetics at the University of Groningen in the Netherlands.

On the other hand, foods containing loads of simple carbohydrates appear to reduce bacterial diversity in the gut, Fu and colleagues found. These include high-fat whole milk and sugar-sweetened soda.

In addition, medications can also play a part in the makeup of your gut bacteria. Antibiotics, the diabetes drug metformin and antacids can cut down on gut bacterial diversity, the researchers found.
Smoking and heart attacks also can have a negative effect, the team said.

Each person's intestines contain trillions of microorganisms, which doctors refer to as the "gut microbiome," said Dr. David Johnson. He is chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Va., and a past president of the American College of Gastroenterology.

The gut microbiome plays an essential but little-understood role in human health, said Johnson, who was not involved with the new studies.

"It's the largest immune system in the body," Johnson explained. "These bacteria have a very dramatic and prominent role in determining health and disease."

To study the effect of lifestyle on the gut microbiome, Fu and her colleagues collected stool samples from more than 1,100 people living in the northern Netherlands.

The samples were used to analyze the DNA of the bacteria and other organisms that live in the gut. In addition to stools, the study collected information on the participants' diets, medicine use and health.

In the second study, researchers with the Flemish Gut Flora Project performed a similar analysis on stool samples taken from 5,000 volunteers in Belgium.

Both studies concluded that diet has a profound effect on the diversity of gut bacteria, although, Fu said, the "underlying theories of these dietary factors remain largely unknown."

Johnson added that medicines can have the same effect, and antibiotics actually can kill off some important strains of gut bacteria. "One dose of an antibiotic may disrupt your gut bacteria for a year," he said.

Both sets of researchers emphasized that their studies only help explain a fraction of gut bacteria variation -- roughly 18 percent for the Netherlands study, and about 7 percent for the Flemish study.

However, the findings from the two groups overlapped about 80 percent of the time, indicating that they are on the right track, the researchers said.

The Belgian researchers estimated that over 40,000 human samples will be needed to capture a complete picture of gut bacteria diversity.

Johnson noted that other research has shown that poor sleep, obesity, diabetes and the use of artificial sweeteners also can interfere with gut bacteria.
"The general rule is a balanced diet with high fiber and low carbs tends to drive a better gut health overall," he said.

According to Fu, once researchers have a clearer understanding of the gut microbiome and its effects on health, doctors could be able to help prevent or heal illness by reading or influencing the bacteria within people's bodies.

"The personalized microbiome may assist in personalized nutrition, personalized medicine, disease risk stratification and treatment decision-making," she said.

Both studies were published in the April 29 issue of the journal Science.

More information
Visit the European Society for Neurogastroenterology and Motility for more on diet and gut bacteria.

Building Muscle Could Boost the Body's Most Important Muscle

Having more muscle and less fat reduces the risk of early death in people with heart disease, a new study suggests.

Doctors should encourage patients to do resistance exercises as part of a healthy lifestyle, rather than emphasizing and monitoring weight loss, the study authors advised.

For the study, Dr. Preethi Srikanthan of the University of California, Los Angeles, and colleagues analyzed data gathered from more than 6,400 Americans with heart disease.

The investigators found that people with higher amounts of muscle and lower levels of body fat were less likely to die of heart problems or any other causes than those in three other groups based on body composition. The groups were: low muscle/high fat; low muscle/low fat; or high muscle/high fat.

Because people with more muscle were more likely to have a high body mass index (BMI, a measurement based on height and weight), the findings could explain what's called the "obesity paradox," where people with a higher BMI have lower death rates, the researchers suggested.

The study results show the importance of maintaining muscle mass in order to reduce the risk of premature death, even in people with a higher heart risk, the study authors said in a university news release.

According to the American College of Sports Medicine, resistance training -- also called strength training -- can be done with common household products, for example, milk jugs filled with sand. Or, people can use traditional free weights and dumbbells, weight machines, elastic tubing or medicine balls. But consult your doctor before starting any exercise program, the experts say.

The findings were published this month in the American Journal of Cardiology.

More information
The American Academy of Family Physicians has more on heart failure.
Posted: April 2016

Kids From Poor Families And The Risk of Food Allergy

Kids From Poorer Families May Have Worse Food Allergy Care

 
 

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A family's income may play a big role in the type of care a child with food allergies receives, a new study suggests.
The researchers found that poorer families -- those making under $50,000 a year -- spent less on non-allergenic foods, medical specialists and important medications, such as lifesaving epinephrine injectors.

As a result, "poor people may therefore be experiencing more food allergy reactions," said study co-author Dr. Ruchi Gupta. She's the director of the Program for Maternal and Child Health at Northwestern Feinberg School of Medicine in Chicago.
The study also found that low-income families incurred an average of $1,021 in emergency and hospital costs per year, compared to $416 for those with household incomes over $100,000.

An estimated 8 percent of U.S. children have food allergies, according to background information with the study. And about 40 percent of those children are believed to have had at least one life-threatening reaction.

The most common food allergies are to peanuts, tree nuts, eggs, milk, shellfish, fish other than shellfish, wheat and soy, Gupta said.

