CDC: Americans Living Longer as Death Rate Drops

We are living longer these days.

Our average life expectancy increased by about one month from 2009 to 2010. In 2010, the average life expectancy rose to 78.7 years, up from 78.6 years in 2009. These are some of the findings from a new report by the CDC on death rates in the U.S. in 2010.

The death rate hit its lowest rate ever in 2010, at 746.2 deaths per 100,000 people. Overall 2,465,936 people died in the U.S. in 2010.

Heart disease and cancer still top the list of causes of death. Together, they accounted for 47% of all deaths in 2010, the new report shows.

For the first time since 1965, homicide fell from the top 15 causes of death. Homicide was replaced by pneumonitis, an inflammation of lung tissue, as the 15th leading cause of death.

Of the top 15 causes of death in the U.S., there were drops in seven of them, including:

CancerHeart diseaseStrokeAccidentsChronic lung diseaseFlu/pneumoniaSepticemia, or blood infection

There was also a decrease in infant mortality rates in 2010.

But there were increases in other causes of death, such as Alzheimer’s disease, kidney disease, liver disease, Parkinson's disease, and pneumonitis, the new report showed.

The new data are based on 98% of death certificates from 50 states and the District of Columbia.

Certain Antidepressants May Raise Lung Risk in Newborns

 Pregnant women who use certain popular antidepressants may have a twofold increased risk for delivering babies with a rare but serious lung disorder, a new study finds.

Researchers analyzed national registry data from 1.6 million births in five Nordic countries in an effort to determine if using selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy raises the risk for neonatal pulmonary hypertension, a life-threatening condition in newborns that normally occurs in one to two births in 1,000.

SSRIs such as Celexa, Lexapro, Paxil, Prozac, and Zoloft are the most widely prescribed class of antidepressants, and millions of women in the U.S. have used them during pregnancy.

Persistent pulmonary hypertension in newborns (PPHN) is a respiratory disorder in which the arteries leading to the lungs remain constricted after birth, limiting blood flow and oxygen.

Risk factors for PPHN include maternal obesity, diabetes, and smoking, and between 5% and 10% babies with the disorder do not survive.

A 2006 study first linked SSRI use during pregnancy to the disorder, finding a sixfold increase in the incidence of neonatal pulmonary hypertension in babies exposed to the antidepressants in the last months before birth.

Studies conducted since then have been mixed, with some supporting the association and others finding no increase in risk associated with SSRI use.

In the newly published study, researchers from Stockholm, Sweden’s, Karolinska Institute examined birth registry data from all babies born between 1996 and 2007 in Denmark, Finland, Iceland, Norway, and Sweden.

About 30,000 women used SSRIs during pregnancy, and about 11,000 filled prescriptions for them in their fifth month of pregnancy or later.

There were 33 cases of persistent pulmonary hypertension among babies whose mothers took SSRIs late in pregnancy, or about three cases per 1,000 births.

This was about double the number of cases that would have been expected in the general population of newborns, but babies born to mothers with a history of a previous hospitalization for a psychiatric disorder who were not taking SSRIs during pregnancy also had a slightly increased risk for the disorder.

Gideon Koren, MD, of Toronto’s Hospital for Sick Children, says the study raises more questions than it answers.

“This is by far the largest study to examine SSRI use and PPHN, but the fact that women with untreated depression had a higher risk for the disorder raises new doubts about this link,” Koren says. “Many doubts remain, and they should be shared with patients.”

Koren directs the Toronto hospital’s “Motherisk” program, which advises women about drug safety during pregnancy.

“We talk to about 200 women a day from all over North America and other parts of the world,” he says, adding that questions about SSRI safety are common.

Climate Tied to Inflammatory Bowel Disease Risk

 Living in a sunny climate appears to reduce women’s risk of developing inflammatory bowel disease, a large new study shows.

An estimated 1.4 million people in the U.S. live with an inflammatory bowel disease, either Crohn’s disease or ulcerative colitis.

Both cause persistent diarrhea, abdominal pain and cramping, fever, and sometimes rectal bleeding. Symptoms can become very severe and sometimes require surgery.

Yet little is known about the causes of these diseases, which are thought to involve a dysfunction of the immune system.

For the new study, researchers combed through data on more than 238,000 women taking part in the long-running Nurses’ Health Study, which began in 1976.

The study collected information on where the women were living at birth, age 15, and age 30. It also recorded any diagnosis of an inflammatory bowel disease up to 2003.

Researchers also followed up with women who reported having inflammatory bowel disease and verified their diagnoses through medical records.

They found that women who lived in Southern regions that got a lot of sunlight had a 52% lower risk of being diagnosed with Crohn’s disease by age 30 and a 38% lower risk of getting ulcerative colitis than those who lived in Northern regions.

That result held up even when researchers tried to rule out other things that might increase a person’s risk for an inflammatory bowel disease, like having a family history.

“The differences are pretty drastic. That’s what surprised us the most. Especially when it comes to Crohn’s disease. We’re seeing a 40% to 50% reduction in risk,” says researcher Hamed Khalili, MD, a gastroenterologist at Massachusetts General Hospital in Boston.

The study is published in the journal Gut.

This study confirms previous research from Europe, and it suggests that the amount of UV light exposure from sunlight may play an important role in the development of inflammatory bowel disease, though researchers aren’t sure why.

One theory is that people in sunnier states may have higher exposure to UV light, leading to higher vitamin D levels. Vitamin D is known to help regulate immunity and inflammation.

Regional differences in environmental pollution or infections could offer other explanations.

“The study was well done,” says Amnon Sonnenberg, MD, MSc, a gastroenterologist at Oregon Health & Science University, in Portland. “The authors are to be commended,” says Sonnenberg, an expert on inflammatory bowel disease who was not involved in the study.

“We know quite well that there is a north-south gradient, and this north-south gradient applies to the American continent as well as to Europe,” he says.

But he says the reasons behind the regional differences are far from clear cut.

For example, he says, studies have shown that miners -- who spend their working hours underground and out of the sunlight -- have less inflammatory bowel disease.

For that reason, he cautions patients against thinking that taking more vitamin D might help their symptoms or lessen their risk if they have a family member who’s affected.

People tend to think “vitamin D is going to protect me,” Sonnenberg says, “And there is absolutely no evidence for this.”

Colorful Meals May Appeal to Picky Eaters

 Is your child a picky eater? A new study may help you expand his or her palate.

Children prefer much more color and variety in food presentation, compared to adults, according to the study. For example, children preferred twice as many colors and different items on their plates.

Children also responded well to figurative designs on their plate, like bacon “smiles” and peas arranged into a heart shape.

Researchers say the results suggest that parents can encourage picky eaters to eat healthier by introducing more color and creativity to their plates.

“What kids find visually appealing is very different than what appeals to their parents,” Brian Wansink, PhD, professor of marketing at Cornell University, says in a news release. “Our study shows how to make the changes so the broccoli and fish look tastier than they otherwise would to little Casey or little Audrey.”

In the study, published in Acta Paediatrica, researchers showed 23 pre-teen children and 46 adults full-size photos of different combinations of food on plates and asked them to choose which food presentations they liked the most.

The results showed children preferred plates with seven different items and six different colors, while adults favored plates with only three items and three colors.

“Compared with adults, children not only prefer plates with more elements and colors, but also their entrees placed in the front of the plate and with figurative designs,” researcher Kevin Kniffin, PhD, of Cornell University, says in the release.

Researchers found simple steps, like shaping a bacon strip into a smile at the bottom of the plate or arranging vegetables into fun shapes, made the food presentation much more appealing to children.

They say the next step is to test whether picky eaters actually eat what they say looks good enough to eat.

If so, giving children a wide array of foods on their plates may widen their palates and help them eat healthier.

Diabetes Medications May Double as Weight Loss Drugs

Two drugs approved to treat type 2 diabetes may also aid weight loss in overweight people with or without diabetes, a new study shows.

The drugs Byetta and Victoza mimic gut hormones that decrease appetite.

They are typically prescribed when patients need medication to help control their blood sugar. A new research review, published in BMJ, reanalyzed data from 25 separate studies.

The review reveals that the drugs helped overweight people without diabetes shed an average of 7 pounds and those with diabetes lose an average of 6 pounds when injected daily or weekly for at least five months.

That makes these agents promising treatments for obesity, study authors say.

“It’s not a cure, but it’s a good treatment. And you still need to combine it with lifestyle changes,” says researcher Tina Vilsboll, MD, DMSc, an endocrinologist and associate professor at Gentofte Hospital in Hellerup, Denmark.

Vilsboll says the modest weight loss many of her diabetic patients see on the drugs helps encourage them to kick up their diet and exercise programs to lose even more weight.

“They use it as a tool for changing their lifestyle,” she says.

The medications also appear to lower blood pressure and cholesterol slightly, which may help heart disease risks.

But the drugs, known as glucagon-like peptide-1 (GLP-1) receptor agonists, also come with side effects. They work, in part, by slowing the movement of food through the stomach. That can sometimes cause a good deal of nausea or even vomiting, especially after a large meal.

But Vilsboll says that side effect generally fades over time and doesn’t usually cause people to stop taking the medication.

Experts who were not involved in the review say they are cautiously optimistic about the drugs’ prospects for weight loss.

“We do have an obesity epidemic. Weight loss by traditional means -- diet and exercise -- is extremely hard, and for people who are successful initially, it’s also very hard to maintain,” says Susan Spratt, MD, an endocrinologist and the director of diabetes services at Duke University Health System in Durham, N.C.

“If we could use these drugs just in people with obesity and know that it’s safe, I think it would be a fantastic addition to our ability to treat obesity,” Spratt says.

“I’ve had [diabetic] patients lose 60 pounds with these medications. Now, those folks were 400 pounds, so they lost 10% to 15% of their body weight,” she says. “Somebody who’s 200 pounds isn’t going to lose that much.”

Because the drugs are already on the market, doctors have the ability to prescribe them solely for weight loss.

But experts say such “off-label” use of the drugs can be risky.

Exercise, Talk Therapy by Phone May Help Relieve Fibromyalgia Pain

 Exercise and/or talking with a therapist on the phone once a week may significantly reduce chronic pain, a new study shows.

About 20% to 40% of adults report experiencing chronic pain, Seth Berkowitz, MD, and Mitchell Katz, MD, of the Los Angeles County Department of Health Services write in an accompanying editorial. Up to 20% of visits to a primary health care provider generate a prescription for a narcotic painkiller, or opioid, they say.

While three non-opioid drugs -- Cymbalta, Lyrica, and Savella -- have been approved by the FDA to treat fibromyalgia pain, none adequately controls the disorder’s multiple symptoms, the authors of the new study write.

The scientists assigned almost 450 patients with chronic widespread pain, some of whom had fibromyalgia, to get either “talk therapy” by phone, exercise, both talk therapy and excerise, or their usual treatment.

Four therapists underwent three days of training to learn how to provide psychological help to study participants receiving talk therapy. Patients chose goals, such as identifying and evaluating unhelpful thinking styles or making lifestyle changes.

After an initial assessment that lasted an hour, those participants receiving talk therapy spoke on the phone with a therapist for 30 to 45 minutes once a week for seven weeks. That was followed by a phone session three months and six months after the study began.

Evidence suggests that this talk therapy delivered by phone is as effective as face-to-face therapy, researcher John McBeth, PhD, an epidemiologist at the University of Manchester, tells WebMD in an email.

Those in the exercise group were invited to meet with a fitness instructor once a month for six months. The goal was to improve their fitness by exercising 20 minutes to an hour at least twice a week.

Three months after the study ended, the phone therapy and/or exercise patients showed more improvement than those who’d stayed with their usual care.

The people who engaged in both talk therapy and exercise did only slightly better than those who received one or the other. Perhaps the therapists included messages about exercise, the authors speculate. Or, they write, perhaps each treatment was so effective that there wasn’t much room for improvement by combining them.

The new study is the latest addition to an “extensive” body of clinical trials demonstrating talk therapy’s effectiveness in treating chronic pain and headache, says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at New York’s Beth Israel Medical Center.

“Cognitive behavioral therapy [talk therapy] should be offered to a far larger proportion of patients with chronic pain than currently is done,” Portenoy, who was not involved in the study, tells WebMD.

He cited several obstacles: Too few therapists trained to provide it, inadequate insurance coverage, a tendency among doctors to focus on medical strategies due to a lack of knowledge about talk therapy, and a lack of reimbursement incentives to offer other treatments.

FDA Panel Backs New Device for Chronic Heartburn

An implantable device to treat chronic, severe acid reflux disease has moved one step closer to approval. An FDA advisory committee unanimously voted that the LINX device was safe and effective for treating chronic gastroesophageal reflux disease, or GERD, that does not respond to medication.

The panel also unanimously voted that the benefits of LINX for those patients outweigh the risks. The FDA usually, but not always, follows its advisory committees’ guidance.

The LINX device is a titanium ring of magnetic beads. It’s placed around the lower end of the esophagus to strengthen the sphincter, or ring of muscle, that’s supposed to prevent acid and other stomach contents from rising. At the same time, it is said to be pliant enough to allow food and liquids to enter the stomach.

Manufactured by Torax Medical of Shoreview, Minn., LINX has been on the market in the United Kingdom, Germany, and Italy for about two years, according to Todd Berg, the company’s president and CEO.

About 19 million U.S. adults suffer from GERD, FDA medical officer Priya Venkataraman-Rao, MD, told the panel. Doctors recommend treating it first with nonsurgical methods, such as raising the head of the bed, losing weight, eating smaller meals, or taking antacids or other medications called H2 blockers or proton-pump inhibitors.  

If none of those work, the main alternative is a surgical procedure in which the top part of the stomach is cut and wrapped around the esophagus.

Torax implanted 100 patients with LINX in its pivotal clinical trial. On average, they’d suffered from GERD for 13 years and experienced about 80 episodes of heartburn a week. People with a BMI greater than 35, a large hiatal hernia (when the stomach bulges into the chest through an opening in the diaphragm), a history of trouble swallowing (more than once a week for the previous three months), a severely inflamed esophagus, or Barrett’s esophagus -- in which the lining of the esophagus, damaged by acid, becomes more like the lining of the intestine -- were excluded from the study.