"We know that food allergy costs $24.8 billion a year in the U.S.," Gupta added. "We know that food allergy has a lot of additional costs including special diets and medications. Also, many parents report needing to leave their jobs or change their jobs to care for their food-allergic child. What we do not know is how this impacts low-income children and minority children."

For the new study, the researchers turned to a survey of more than 1,700 parents and guardians who took care of kids with food allergies. The survey was conducted in 2011-2012.

The poorer families spent an average of $744 on non-allergenic food per year compared with $1,545 by the richest families. There was also a big difference in overall out-of-pocket costs related to food allergy: about $3,200 a year for the poorest families and over $5,000 for the richest families.

The researchers also discovered that black families -- regardless of income -- spent far less on out-of-pocket and direct medical costs than other families. The total annual out-of-pocket cost for black families averaged $395.

For white families, that total was about $4,200. For Hispanic families, it was nearly $1,100 each year, and for Asian families, the total annual out-of-pocket expenses were just over $1,300, the survey revealed.

"This is confusing," Gupta said of the finding that black families spend so much less on food allergies. She noted that black children often have asthma -- another allergy-related disease -- and that their food allergy symptoms likely represent true allergic reactions.

But the study authors said there may be a protective effect in black families, such as a greater awareness of the need to avoid allergic foods. The researchers added that more study is needed to tease out these differences.

The study authors acknowledged limitations in their research. Among them, they said, is the fact that study participants were recruited from support and advocacy organizations, meaning they may not reflect the population as a whole.

Dr. Jonathan Bernstein, a professor of medicine at the University of Cincinnati who studies allergies, said the study results make sense. The findings reflect the differences between rich and poor when it comes to chronic diseases, such as asthma, he said.

Why might poorer families incur the highest hospital costs while spending the least on out-of-pocket preventive measures? "They either don't have access to specialty health care or don't take advantage of these resources," Bernstein said.

Gupta said awareness is important. Epinephrine auto-injectors, such as EpiPen -- which treat allergic attacks -- are usually covered by insurance, she said. "The manufacturer also has programs to help those who cannot afford the medication. All families may not be familiar with these programs."

Overall, she said, "we need better policies to keep all kids safe. We need to make sure all kids have access to epinephrine auto-injectors in schools and public places. We also need to make sure kids have access to safe foods at affordable costs. There should be an allergen-free food aisle in all grocery stores. We also need to improve our labeling laws."

The study was released online April 27 and published in the May print issue of the journal Pediatrics.

More information
For more about food allergies, visit the U.S. Food and Drug Administration.
Posted: April 2016

Antibody Shot Protects Monkeys From HIV-Like Infection

A single injection of a powerful HIV-fighting antibody protected monkeys from an HIV-like infection for up to six months, scientists report.

Researchers from the U.S. National Institute of Allergy and Infectious Diseases (NIAID) found that each of four HIV antibodies helped protect macaque monkeys from repeated exposure to a modified version of HIV, although some of the antibodies protected the animals longer than others.

Experts said the findings, published April 28 in the journal Nature, represent progress in a new approach to eventually creating an HIV vaccine.

Scientists have worked for decades toward the goal of having an HIV vaccine, with little success.

In 2009, a clinical study known as the "Thai trial" produced the first vaccine to offer some protection against HIV, the virus that causes AIDS, but it only lessened transmission by a modest degree.
Scientists are still studying a range of vaccine candidates they hope will be more effective.

With any traditional vaccine, the idea is to get the immune system to generate antibodies that will recognize and attack a specific foreign invader, explained Rowena Johnston, vice president of research for amfAR, a nonprofit that supports HIV/AIDS research.

But scientists have also wondered whether it could be possible to directly inject HIV-targeting antibodies into the body, said Johnston, who was not involved in the latest study.

In recent years, researchers have isolated a number of powerful antibodies that certain people with HIV produce against the virus.

One, called VRC01, was isolated from an HIV-infected man and later found to neutralize almost all known HIV strains in the world, according to NIAID.

That antibody has already moved into early human clinical trials, said Dr. David Hardy, a spokesperson for the HIV Medicine Association.

"The real value of this new study is that it shows there are at least three good [antibody] candidates to move into trials," said Hardy, who was not involved in the research.

For the study, the NIAID scientists started with three HIV-fighting antibodies -- VRC01 and two others. They created a fourth by genetically tweaking VRC01.

The researchers found that all four antibodies temporarily protected macaque monkeys from infection with SHIV -- a combination of HIV and the simian form of HIV that naturally infects many primates.

A single infusion of one of the antibodies -- dubbed 10-1074 -- kept the infection at bay for up to 23 weeks.

The researchers also found that the genetically altered version of VRC01 offered nearly double the protective window of the original version.

According to Johnston, that's an interesting finding because it suggests that with more genetic tinkering, the antibodies could be altered so protection lasts longer.

Many questions remain, however. Research with animals often doesn't produce the same effect in humans. And even if one or more antibodies can safely stave off HIV infection in humans, there are practical barriers to using them in the real world, both Johnston and Hardy said.

Creating antibodies in the lab is very expensive, so there is the cost issue, Johnston pointed out.
And because the body eventually degrades the infused antibodies, Hardy said, the treatment would have to be repeated.