The acid level in the patients’ esophagus was assessed before and 12 months after LINX was implanted via minimally invasive “keyhole” surgery. Just over half of the patients saw their acid level fall by at least one-half. 

Improvement on a subjective quality-of-life assessment -- which asked such questions as when and how often heartburn occurred and whether it kept them up at night -- was even greater, both at 12 months and 24 months after surgery, Venkataraman-Rao said.

But because the study did not have a comparison group that did not get the device, there’s “no way of knowing whether subjects would have improved on their own,” Venkataraman-Rao said.

How to Wreck Your Heart

What not to do for your heart's health.

When it comes to the heart’s health, there are some things you can’t control -- like getting older, or having a parent with heart disease. But there are many more things you can do to lower the chances of sabotaging your ticker.

“An ounce of prevention really is worth a pound of cure in this instance,” says Gregg Fonarow, MD, an American Heart Association spokesman and associate chief of UCLA's division of cardiology.

To help your heart keep on keeping on, here are 10 things not to do.

A major cause of heart disease, smoking raises blood pressure, causes blood clots, and makes it harder to exercise. And it’s the number one preventable cause of premature death in the U.S., according to the American Heart Association.

Even though it may be one of the most difficult habits to quit, the rewards of stopping smoking are perhaps the greatest and most immediate.

When you toss the smokes, your heart risk goes down within just a few days of quitting. Within a year, your risk is cut by half. After 10 years of living smoke-free, it’s as if you never smoked at all, says Nieca Goldberg, MD, cardiologist and medical director of the New York University Women’s Heart Program.

When your heart literally aches and you don’t know why, it’s time to get checked out.

If you have chest pains while exercising, that’s a red flag. But if it happens after a heavy meal, it’s more likely to be your stomach causing trouble, says Goldberg, who is an American Heart Association spokeswoman and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health.

Heart pain can feel more like a pressure rather than actual pain. People tend to feel it in the front of their chest, with the sensation sometimes extending into the shoulders, up into the jaw, or down the left arm. If you feel like an elephant is sitting on your chest and you’re breaking out in a sweat, that’s an urgent matter. Call 911.

Regardless of what you’re feeling or when, even a doctor can’t tell if you’re in real trouble over the phone. So you have to seek medical attention in person to get a definitive answer for chest pain.

Having a family history of heart disease is a strong risk factor for predicting your own chances of heart trouble.

Having a parent who has had an early heart attack doubles the risk for men having one; in women the risk goes up by about 70%, according to an American Heart Association report from December 2010.

Is Your Teen's Bedroom a Health Hazard?

Unless your kid is using his room to harbor wild animals or make explosives, it's probably not a true health hazard. But it might get plenty yucky in there.

Could your teen's bedroom be a health hazard? With the piles of crusty socks, the old cereal bowls of curdled milk, and the mildewed towels, it certainly might look -- and smell -- that way.

Happily, as disgusting as your teen's messy room might be, it's unlikely to pose any serious health risks. "I've never seen any teenager who actually got sick because her room was unsanitary," says Tanya Remer Altmann, MD,a pediatrician and author of Mommy Calls and The Wonder Years.

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Of course, whether or not your teen's messy room meets the Department of Health's legal definition of a health hazard isn't really the issue. If your teen's bedroom is disgusting, and it bothers you, you need to do something about it.

"Teenagers need to learn how to look after themselves, and cleaning their rooms is part of that," says Charles Wibbelsman, MD, chairman of the Chiefs of Adolescent Medicine for Kaiser Permanente of Northern California and co-author of The Teenage Body Book. It's a basic responsibility and a skill they'll need as adults, he says.

So how can you get your teen to keep his or her room clean, or at least somewhat less disgusting? Here's some advice from the experts.

Unless your kid is using his room to harbor wild animals or make explosives, he's probably not created a genuine health hazard. But it still might get plenty yucky.

"If you can smell your teen's room down the hall -- because of old food or old laundry -- that's not sanitary," Altmann tells WebMD. "And it could even conceivably pose some health problems." Like what?

Mold. Depending on the weather, it won't take long for mold to start growing on a half-eaten sandwich. Large amounts of mold could actually affect the air quality and aggravate a person's allergies or asthma.Insects and other pests. As you've no doubt already said to your teen a thousand times, dirty dishes attract insects -- like ants and cockroaches -- as well as other pests like mice and rats. Dust mites can thrive in clutter. Finding any of these creatures in your house is disgusting. But some can carry disease as well as trigger allergies and asthma, Altmann says.Bacteria and other fungi. Some nasty things can grow on unwashed, damp clothing in a messy room. And if your teen keeps wearing the clothes pulled off the floor rather than out of the bureau, he could develop rashes and other problems -- like jock itch, which is caused by a fungus.

While you may be horrified by the revolting things that you discover in your teen's bedroom, you may still feel powerless to do anything about them. Asking, pleading, and screaming don't seem to work. So how should a parent handle it?

IVF: Are 3 Embryos Too Many to Transfer?

Transferring more than two embryos during an IVF cycle is a dangerous practice that does not improve a woman’s chances of delivering a baby, a European study finds.

Researchers analyzed close to 125,000 in vitro fertilization (IVF) cycles performed in the U.K. over a five-year period in one of the largest studies ever to compare outcomes in women younger than 40 to those of older women.

The conclusion that there is no medical justification for transferring three or more embryos, even in women over the age of 40, has major implications in the U.S., where 1 in 3 IVF procedures involves the transfer of more than two embryos.

While that represents a decline from a decade ago, when closer to 2 out of 3 IVF procedures in the U.S. involved three or more embryos, there is still plenty of room for improvement, a study co-author says.

“The practice of transferring multiple embryos is very much market-driven in the United States,” says Scott M. Nelson, MD, PhD, of the University of Glasgow Centre for Population and Health Sciences. “There is an economic incentive for transferring more embryos in the U.S., but no sound medical reason for doing so.”

New York infertility specialist Glenn L. Schattman, MD, disagrees. Schattman is president of the Society for Assisted Reproductive Technology (SART).

SART guidelines call for the transfer of one or two embryos per IVF cycle in younger patients with the best prognosis, and as many as four embryos per cycle in patients in their late 30s and 40s with a poor chance of achieving a pregnancy.

He says it is clear from SART’s own statistics that the poorest-prognosis patients have a much better chance of having a baby when more than two embryos are transferred.

“There is a continuous and constant decline in fertility with increasing age, so it makes no sense to treat a 39- or 40-year-old the same way we would a 26-year-old,” he says.

The 124,148 IVF cycles analyzed by Nelson and colleague Debbie A. Lawlor, PhD, of the University of Bristol, resulted in 33,514 live births.

The live birth rate was greater with the transfer of two embryos, compared to one, in women under the age of 40 and in women who were older. Transferring three embryos resulted in a lower birth rate than transferring two in the younger women and made no difference in outcomes in older women.

Compared to single-embryo transfer, transferring two or three embryos was associated with a higher risk for all adverse birth outcomes, including low birth weight and preterm delivery.

Not surprisingly, the overall live birth rate was lower in older women compared to younger ones, no matter how many embryos were transferred.

“A clear implication of our study is that [the] transfer of three embryos should no longer be supported in women of any age,” Nelson and Lawlor write.

Juicing: How Healthy Is it?

What to know before adding fresh juice to your diet.

Juicing is popular. But before you give it a whirl, you might want to know what it may -- and may not -- do for your health.

What are the nutritional benefits and drawbacks? Can you juice for weight loss? What about food safety and claims about cleansing your system? Here's what you need to know.

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Jennifer Barr, a Wilmington, Del., dietitian, often makes fresh juice as a snack for her kids. Her favorite juice combines kale, carrots, ginger, parsley, and apples. She then adds the leftover pulp from her juicing machine into muffins.

“If you’re not big into fruits and vegetables, it’s a good way to get them in. It can help you meet daily recommendations in one drink” and be part of a healthy diet, says Barr, MPH, RD, LDN, who works at Wilmington's Center for Community Health at Christiana Care Health System.

But you shouldn't count on juicing as your sole source of fruits and vegetables.

"Don’t think because you’re juicing that you’re off the hook with eating fruits and vegetables,” says Manuel Villacorta, MS, RD, CSSD, an Academy of Nutrition and Dietetics spokesman and founder of Eating Free, a weight management program.

Aim to eat two whole fruits, and three to four vegetables a day. They should come in different colors, as the colors have different vitamins and minerals, Barr says.

A juicing machine extracts the juice from whole fruits or vegetables. The processing results in fewer vitamins and minerals, because the nutrient-rich skin is left behind. Juicing also removes the pulp, which contains fiber.

You can add some of the leftover pulp back into the juice or use it in cooking.

Besides muffins, Barr uses other combinations -- such as spinach, pears, flaxseed, celery, and kale -- to make broth for cooking soup, rice, and pasta. She calls it "going the extra step to fortify your meals."

Juicers can be expensive, ranging from $50 to $400. Some more expensive juicers will break down a lot of the fruit by grinding the core, rind, and seeds, Barr says.

You may not need a juicing machine to make juice. You can use a blender for most whole fruits or vegetables to keep the fiber -- add water if it becomes too thick, Villacorta says.

You’ll also want to remove seeds and rinds, and some skins.

Psoriatic Arthritis: Caring for Skin and Joints

If you've been diagnosed with psoriasis, it's important to be on the lookout for painful or swollen joints in your body that could indicate the development of psoriatic arthritis.

About 30% of people with psoriasis develop psoriatic arthritis symptoms, usually when they are between 30 and 50 years of age. Psoriatic skin lesions usually occur before the onset of arthritis. Early detection and receiving prompt psoriatic arthritis treatment are essential. Untreated psoriatic arthritis can result in permanent, crippling joint damage.

Since most people with psoriatic arthritis also have psoriatic skin lesions, it's important to balance treatment for your skin and joints. The good news is there are a variety of psoriatic arthritis treatments, including lifestyle habits and medications. Many are effective against psoriasis and psoriatic arthritis, meaning the same therapies can benefit your joints and your skin.

"At the moment, the key thing is awareness among patients with psoriasis and dermatologists who treat psoriasis to help prevent the progressive damage that can occur with psoriatic arthritis," says Seattle-based rheumatologist Philip Mease, MD.

Researchers don't know what causes some people with psoriasis to develop psoriatic arthritis. Evidence suggests that a combination of genetics and the environment can trigger an autoimmune response in which the body attacks its own tissues. That autoimmune response causes psoriatic arthritis symptoms, such as inflammation in the joints.

If you have psoriasis, you could be at risk of developing a variety of different forms of psoriatic arthritis, each of which can vary in severity among individuals and within a given person over a period of time. Psoriatic arthritis can be symmetric, meaning it occurs in the same joints on both sides of the body. But it is more often asymmetric, meaning it may affect the fingers of your left hand and toes of your right foot, for example.

For many people, the symptoms of psoriatic arthritis include swelling of the fingers and toes. They may take on a characteristic sausage shape, which is called dactylitis. If psoriatic arthritis affects the joints of your toes and fingers, it is most likely to strike the ones closest to the nail. Psoriatic arthritis can cause your nails to develop pits or peel away from the nail bed. In contrast, rheumatoid arthritis (RA) -- another autoimmune disease -- is more likely to affect the toe and finger joints closest to the hand or foot.

At times, psoriatic arthritis symptoms can cause your joints to be painful and stiff even when there is no swelling. In some instances, psoriatic arthritis leads to arthritis of the spine, known as spondylitis. In rare cases, it can lead to a disfiguring condition in the hands and feet called arthritis mutilans.

Regardless of which joints are affected by psoriatic arthritis, you may find you have morning stiffness and fatigue.

Study: Higher Heart Attack Risk From Pradaxa

People Taking Pradaxa Have 33% Higher Heart Attack Risk Than People Taking Warfarin

Patients taking the new anti-clotting drug Pradaxa have a 33% higher risk of heart attack or severe symptoms of heart disease than do patients taking warfarin.

The finding, from Cleveland Clinic researchers Ken Uchino, MD, and Adrian V. Hernandez, MD, PhD, is based on data from seven clinical trials that enrolled 30,514 patients.

"The risk of [heart attack] or acute coronary syndrome is increased with [Pradaxa] compared with various control treatments, which include adjusted-dose warfarin, [Lovenox], or placebo," Uchino and Hernandez conclude.

Acute coronary syndrome -- acute symptoms of serious heart disease -- is usually caused by the rupture of a plaque in a heart artery.

In an editorial accompanying the study in the Jan. 9 issue of Archives of Internal Medicine, journal editor Rita Redberg, MD, notes that this isn't the first safety warning issued for Pradaxa.

The FDA is investigating an unusually large number of reports of serious bleeding linked to the drug. Japan and Australia already have issued a safety warning. The European Medicines Agency advises doctors to check patients' kidney function before prescribing Pradaxa. And last year the FDA warned patients that the drug breaks down quickly when removed from its original container.

"These additional concerns deserve serious consideration in weighing the risks and benefits of [Pradaxa]," Redberg concludes.

Despite the apparent increase in heart attack risk, Uchino and Hernandez note that the benefits of Pradaxa -- particularly its ability to prevent stroke in patients with atrial fibrillation -- outweigh its risks.

And they note that while the risk of heart attack or acute coronary syndrome is higher in patients on Pradaxa than in those on warfarin, the actual risk of these events is increased by only 0.25% per year.

That's still an important added risk for patients who may already be piling up risk factors for heart disease, says Kirk Garratt, MD, clinical director of interventional cardiology research at New York's Lenox Hill Hospital.

While absolute risk may not be bad, when added on top of measurable risk it becomes worth noting.

"If I have a patient on this drug for 10 years, I'd expect a 5% increased lifetime risk of heart attack," Garratt tells WebMD. "The most important aspect of this study is that it allows us to see a consistent risk across studies and types of patients. That speaks to the conclusion that this study is well done and that the risk is real."