An NIAID-run clinical trial is starting in sub-Saharan Africa, looking at whether VRC01 infusions can prevent HIV infection in women at high risk. The infusions will be given every two months.

But it's not yet clear, according to Hardy, whether antibody infusions could be realistically adopted in the low-income countries where most HIV infections occur.
Johnston added, "This is not something that's going to be available tomorrow, but this is a great step in the right direction."

Antibody infusions would be more feasible in higher-income countries like the United States. Right now, Hardy said, the HIV drug Truvada is approved for preventing infection in people at high risk. A periodic infusion of antibodies could potentially be easier than taking that daily -- and expensive -- pill, he said.

But Hardy also pointed to the bigger picture: Now that researchers are learning which antibodies neutralize HIV, they may be able to "work backwards" to develop vaccines that spur the immune system to produce those antibodies.

That won't be "easy," he stressed, but it's a different approach to finding the elusive HIV vaccine.

In the United States, where antiretroviral drugs have turned AIDS into a manageable condition, people may forget it remains one of the top causes of death worldwide, Hardy pointed out.

"This epidemic is not, by any means, over," he said.

More information
NIAID has more on HIV vaccine research.

Relativeness of Pre-pregnancy Weight And Child's Seize

Mom's Pre-Pregnancy Weight May Help Predict Child's Size

Toddlers whose mothers were overweight or obese before pregnancy may be more likely to be overweight, a new study suggests.

The study also found that mothers who gain too much weight during pregnancy may be more prone to having overweight toddlers.

The study had a bit of good news -- breast-feeding for at least six months could reduce a toddler's risk of being overweight.

"Childhood obesity is linked with adult obesity and long-term negative health outcomes, which is why it is important to explore which factors may contribute to excessive weight during early childhood," said lead author Anny Xiang, from Kaiser Permanente's Southern California Department of Research and Evaluation.

"Our study findings highlight the need for more public health efforts to reduce maternal obesity, appropriate gestational weight gain and to promote breast-feeding," Xiang said in a Kaiser news release.

The new study included almost 16,000 women in Southern California who gave birth in 2011. Researchers checked their children's weight at age 2 years.

Compared to those whose women who were at normal weight before pregnancy, toddlers of mothers who were obese before pregnancy were more than twice as likely to be overweight. Those 2-year-olds whose mothers were overweight before pregnancy were 50 percent more likely to be overweight, the study reported.

Meanwhile, excessive weight gain during pregnancy was associated with a 23 percent increased risk of a toddler being overweight.

The researchers defined excessive weight gain during pregnancy as a normal-weight woman gaining more than 35 pounds, an overweight woman gaining more than 25 pounds, and an obese woman gaining more than 20 pounds.

Breast-feeding for at least six months was associated with a 24 percent lower risk of a toddler being overweight, regardless of a mother's weight before pregnancy, or gestational diabetes or excessive weight gain during pregnancy, the study authors said.

The findings were published recently in the journal Pediatric Obesity. Although the study found a connection between mom's pre-pregnancy weight or pregnancy weight gain and her child's weight, it did not prove a cause-and-effect relationship.

In the past 30 years, obesity has more than doubled among American children and quadrupled among teens. More than one-third of children and adolescents were overweight or obese in 2012, the U.S. Centers for Disease Control and Prevention says.

More information
The U.S. Centers for Disease Control and Prevention has more about childhood overweight and obesity.
Posted: April 2016

Sleep Disorder In Persons With Brain Injuries

Sleep Doesn't Come Easy to Those With Brain Injuries

Many people who suffer a traumatic brain injury struggle with sleep problems they may not be aware of, Swiss researchers report.

These patients also can suffer daytime sleepiness for as long as 18 months after their injury, the small study found.

And these sleep problems may adversely affect daytime performance at work or school, the researchers said.

"Sleep-wake disorders are highly prevalent after traumatic brain injury of any severity but are difficult to diagnose because many affected patients are unaware of their disorder," said lead researcher Dr. Lukas Imbach.

It's not known why sleep problems in traumatic brain injury patients are underestimated, he said.
Every year in the United States, 1.7 million people suffer a traumatic brain injury, and evidence suggests that number is rising worldwide, the researchers said.

Sleep problems are known to be related to mood changes and depression, and also to learning and memory difficulties, said Imbach, who's with the department of neurology at University Hospital Zurich.

"A link between these neuropsychiatric problems and sleep disturbances after traumatic brain injury is absolutely possible, although our study did not test this hypothesis," he noted.

This study provides evidence that sleep-wake disturbances after traumatic brain injury persist over a long period of time, Imbach said, but they are neglected by the majority of affected patients.

"Therefore, we believe that our observations are important for any clinicians and neurologists involved in the management of [brain] trauma patients," he said.

The report was published April 27 in the journal Neurology.

For the study, Imbach and his colleagues followed 31 people for 18 months who had experienced a first traumatic brain injury. Their injuries ranged from mild to severe. The researchers compared these patients with 42 healthy people.

Imbach's team found that 67 percent of the brain-injured patients suffered from excessive daytime sleepiness, compared with 19 percent of healthy people. In addition, when asked about sleepiness during the day, people with a brain injury said they didn't feel any sleepier than those without a brain injury.