John Smith, MD, senior vice president of clinical development and medical affairs for Pradaxa maker Boehringer Ingelheim, does not agree that the study was well done.

While Garratt sees the diversity of studies as a strength, Smith says the different studies -- which compared patients taking Pradaxa for different reasons to patients taking warfarin, the blood thinner Lovenox, or placebo -- should not be lumped together.

Smith notes that a recent manufacturer-funded study found that the increase in heart attacks with Pradaxa is not large enough to be scientifically meaningful. But more important, he says, is that even the authors of the current study find Pradaxa's benefits to outweigh its risks.

"We have done the analysis and feel there is still a very favorable risk/benefit profile for the drug as prescribed in clinical practice," Smith tells WebMD. "We take the safety of patients taking our medicines as a top priority. This is something we actively monitor and are in communication with the FDA and other regulatory agencies. Safety is paramount in our minds."

Teach Your Kids Cold- & Flu-Fighting Habits

How soon should your kids learn how to avoid cold and flu viruses? The sooner the better.

As your babies get older -- and grow out of that maddening I-must-put-everything-in-my-mouth phase -- you can start teaching them habits that will protect them from germs like cold and flu viruses. How soon? The sooner the better.

"Good hygiene habits are much easier to introduce when your kids are young," says Laura A. Jana, MD, a pediatrician in Omaha, Neb. and co-author of Heading Home with Your Newborn and Food Fights. "Bad habits are hard to break."

Adopting healthy habits for kids can have concrete benefits. Dodging just one or two of those day care cold viruses could save you a lot of misery. And healthy habits can help protect your child from swine flu this fall and winter. Even if the benefits aren't immediate, teaching healthy habits will pay off.

"If they start learning proper hygiene when they're young, they may not get sick as much when they're older," says Tanya Remer Altmann, MD, a pediatrician and author of Mommy Calls:Dr. Tanya Answers Parents' Top 101 Questions About Babies and Toddlers.

What Your Teen Isn't Telling You

By Valerie Frankel On a recent Tuesday afternoon, my daughter Maggie, 15, didn’t come home on time from school. I tried her cell phone; no answer. To my knowledge, she didn’t have any activities or specific plans. By five o’clock, genuine worry kicked in. My hand was poised over the phone. I had no idea whom to call. Her friend circle was in heavy rotation. At 5:13, she walked in, dropped her backpack on the floor, and said with infuriating nonchalance, "Hey. What’s for dinner?" "Where have you...

Read the What Your Teen Isn't Telling You article > >

So what sort of healthy habits for kids are realistic? Can a preschooler really learn ways to get protection from cold and flu viruses? Here's what the experts have to say.

When teaching healthy habits, focus on what's important. You probably don't need to lecture toddlers on the germ theory of disease. Concepts like contagion are probably too hard to grasp for little kids.

"You really can't teach a preschooler to stay away from a friend who's coughing," Jana tells WebMD.

So instead of explaining, the key is to practice and ritualize some good behaviors. If you make them systematic, the odds are much better that you kids will stick with them -- and stay a little healthier as a result.

"If you make good habits part of a routine, it all becomes much easier," says Jana. "Your kids will do them without thinking."

When it comes to healthy habits for kids, hand washing is the most important one. To make it work, it's got to be built into their daily routines.

"Parents should make hand washing a ritual, like brushing their teeth," says Jana. You don't have to do it so obsessively that their hands get chapped. But you should always have your kids wash their hands:

When they arrive at day care or preschoolBefore they eatAfter changes or after using the potty or toiletAfter a play dateAs soon as they come in the house -- whether it's from school or from playing in the yard

The key is consistency. Get them to do it every time. If you do, your kids might start hand washing automatically. They might even start reminding you if you forget.

Teen Girl Safety: Parties, Raves, Drugs, Alcohol, and More

Why partying may be riskier than you think

Partying sounds fun. But sometimes, parties get out of hand.

Here are seven risky scenarios and ways to work around them.

You already know that it's illegal if you're underage. But alcohol is often part of parties -- and some teens drink so much that they put their lives at risk.

"I've seen people come in barely breathing, they can't remember what happened the night before, they've thrown up, fell over, or peed on themselves, and ended up in the hospital with a plastic tube in their nose. There's nothing sexy or attractive about that," says Yale University ER doctor Darria Gillespie, MD, MBA.

And the earlier you start using alcohol or other drugs, the more likely you'll be addicted later on, Gillespie says.

What to do: Stay calm and say no. Pretty soon, people will forget about whether or not you're drinking. Bring your own cup to the party, filled with fruit punch and covered with a lid. That way you can say, "Thanks, I've got one," and change the subject, says Amee Nash, LPC, a counselor and community educator who has worked with teens and addiction for more than 10 years.

Or blame your parents, Nash says. Try one of these lines:

"If I do, this is the last time you'll see me at a party.""I'll lose my car if I get caught.""I was just grounded, so I don't want to get in trouble again."

Be aware that it wouldn't be hard for someone to slip something into your drink, such as a date rape drug like Rohypnol or GHB. So stick to nonalcoholic drinks, pour the drink yourself, and don't leave it unattended.  

"Whatever is going to help you stay safe, do it," Nash says.

Apart from drinking games, there are some other dangerous party games you should absolutely never play.

Teen Girls’ Guide to Teen Boys: Changes During Puberty

The physical and emotional changes teen guys go through.

You may be noticing guys more often than when you were a kid.

Understanding boys can be tricky. So here’s the inside scoop on what teen guys go through.

Boys usually begin puberty between the ages of 10 and 15. That's two years later than most girls.

Starting at about age 12 or 13, and as early as 9, hormones called androgens bring on a number of physical changes, says Lori Legano, MD, assistant professor of pediatrics at New York University and attending physician for the adolescent clinic at New York's Bellevue Hospital Center.

One of the first things guys start to notice is that their testicles and scrotum (the sac located underneath the penis) start to get larger. Their penis gets longer and wider and pubic hair begins to grow in, too.

Legano says male hormones are the reason for a number of other changes. Maybe you’ve noticed some of these developments in the boys you know:

Hair has started to grow on their faces.Hair under the arms starts to show up.Body odor becomes an issue. 

Guys and girls have different timelines when it comes to puberty.

It breaks down like this:

Girls grow very fast (this could start as young as age 8), get their periods, their growth plates fuse, and they stop growing. Puberty over.

Boys, on the other hand, take their sweet time. They may not have a major growth spurt until age 15 or 16, and they sometimes keep growing into their early 20s.

That’s why around the 8th grade you have taller girls and smaller boys.

 “Boys are slow to grow but then they catch up later,” Legano says.

Puberty is the fastest you’ll grow, other than when you’re a little baby, says Marc Lerner, MD, of the University of California, Irvine.

All that change can be awkward at times.

“Guys are also sometimes uncomfortable with how their body is changing in terms of height, their physical strength, or acne,” Lerner says. And, guys who develop slower and are smaller than other boys may feel really stressed about it.