People with mild traumatic brain injury were as likely to have sleep problems as people with severe brain injury, Imbach said. No other medical conditions accounted for these sleep problems, he said.

The researchers also found that brain-injured patients needed an average of eight hours of sleep a night, compared with healthy people, who needed an average of seven hours of sleep each night.
Dr. Brian Edlow is a member of the neurocritical care staff at Massachusetts General Hospital in Boston. "Doctors who take care of patients with post-traumatic sleep disorders often rely on patients to report their own symptoms when deciding whether to perform a formal diagnostic sleep study," said Edlow, who co-authored an accompanying journal editorial.

"However, if patients are not recognizing their own sleep disorders or their own daytime sleepiness, we as clinicians need to rethink our approach to the assessment and diagnosis of post-traumatic sleep disorders," he said.

Earlier studies have suggested that as many as 50 percent of patients with traumatic brain injury experience sleep disturbances or daytime sleepiness. And, since many of these patients may not recognize their own symptoms, the fundamental question is whether all patients with traumatic brain injury should be tested for sleep problems, Edlow said.

Additional studies are needed to establish the link between sleep-wake disturbances and impaired daytime performance at work or school, which is the most important indicator of how these disturbances are affecting a patient's quality of life, Edlow said.

More information
Visit the Brainline.org for more on traumatic brain injuries.

Hearing Aids May Help Keep Seniors' Minds Sharp

A hearing aid may do more than help you hear better: New research suggests that the devices might also help prevent mental decline in elderly people with hearing loss.

"We know that hearing aids can keep older adults with hearing loss more socially engaged by providing an important bridge to the outside world," Dr. Anil Lalwani, a professor of otolaryngology/head and neck surgery at Columbia University Medical Center in New York City, said in a center news release.

"In this study, we wanted to determine if they could also slow the effects of aging on cognitive function," he added.

The study included 100 adults, aged 80 to 99, with hearing loss. The 34 who regularly used a hearing aid had much better scores on tests of mental function than those who didn't use a hearing aid.

The researchers also found that mental function was directly linked to hearing ability in those who didn't use a hearing aid.

The study was published online April 25 in the American Journal of Geriatric Psychiatry.
"Our study suggests that using a hearing aid may offer a simple, yet important, way to prevent or slow the development of dementia by keeping adults with hearing loss engaged in conversation and communication," Lalwani said.

More than half of people older than 75 have hearing loss. But, fewer than 15 percent of those with hearing loss use a hearing aid, the researchers said.

Previous research has shown that hearing-impaired elderly people are at increased risk for fall- and accident-related death, social isolation and dementia, compared to those without hearing loss.

Previous studies have also found that hearing aid use can improve hearing loss-related social, functional and emotional problems, the researchers said.

More information
The U.S. National Institute on Deafness and Other Communication Disorders has more on hearing aids.
Posted: April 2016

Psoriasis Tied to Obesity And Type 2 Diabetes

The chronic skin disease psoriasis may be linked to excess weight and type 2 diabetes, results of a new study suggest.

Danish researchers found that people with type 2 diabetes had more than 50 percent greater odds of having psoriasis compared to people without diabetes.

The study also found that the rate of psoriasis went up with increasing weight. For example, obese people with a body mass index (BMI) over 35 had almost double the odds of psoriasis than normal weight people did. BMI is a body fat measurement based on height and weight. A BMI of 30 or over
is considered obese.

Exactly how these conditions might be connected isn't clear, but the study authors suggested that genetics, smoking, drinking alcohol, or inflammation might play a role.

"Psoriasis is a complex disorder," said lead researcher Dr. Ann Sophie Lonnberg, of the University of Copenhagen. "The genetic background for the disease and its many comorbidities [co-existing conditions] have not yet been fully uncovered," she said.

This study can't prove that psoriasis causes type 2 diabetes or obesity or vice versa, Lonnberg added. However, the study suggests the association between psoriasis and obesity could partly be tied to a common genetic cause, she explained.

"The reason psoriasis and obesity are associated is not only due to a common lifestyle, but they are also associated due to common genes," Lonnberg said. "It is important to treat psoriasis and obesity and diabetes, since they are risk factors for heart disease and could have serious effects on overall health."

For the study, Lonnberg and her colleagues collected data on nearly 34,000 twins, aged 20 to 71. Just over 4 percent had psoriasis, slightly more than 1 percent had type 2 diabetes and over 6 percent were obese, the findings showed.

Among the nearly 460 individuals with type 2 diabetes, about 8 percent also had psoriasis. Among people without type 2 diabetes, just 4 percent had psoriasis, the investigators found.

People with psoriasis tended to weigh more than those without the skin condition, the researchers said. The risk for obesity was also greater among those with psoriasis -- 11 percent of people with psoriasis were obese, but only 8 percent of non-obese study participants had psoriasis, the findings showed.

The researchers also looked at 720 twin pairs in which one twin had psoriasis and the other didn't. The twins with psoriasis weighed more than the twins without psoriasis, and were also more likely to be obese, the study found. The prevalence of type 2 diabetes, however, was the same in twins with and without psoriasis, according to the report.

The study was published in the April 27 online edition of the journal JAMA Dermatology.