On top of that, boys’ voices become deeper and may start to crack. Guys can blame their growing larynx, or voice box, for that.

If a boy seems pretty shy about talking to you or speaking up in class at this age, it could be that he feels awkward about his voice.

When Kids Are Sick: How to Prevent Germs from Spreading

Want to prevent viruses from spreading in your home? These quick tips from the pros may help.

Taking care of a sick toddler isn’t fun. But taking care of two sick children is worse. It means more misery and sleepless nights -- and for you, more missed days of work.

So short of ordering everyone into hazmat suits, what are you supposed to do the next time one of your kids comes home from daycare flushed and feverish? How can you protect the rest of the family and prevent germs from spreading?

“I know some parents who just give up,” says says Tanya Remer Altmann, MD, a pediatrician and author of Mommy Calls:Dr. Tanya Answers Parents' Top 101 Questions About Babies and Toddlers. “They assume that once the virus is in the house, everyone’s going to get it. But there are some precautions that can help.”

Containing a virus isn’t easy -- especially within a family. But here’s some advice from pediatricians and experts on infectious disease on how to prevent germs from getting the rest of the family sick.

Get your kids to wash their hands. Yes, this one should be obvious. But it really can’t be stressed enough: hand washing is a crucial way to prevent germs from spreading. About 80% of infectious diseases are spread by touch.

 “Two of the most important things we’ve done in medicine are getting people vaccinated and getting them to wash their hands,” says Robert W. Frenck Jr., MD, professor of pediatrics at the Cincinnati Children's Hospital Medical Center and member of the American Academy of Pediatrics’ Committee on Infectious Disease. 

When you have a sick toddler, germs can get absolutely everywhere. That means that your healthy child is bound to pick them up on his hands. But as long as he’s washing his hands regularly, the germs might not make it from his hands into his eyes or mouth. 

If kids are going to wash their hands, teach them to do it right. Experts recommend scrubbing hands for 20 seconds or so -- as long as it takes to sing “Happy Birthday” twice. The type of soap doesn’t matter -- to prevent germs, the regular stuff will work just as well as antibacterial soap.

When warm water and soap aren’t available, use an alcohol-based sanitizing gel -- just make sure to rub your hands together vigorously for about 20 seconds until the gel evaporates.

Wash your own hands. To prevent germs from spreading, the same advice goes for you too. Don’t get so focused on wiping down your sick toddler’s toys that you forget to wash your own hands. It’s important for a couple of reasons. First, you don’t want to get sick -- taking care of a sick toddler while being sick yourself can be punishing.

But second, if you’re not washing your hands, you could actually be the one who infects your healthy child -- even if you don’t get sick. All it might take is for you to pick up your sick toddler’s tissues and then make your healthy kid’s lunch. Bingo: you’ve got two sick children.

Step up your disinfecting. Even if you’re not germ-obsessed usually, now might be a time to focus more on disinfecting surfaces in your home. It can help prevent germs from spreading.

“I think when one child is sick, some extra sanitizing around the house can definitely help prevent other family members from getting it,” Altmann tells WebMD.

What should you do? You could wipe off surfaces that your sick toddler has touched -- like doorknobs, tables, and handrails -- with a disinfectant. Many plastic toys can be thrown in the dishwasher, and many stuffed animals in the washing machine. If your sick toddler is suffering from vomiting and diarrhea, take extra care to disinfect the toilet, floor, and sink in the bathroom.

That said, don’t make yourself crazy in your attempts to prevent germs from spreading. You don’t want to spend your days following your sick toddler around the house, spraying everything in her wake with disinfectant. Besides, it won’t work. There’s no way that you’ll be able to eradicate all of the germs anyway.

Why Is Alcohol Addictive? Study Offers Clues

 We know alcohol makes many people feel good, and that it affects the brain, but new research goes a step further by tightening the focus on areas of the brain most likely affected by alcohol.

The new brain imaging research may lead to a better understanding of alcohol addiction and possibly better treatments for people who abuse alcohol and other drugs.

Investigators say they have identified specific differences in how the so-called reward center of the brain responds to alcohol in heavy and light drinkers.

In both groups, drinking alcohol caused the release of naturally occurring feel-good opioids known as endorphins in two key brain regions associated with reward processing.

But heavy drinkers released more endorphins in response to alcohol, and they reported feeling more intoxicated than the lighter drinkers after drinking the same amount of alcohol.

The findings suggest that people whose brains release more natural opioids in response to alcohol may get more pleasure out of drinking and may be more likely to drink too much and become alcoholics, researcher Jennifer M. Mitchell, PhD, of the University of California, San Francisco, says.

“Greater endorphin release was associated with more hazardous drinking,” Mitchell says. “We believe this is an important step in understanding where and how alcohol acts in the brain.”

Mitchell says the findings could lead to better versions of the existing alcohol abuse drug naltrexone, which blocks the opioid response and blunts alcohol cravings in some, but not all people.

Mitchell says a better understanding of the specific endorphin receptors involved in the alcohol “high” could lead to treatments that better target these reward centers. Currently, naltrexone takes more of a buckshot approach, affecting multiple receptors. This research could lead to more focused medications.

The University of California study included 13 people who identified themselves as heavy drinkers and 12 people who did not.

Using PET imaging, the researchers were able to measure opioid release in the brain before and immediately after the study participants drank the same amount of alcohol.

Drinking alcohol was found to be associated with opioid release in the nucleus accumbens and orbitofrontal cortex -- two areas of the brain associated with reward processing.

The study appears in the Jan. 11 issue of the journal Science Translational Medicine.

Although the nucleus accumbens has been previously associated with opioid regulation and reward processing, the involvement of the orbitofrontal cortex was unexpected, Mitchell and colleagues write.

Raymond F. Anton, MD, who directs the Center for Drug and Alcohol Programs at the Medical University of South Carolina, says it is likely that there are other, as-yet-unidentified regions of the brain associated with addiction.

“It is also likely that alcohol dependence is not one disease, but many, with many systems involved,” he says. “People drink for different reasons, so a treatment that works for one person may not work for another.”

Anton is conducting genetic research in hopes of discovering why naltrexone blunts alcohol cravings in some people but not others.

“We may be able to say in a few years if genetic predisposition can predict who will and will not respond to this drug,” Anton says.

Why Coffee May Reduce Diabetes Risk

Chinese Researchers Zero in on Coffee Substances That May Explain the Benefit

Coffee drinking has been linked with a reduced risk of diabetes, and now Chinese researchers think they may know why.

Three compounds found in coffee seem to block the toxic accumulation of a protein linked with an increased risk of type 2 diabetes.

''We found three major coffee compounds can reverse this toxic process and may explain why coffee drinking is associated with a lower risk of type 2 diabetes," says researcher Kun Huang, PhD, a professor of biological pharmacy at the Huazhong University of Science & Technology.

Previous studies have found that people who drink four or more cups of coffee a day have a 50% lower risk of getting type 2 diabetes.

The new study is published in the Journal of Agricultural and Food Chemistry.

Type 2 diabetes is the most common type. In those who have it, the body does not have enough insulin or the cells ignore the insulin. The hormone insulin, made by the pancreas, is crucial to move glucose to the cells for energy.

Other researchers have linked the ''misfolding'' of a protein called hIAPP (human islet amyloid polypeptide) with an increased risk of diabetes. HIAPP is similar to the amyloid protein implicated in Alzheimer's disease, Huang says.  When these HIAPP deposits accumulate, they can lead to the death of cells in the pancreas, Huang tells WebMD.

The Chinese researchers looked at three major active compounds in coffee and their effect on stopping the toxic accumulation of the protein:

Caffeine Caffeic acid or CAChlorogenic acid or CGA

"We exposed hIAPP to coffee extracts, and found caffeine, caffeic acid, and chlorogenic acid all inhibited the formation of toxic hIAPP amyloid and protected the pancreatic cells," Huang tells WebMD.

All three had an effect. However, caffeic acid was best. Caffeine was the least good of the three.

Those results suggest decaf coffee works, too, to reduce risk, Huang says. "In decaffeinated coffee, the percentage contents of caffeic acid and chlorogenic acid are even higher [than in regular coffee], whereas the level of caffeine is greatly reduced."

"We expect that decaffeinated coffee has at least equal or even higher beneficial effect compared to the regular caffeinated types," Huang says.

In patients who already have diabetes, he says, several studies suggest decaf is better for them than regular coffee.

The National Basic Research Program of China, the Natural Science Foundation of China, and other non-industry sources funded the research.

1911 medical conditions: wife's long tongue and children's quarrelsome stubbornness

In many of the entries individuals' negative attributes are listed, rather than their illnesses.

One record, written by John Underwood from Hastings, East Sussex, describes his children as ''quarrelsome'', ''stubborn'', ''greedy'', ''vain'' and ''noisy'' while he records himself as ''bad-tempered'' and his wife as suffering from a ''long tongue''.

Another unusual entry is from Thomas Wallace Young, who was described as ''bald and toothless''.

The cause of the suffragettes is also illustrated within the records, with some women listing their infirmities as not having the vote or not being enfranchised. For example, four women living in the same household recorded their infirmities as ''voteless, therefore classed with idiots and children''.

Others chose to make a note of their good health instead of the health problems the form enquired about, giving answers such as ''well'', ''healthy'', ''sane'', ''alright'', and even ''perfect''.

Evelyn Baker and her family from Leeds were recorded in the census by their father, Addiman Parkin Barker, as simply being ''alive'' and 72 entries said of their illnesses: ''none, thank God''.

The census also shows a correlation between infirmity and occupation. The biggest source of employment for blind men and women was basket-weaving. Other trades for blind men were as musicians or musical instrument makers.

Women who were deaf and dumb were often employed within the textile or garment trades, or in domestic service, while men were most likely to be labourers.

Debra Chatfield, family historian at findmypast.co.uk, said: ''The infirmities column is the last piece of the jigsaw completing the 1911 census. This column alone provides a fascinating insight into life a hundred years ago.

''It not only reflects health conditions, but also a time before society became aware of political-correctness and certain terminology was deemed acceptable.

''In the more unusual entries we also get a wonderful sense of post-Edwardian humour, society and family dynamics at this time.''

Audrey Collins, family history records specialist at The National Archives, said: ''The information in the infirmities column being released today helps add an extra dimension to the picture of our ancestors' lives in 1911.

''We have to remember that the census returns were completed by relatives living in the same house who for the most part had no specialist medical knowledge.

''Their descriptions provide us with a clue as to how each individual was viewed by other family members, although many would have been reluctant to admit that their relatives suffered from any defect.''

'Am I drinking too much?'

By all current assessment, that makes me a raging social alcoholic and groups me with the girl in the purple miniskirt and white court shoes, splayed face down on the pavement outside a pub in central Manchester on a Friday night. But I credit myself with a more sophisticated approach to my drinking, something akin to Madame Bollinger’s to champagne: “I drink champagne when I’m happy and when I’m sad,” she said “Sometimes I drink it when I’m alone. When I have company, I consider it obligatory. I trifle with it if I’m not hungry and drink it when I am. Otherwise, I never touch it – unless I’m thirsty.”

Quite so, except I tend to drink water when thirsty and I am extremely fussy about the quality of wine that I drink. If it is disgusting, I will not take more than a couple of sips. I am a middle-class, middle-aged social drinker with taste – and that, I believe, is the saving grace when it comes to my alcohol intake. Unfortunately, the NHS does not agree.

For the purposes of research, I visited the NHS Choices website, which provides a link to an online gadget that calculates whether you drink too much. “How often do you have 6 or more units [three glasses of wine] of alcohol on one occasion,” it asks. I tick “Weekly”.

“How often during the last year have you found that you were not able to stop drinking once you have started?” I tick “Weekly,” wanting to add, “because it was so delicious.”

“How often have you needed an alcoholic drink in the morning to get yourself going?” “I’m not that bad,” I mutter in protest, ticking “Never”.

Then a window pops up on screen saying it is ''concerned’’ about my overall drinking habits. It does not advise Alcoholics Anonymous, but says to stop friends topping me up, and to join in activities that do not involve drinking.

I bristle. This makes me sound as if I drink all day every day, when the truth is that I am amazed I can fit in the units I do consume, so busy am I not drinking. If I have to write or do other work the next day, I may only drink a glass, but quite often nothing at all. I cannot, like some legendary alcohol-fuelled authors, produce decent prose on a bottle or two of wine.

Included in non-drinking time are household and family chores, shopping trips, dog-walking and an occasional run in the park – and sleeping, of course. Ideally, I prefer not to drink between Sunday night and Friday afternoon. I do drink more at weekends. This puts me back in the purple miniskirt as a “binge drinker”, hints my NHS cyber-confidant. “But you do not understand,” I plead with the screen. “I drink nicely, not disgustingly.”

I am not being flippant, nor am I unaware of the tragic consequences of drinking heavily – and addiction. Some 25 years ago, a close relative died of a stroke, the result of liver disease, when he was only 53. He had been told to stop drinking, and could not. Afterwards I became curious about the psychological side of alcoholism, attending AA family group meetings and consulting experts. Learning at what point a drinker becomes an alcoholic, I found the differential being when your drinking is an obvious cause of harm to yourself and others.

I have a stronger head than many. I do not slur my words or stagger when drunk. I may talk louder and laugh easier, but I don’t start singing ballads or get angry. I have noticed, however, that now I am older my head is less clear the next day, which is why I do not drink when full concentration is needed. After drinking too much, I may wake with a painful headache and feel spaced out and shivery until late afternoon. Wine also makes me fat.

So I am, in every sense, a controlled drinker, adapting my intake of alcohol and its consequences to the demands of my life. But I do still worry about my liking for it. A recent week long trip to a “dry” state in the Middle East filled me with enough foreboding to ask for several refills on the plane. Meze without wine, I thought gloomily. I did not feel panicky about it but very petulant.

Oh dear. On paper this does not look good. Avid wine drinkers may do better not to try and explain their passion and habits, when medical advice is so black and white. The health authorities do not discriminate over social-economic status, genetics or the choice of “poison” – organic, biodynamic wine or Mike’s Hard Lemonade. Yet, my conclusion is that there is only one person who knows if you are overdoing it: yourself. And while I still have a choice in the matter of whether or not to pour myself a drink, I do not think I drink too much. Do I?