"Psoriasis is not just a disease of the skin -- patients and health care professionals need to be aware of systemic health issues associated with psoriasis," said Dr. Joel Gelfand. He's an associate professor of dermatology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, and author of an accompanying journal editorial.

Other studies have suggested that people with psoriasis are more likely to develop type 2 diabetes even if they don't have major risk factors for the blood sugar disease, and that this risk increases with the severity of the psoriasis, Gelfand said.

"Some of this risk may be due to shared genetics between psoriasis and diabetes. It is also thought that chronic inflammation in psoriasis may predispose patients to diabetes," Gelfand explained.

He suggested that people with psoriasis -- particularly those aged 40 to 70 with more extensive skin disease -- should receive medical screenings for diabetes.

"Patients with psoriasis who are overweight or obese may lower their risk of diabetes while making the skin disease less active if they are able to achieve and maintain a more healthy body weight," Gelfand said.

Another doctor thinks genetics may help explain what she has seen in her own practice.
"I have seen that psoriasis is linked with diabetes, which suggests that a genetic link may help explain why it's a lot harder to control diabetes in patients with psoriasis," said Dr. Doris Day. She is a dermatologist at Lenox Hill Hospital in New York City.
"We are understanding more about psoriasis and coming up with better treatments for it," she said. "If you have psoriasis, you need to see a dermatologist, a cardiologist and an endocrinologist to make sure you have other conditions under control," Day advised.

More information
For more on psoriasis, visit the American Academy of Dermatology.

Study Finds:Type 2 Diabetes May Damage Hearing,

 

Type 2 diabetes may raise the risk of hearing loss, say researchers who recommend hearing tests for patients with the blood sugar disease.

The researchers reviewed prior studies examining the link between diabetes and hearing loss. However, further research is needed to confirm this connection, said the team at the State University of New York Downstate Medical Center in New York City.
"An association between diabetes and hearing impairment in human subjects has been shown in many, but not all, studies," said Elizabeth Helzner, an assistant professor in the School of Public Health.
"Direct comparison of these studies is complicated due to a lack of consistency in defining hearing impairment and other factors," she said in a SUNY news release.

However, Helzner added, the association between diabetes and hearing impairment tends to be stronger in studies that included younger participants. It's possible that in older patients, other causes of age-related hearing impairment may mask the contribution of diabetes, she said. "This factor in itself lends weight to the notion that type 2 diabetes can damage hearing," she explained.

Hearing loss affects more than 16 percent of American adults, with nearly half of people older than 75 having difficulty hearing, according to the U.S. National Institute on Deafness and Other Communication Disorders.

Hearing loss has been linked with social isolation, depression, mental decline, dementia, and increased risk for falls, hospitalization and death, the researchers say.
The study results were published recently in the journal Current Diabetes Reports.

More information
The U.S. National Institute on Deafness and Other Communication Disorders has more on hearing loss.
Posted: April 2016

Mindfulness Therapy May Help Ease Recurrent Depression

Mindfulness therapy may help reduce the risk of repeated bouts of depression, researchers report.
One expert not connected to the study explained the mindfulness approach.

"Mindfulness-based cognitive therapy enhances awareness of thoughts and emotions being experienced, and enables development of skills to better cope with them," said Dr. Ami Baxi, a psychiatrist who directs adult inpatient services at Lenox Hill Hospital in New York City.

In the new study, a team led by Willem Kuyken, of the University of Oxford in England, analyzed the findings of nine published studies. The research included a total of almost 1,300 patients with a history of depression. The studies compared the effectiveness of mindfulness therapy against usual depression care and other active treatments, including antidepressants.

After 60 weeks of follow-up, those who received mindfulness therapy were less likely to have undergone a relapse of depression than those who received usual care, and had about the same risk of those who received other active treatments, the team reported.

The study authors also believe that mindfulness therapy may provide greater benefits than other treatments for patients with more severe depression.

The study was published online April 27 in the journal JAMA Psychiatry.
"Mindfulness practices were not originally developed as therapeutic treatments," Richard Davidson, of the University of Wisconsin-Madison, wrote in an accompanying editorial. "They emerged originally in contemplative traditions for the purposes of cultivating well-being and virtue," he explained.

"The questions of whether and how they might be helpful in alleviating symptoms of depression and other related psychopathologies are quite new, and the evidence base is in its embryonic stage," according to Davidson.

While this review is the most comprehensive analysis of data to date, it "also raises many questions, and the limited nature of the extant evidence underscores the critical need for additional research," Davidson concluded.

However, another psychologist said she is already using mindfulness therapy in her practice.
"I have increasingly incorporated mindfulness based-interventions into my work with children, adolescents and adults, and I've seen how it has improved treatment outcome and overall well-being in my clients," said Jill Emanuele. She is senior clinical psychologist at the Child Mind Institute in New York City.

Emanuele said there is growing evidence that the approach brings patients "increased awareness of emotions and thoughts, and the ability to more effectively regulate and cope with them."

More information
The University of California, Los Angeles has more about mindfulness.

Study Suggests, Pharmacists Can Manage Some Chronic Conditions Effectively

Pharmacists may do a better job than doctors helping chronically ill patients manage their blood pressure, cholesterol and blood sugar levels if they're allowed to direct people's health care, a new evidence review suggests.

The review also found that pharmacists could manage chronic diseases with about the same efficiency as doctors.

However, current evidence doesn't show whether pharmacists can actually improve a patient's overall
health if they take over someone's care from a doctor, said study senior author Dr. Timothy Wilt. He's a professor of medicine at the University of Minnesota Medical School, and a staff physician at the
Minneapolis VA Health Care System.

Wilt and his colleagues also couldn't show whether having a pharmacist manage your care can help you live longer or reduce symptoms caused by chronic ailments such as heart disease or diabetes.

"That was a bit frustrating for us, because that's really what patients really care about -- will it help them live longer and live better?" Wilt said.

The reason for the interest in pharmacist-driven care is that some areas of the United States don't have enough doctors. Due to these shortages, other types of health care workers, such as nurse practitioners or physician assistants, are being called on to help fill the gaps, Wilt said.

New legislation introduced in Congress would establish pharmacists as health care providers, and pay them accordingly through Medicare in communities where there aren't enough doctors, the study authors said.

Pharmacists acting as a person's primary care provider would be able to evaluate a patient's health, advise them how to best manage their chronic conditions, and possibly even have the power to order tests or prescribe medicines, Wilt said.

They also could send patients to a doctor for any procedure they might need, such as an injection for knee pain or removal of a wart, he said.

To determine how well pharmacists might perform if they led the management of a person's chronic disease, Wilt and his colleagues reviewed 63 published studies. The studies included 65 different patient populations with more than 33,000 people.

The findings suggest that patients receiving pharmacist-led care were more likely to achieve target goals for blood pressure, cholesterol and blood sugar compared with patients receiving usual care.

Pharmacist-led care also increased the dosage or the number of medications being received. "It's not clear whether that's a good thing or not," Wilt said. "Some people should be on more medications, but for others, they should be on less."

But the study authors concluded there's not enough evidence to say whether people actually are healthier and do better when a pharmacist manages their care.
Anne Burns, vice president of professional affairs for the American Pharmacists Association, said the study shows "pharmacists' medication expertise and extensive training can help to address unmet health care needs in this country.
"We are pleased that this study found that pharmacists can effectively manage the care of patients with chronic conditions," Burns said.
There are a number of ways health care dollars could be saved if pharmacists are managing chronic diseases, Wilt said.
Pharmacists are paid less than physicians, and having them handle day-to-day chronic disease care would free up doctors to see patients with more serious and complex health problems, Wilt said.
Dr. David Katz, director of the Yale University Prevention Research Center, agreed that the findings show that "some portion of what now constitutes the primary care management of chronic conditions can be taken over ably by pharmacists."
However, some tasks such as initial diagnosis, troubleshooting and customization of treatment should remain the responsibility of a physician, Katz said.
"But the [long-term] oversight of an established treatment plan may be provided as ably by a pharmacist as a physician, and at lower cost," he said. "Health care professionals embracing complementary roles as part of an overall care team is one of the best, short-term strategies for raising the quality while lowering the costs of such care. I am all for it."
The study was published online April 25 in the Annals of Internal Medicine.
More information
For more on pharmacist-led care, visit the American Society of Health-System Pharmacists.
Posted: April 2016

Health Benefits of Omega-3 Fish Oil

Omega-3 Fish Oil Supplements Might Boost Antidepressants' Effects

Omega-3 fish oil supplements may improve the effectiveness of antidepressants, new research suggests.

Researchers reviewed the findings of eight clinical trials worldwide, as well as other evidence, and concluded that the supplements appear to help battle depression in people already on medication.

"Omega-3 fish oil -- in combination with antidepressants -- had a statistically significant effect over a placebo," said study leader Jerome Sarris. He is head of the ARCADIA Mental Health Research Group at the University of Melbourne in Australia.

The study looked at the result of trials where patients battling depression took either a standard antidepressant plus a form of omega-3 fish oil, versus the antidepressant plus an inactive placebo.

"The difference for patients taking both antidepressants and omega-3, compared to a placebo, was highly significant," Sarris said in a university news release. "This is an exciting finding because here we have a safe, evidence-based approach that could be considered a mainstream treatment," he explained.
"Many studies have shown omega-3s are very good for general brain health and improving mood, but this is the first analysis of studies that looks at using them in combination with antidepressant medication," Sarris said.

Doctors may be reluctant to prescribe dietary supplements in combination with antidepressants due to a lack of scientific evidence and concerns about safety. But, Sarris noted, the researchers found no major safety concerns in combining the two therapies.

However, the study authors stressed that patients should always talk with their health care provider before taking dietary supplements. In addition, people need to be aware that these supplements can differ in quality.

"We're not telling people to rush out and buy buckets of supplements. Always speak to your medical professional before changing or initiating a treatment," Sarris said.

One expert in the United States believes the findings might be of use to patients.

"The general population is often looking for natural remedies to treat health problems," said Dr. Victor Fornari.

"A large number of individuals with depression do not reach remission with one or two trials of medication," added Fornari. He directs child and adolescent psychiatry at Cohen Children's Medical Center in New Hyde Park, N.Y.

"This may enhance the recovery of individuals who do not respond to antidepressants alone," he said. However, Fornari agreed with the authors that "individuals are cautioned to consult with their medical professional before proceeding."

The study was published April 26 in the American Journal of Psychiatry.
More information
The U.S. Food and Drug Administration has more on dietary supplements.

Anti-Fungal Drugs And The Risk of Miscarriage: FDA

Drug for Yeast Infections May Raise Miscarriage Risk, FDA Warns

Doctors should use caution when prescribing the antifungal drug fluconazole during pregnancy because it may raise the risk of miscarriage, the U.S. Food and Drug Administration warns.

Fluconazole (brand name Diflucan) is used to treat vaginal yeast infections.
"Patients who are pregnant or actively trying to get pregnant should talk to their health care professionals about alternative treatment options for yeast infections," the FDA advised Tuesday.

The agency said it is evaluating the results of a recent Danish study that suggested a link between fluconazole and miscarriage, along with additional data and will release final conclusions and recommendations when the review is completed.

Current labeling information suggests that a single 150 milligram (mg) dose of oral fluconazole to treat vaginal yeast infection is safe to take during pregnancy. However, the FDA noted that in rare cases higher doses taken during pregnancy (400 mg to 800 mg a day) had been linked to abnormalities at birth.

In the Danish study, most of the fluconazole use appeared to be one or two doses of 150 mg.
"Until FDA's review is complete and more is understood about this study and other available data,

FDA advises cautious prescribing of oral fluconazole in pregnancy," the agency said in a news release.

The agency noted that the U.S. Centers for Disease Control and Prevention recommends only antifungal creams to treat pregnant women with vaginal yeast infections -- even for longer periods than usual if the infections persist or recur.

While the Danish study showed that pregnant women treated with fluconazole had a greater risk of miscarriage than those who used an antifungal cream, it did not prove the drug causes miscarriages, the authors noted.

Still, "women who are trying to become pregnant or who are pregnant should avoid fluconazole," said Dr. Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in New York City, when the
Danish study results came out. "For these women, a topical medicine is the preferred treatment."

Fluconazole (available as a pill or suspension liquid) is the only oral drug used to treat yeast infections during pregnancy, Wu said.

More information
The U.S. Office on Women's Health has more about vaginal yeast infections.

Norovirus Epidemics

Norovirus a Costly Bug

The stomach bug norovirus sickens nearly 700 million people worldwide annually and costs health care systems more than $4 billion a year, researchers report.

And when lost productivity and other societal costs are included, that price tag jumps to more than $64 billion, the researchers added.

The findings are believed to be the first to assess the global economic impact of the highly contagious virus, which is common in both poor and rich nations, the researchers said.

"You only seem to hear about it when people get sick on a cruise ship or at a restaurant, but norovirus is everywhere," said study leader Sarah Bartsch, a research associate at Johns Hopkins Bloomberg
School of Public Health, in Baltimore.

"It doesn't matter how old you are or if you're in a wealthy country or a poorer one or if you've had it before -- you can get it again. And it really is unpleasant," Bartsch said in a Hopkins news release. "But if we don't focus on norovirus and teach people how to prevent it, little headway will be made to combat it."

Norovirus can cause symptoms such as nausea, diarrhea and vomiting. There is no vaccine or
treatment once you are infected, the researchers said.

The study, published online April 26 in the journal PLoS One, shows the need for increased efforts to prevent the disease, according to the authors.

"The costs associated with norovirus are high -- higher than for many diseases, including rotavirus -- that have gotten a lot more attention. Our study presents an economic argument for greater consideration of norovirus. It has been flying under the radar for too long," study senior author Dr.

Bruce Lee said in the news release. He is an associate professor in the department of international health at the Bloomberg School.

Measures to prevent transmission of norovirus include: proper hand washing; following safety precautions when preparing food; improving food and water sources; and keeping people who are sick with norovirus away from others.

More information
The U.S. Centers for Disease Control and Prevention has more on norovirus.

Lipid Controlling Drugs May Not Lower The Risk of Colon Cancer

Statins Might Not Lower Colon Cancer Risk: Study

Long-term use of cholesterol-lowering statins does not appear to reduce the risk of colon cancer, but a person's cholesterol levels might affect risk, a new study suggests.

Both statins and cholesterol levels have been linked with lower colon cancer risk, but pinpointing which one is actually responsible has been difficult, the University of Pennsylvania researchers
explained.

So, they compared statin use and cholesterol levels in more than 22,000 British patients with colon cancer and more than 86,500 without the disease.

The results confirmed findings from previous studies that showed a lower risk of colon cancer in people who take statins. But the risk was not significantly different between people who kept taking statins and those who stopped taking the drugs.

Instead, the higher the cholesterol level, the lower the colon cancer risk for patients, regardless of statin use, the study found.

The researchers also discovered that an unexplained drop in cholesterol levels one year before a cancer diagnosis was linked to an increased risk of cancer in both statin users and nonusers.

But the study did not prove that lower cholesterol levels caused colon cancer risk to increase, it only showed an association between the two.

The findings, published online April 26 in the journal PLoS Medicine, suggest that cholesterol levels, and not statins, may influence colon cancer risk.

"There appears to be an artificially protective effect of statins," lead study author Dr. Ronac Mamtani said in a university news release. He is an assistant professor of hematology/oncology at the Perelman
School of Medicine at the University of Pennsylvania, in Philadelphia.

"Although the risk of colorectal cancer was lower in statin users versus nonusers, when we compared those who continued statin therapy versus those who discontinued the therapy, such that each group shared the same indication for statin therapy, there was no difference in risk," Mamtani said.

The findings suggest that cholesterol levels could help diagnose colon cancer earlier, according to the researchers.

"Together, these data demonstrate a complex association between statins, cholesterol and colorectal cancer," Mamtani said. "While unexplained decreases in blood total cholesterol should alert physicians to consider colon cancer as one potential explanation, future studies are needed to determine the utility of blood cholesterol as a marker for early detection of colon cancer."

More information
The American Cancer Society has more about colon/rectum cancer.

Young Gay, Bisexual Men May Be at Higher Risk for Suicide, Study Finds

Young gay and bisexual men may be much more likely to attempt suicide or harm themselves than their older counterparts, and blacks are at greater risk than whites, British researchers report.

"We know minority groups are at higher risk of poor mental health than the heterosexual majority, however the mental health differences within sexual minorities is unclear," said study author Ford Hickson, from the London School of Hygiene & Tropical Medicine.

"Our study showed that among gay and bisexual men, age and ethnicity had a significant impact on mental health, as did income and education. This is possibly because men are better able to cope with homophobia the older they are, or if they are relatively privileged in other areas of their lives," he said in a school news release.

In the study, the researchers examined survey responses from nearly 5,800 gay and bisexual men from the United Kingdom 16 and older. The results: those younger than 26 were two times more likely to be depressed or anxious, and six times more likely to attempt suicide or harm themselves than those older than 45.

Blacks were two times more likely to be depressed and five times more likely to have attempted suicide than whites, according to the study published April 26 in the Journal of Public Health.

The researchers found that those with lower incomes were more likely to be depressed, anxious, and
to attempt suicide or harm themselves than those with higher incomes. Those with lower levels of education were two times more likely to be depressed, anxious, and to attempt suicide or harm themselves than those with a university degree.

The study also found that gay and bisexual men living with a male partner were 50 percent less likely to have depression than those living alone.

"Poor mental health is not evenly distributed across race, income or education. We must ensure that access to life-changing support services are targeted to where they are needed most. Everyone has the right to good mental health," Hickson concluded.

More information
The National Alliance on Mental Illness has more about LGBTQ mental health.

Skateboarding Mishaps Send 176 Kids to ERs Every Day

Skateboarding can be a fun and challenging activity, but it also comes with a significant risk of injury, researchers report. The researchers examined data spanning two decades and found that more than 64,500 U.S. children and teens were treated in hospital emergency rooms each year -- about 176 a day -- for skateboarding-related injuries. Fractures and dislocations were among the most common injuries, the study indicated. "Part of the fun of skateboarding and board sports in general is using gravity to kind of get away with something you can't get away with just running on your own two feet. But when you come down, it's just like when someone hits you with a hammer. It hurts, and things can break," said Dr. Mark Morocco, an associate clinical professor of medicine/emergency medicine at Ronald Reagan UCLA Medical Center. Morocco was not involved in the current research. Five deaths were reported during the study period. All were due to motor vehicle collisions. But the study's lead author, Lara McKenzie, suggested that the death rate may be underreported. McKenzie is a principal investigator with the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. The study included data for kids between 5 and 19 years old. All were treated in U.S. emergency departments for skateboarding-related injuries from 1990-2008. From 1990 to 1994, the number of skateboarding injuries actually fell. But from 1994 through 2008, the rate of injuries rose again, according to the study. McKenzie believes those changes can be attributed to "the waxing and waning of the popularity of the sport. Kids want to do it, they do, then move on to the next thing," she said. Males were far more likely than females to be injured. Almost 40 percent of injuries occurred at home. Just under 30 percent occurred on a street or highway, the study found. One piece of good news from the study is that most of the kids injured don't end up admitted to the hospital. Young daredevils may try to emulate tricks they've seen professionals do, but Morocco noted that professionals take extra safety precautions. "Professionals try to balance [the risk] by doing them in places like a controlled course; a controlled setting, where there are run off areas that make it easier to slow down. As riders come off a skateboard, they'll slide off a slope and come to a stop, rather than into a tree. And they're wearing pads and full armor," he said. "They might get a scrape, but tend not to get the fractures. The problem we see is as kids get more skilled on skateboards, they'll take slightly higher risks and often don't up the safety ante by adding more safety elements, like helmets and elbow pads," Morocco added. So, if kids are going to try to copy their favorite pro's moves, they need to make sure they also copy the protection that the pros wear, he advised. Neither expert expects that kids will give up skateboarding. "If my kids like to skateboard, I'd just institute all the best practices to make sure they have the lowest risk of getting injured," said McKenzie. "I'd try to take them to a skate park that's designed for skateboarding instead of letting them do it in the street. Or I'm going to make them wear helmets instead of saying 'let them just go and we'll see what happens.' I wouldn't take it away from them just because there's a risk." Findings from the study were published this month in the journal Injury Epidemiology. More information Find out more about skateboarding safety at Safe Kids Worldwide.