Alcohol – good or bad?

While most of us know that heavy drinking is harmful, there is confusion as to whether a regular, moderate tipple is good or bad for our health. Here’s what the best research has established:

Light or moderate drinking reduces the risk of heart disease by a quarter compared with not drinking at all, according to a large study that included all types of alcohol. But heavy drinking increases heart disease risk.

Alcohol increases the risk of breast cancer in women, bowel cancer in men and cancer of the mouth, throat, voicebox and gullet (oesophagus) in both sexes, says the World Cancer Research Fund. It also probably increases the risk of liver cancer, and bowel cancer in women.

Where cancer is concerned, there seems to be no safe level: one UK study found that, for middle-aged women, even low to moderate consumption significantly raised the risk of breast cancer.

Light to moderate drinkers have a significantly reduced risk of dying earlier (with wine having the strongest effect). Heavy drinkers increase their risk of an early death.

Heavy drinking is also associated with liver disease, digestive disorders, depression, sexual difficulties, muscle disease and obesity.

Pregnancy: heavy drinking is harmful to the unborn baby but less is known about light or moderate consumption. Pregnant women are advised to avoid alcohol altogether if possible.

The conclusion? Moderate drinking has modest benefits for the heart but may also raise cancer risk. It’s wise to stick to recommended limits: no more than 3-4 units of alcohol a day for men and 2-3 units daily for women.

A unit is about equal to half a pint of ordinary strength beer, lager or cider and a small measure (25ml) of spirits. A small glass (125ml) of wine contains about 1.5 units.

Government will pay for women who had breast implants on NHS to have them removed

But it said the 5% of women who had their implants on the NHS as part of breast reconstruction surgery will be able to have them removed and replaced if they are concerned, and following consultation with their doctor.
The Government said it expects private firms to offer the same deal to anxious women who also wish to have their implants removed.
A Government review ordered by Health Secretary Andrew Lansley has concluded there is no clear evidence that patients with PIP implants are at greater risk of harm than those with other implants.
Advice from the Medicines and Healthcare products Regulatory Agency (MHRA) has not changed: there is still no evidence of health risks to support routine removal of the implants.
But experts behind the review concluded that anxiety is a form of health risk and recognised that many women would be anxious.

Health boss says patients should sue health trust for best drugs

Professor Rawlins, the chairman of the National Institute of Health and Clinical Excellence, said the economic pressure on trusts meant that “completely illegal” decisions were being made to limit the use of expensive drugs.
He told the Financial Times: “I just wish a patient organisation would take a Trust to court for failing to comply.”
Nice has been criticised for ruling against the prescription of expensive new drugs on the grounds that they are not cost-effective.
But Sir Michael told the paper that most of Nice’s recommendations were in favour of prescription and that it was other bodies that blocked the drugs’ use.
Sir Michael criticised the local lists of approved medicines drawn up across the NHS which “second-guess” and sometimes ignore Nice recommendations.

Leading cosmetic surgery group refusing to fund new breast implants

Ministers have agreed to pay for the removal of the French-made silicone products for women who had them on the NHS, and have called on private clinics to acknowledge their “moral duty” to offer the same service.
Although the Department of Health said it would “pursue private clinics with all means at its disposal to avoid the taxpayer picking up the bill”, it confirmed on Friday night that it would help women if their clinic was no longer in operation or refused to care for them.
Officials say the implants – thought to have been fitted in some 52,000 women who wanted larger breasts for cosmetic reasons or after cancer surgery – only need to be replaced if they have ruptured but will also carry out the procedure if the patients are worried about them.
Most independent providers have agreed to provide free surgery for their patients who received implants made by the now-defunct Poly Implant Prothèse – which were filled with non-medical grade silicone intended for use in mattresses – at least one is holding out while another has so far refused to reveal its policy.
Transform Cosmetic Surgery said the Government needed to “accept its responsibility” for the problem as the implants had been approved for use by a watchdog, the Medicines and Healthcare products Regulatory Agency.

More than half of hospital beds cut were for elderly patients

Experts have warned that elderly patients are being discharged too early, putting their health at risk and increasing the likelihood of them being readmitted to hospital.
The full scale of the cuts emerged after a year in which the NHS faced sustained criticism for its treatment of the elderly.
The Daily Telegraph surveyed 172 NHS trusts about how many beds they had closed.
Of the 39 trusts which responded, it emerged a total of 469 hospital beds have been cut since April 2010. Of these, 259 were specifically elderly beds.
According to the latest Department of Health figures, 17% of the 121,000 beds in NHS hospitals are for the elderly, suggesting that managers have deliberately targeted elderly beds for cuts.

Radioactive cream used to treat skin cancer

The therapy for basal cell carcinoma, the most common form of skin cancer, uses a radioactive isotope to kill tumour cells in just half an hour while leaving the skin around it unharmed.

Although it has not yet been approved for use, a study of 1,000 patients in Rome found it completely removed tumours in 95 per cent of patients with just one treatment.

Larger trials have been set up in Germany with the intention of bringing the therapy to the market.

Basal cell carcinoma is caused by exposure to harmful UV rays from natural light or sunbeds and accounts for about 80 per cent of all skin cancer cases, or 90,000 cases a year in Britain.

It not normally metastatic, meaning it does not spread through the body or pose a threat to life, but the routine treatment is surgery which although effective can leave unsightly scars.

 

In some cases, for example where the tumour is on the face, there are alternative ointments and light-based therapies but most are only suitable for lumps which do not penetrate too deeply into the skin.

Now researchers say they have developed a new cream using rhenium-188, a radioactive isotope, which can kill even deep tumours without side-effects in the vast majority of cases.

A base layer applied directly onto the skin protects healthy cells from the radioactive element, which sits on top of the base where it can irradiate the skin below and shrink the tumour.

It could dramatically improve the quality of life of patients who could otherwise require skin grafts and face serious scarring as a result of surgery, researchers said.

Dr Ulli Köster, a researcher at the Institut Laue-Langevin (ILL) in Grenoble, France, where the radioactive material is produced, said: "Typically this disease is treated by surgery, and since it doesn't metastase this is usually OK.

"But the problem is if the tumour is on the face, on the nose, ear or somewhere, it is strongly disfiguring – someone can have a big scar or lose half of his face.

"This is a localised radiation therapy which in more than 95 per cent of cases a single treatment is sufficient to make the cancer go away."

Dr Maria Gonzalez, a dermatologist based at Cardiff University, said: "It is very specific types of patients who would choose this treatment.

"It would be very useful to have as an alternative to surgery. Sometimes if the tumour is very large, especially on the face, or the patient is elderly then it is not a reasonable approach to excise it (cut it out)".

Martin Ledwick, of Cancer Research UK, added: "I would imagine we are not talking about a major breakthrough but another option. It is nice to have a menu of different options for people, particularly with things that can have a cosmetic impact."

 

Sleep apnoea and trying to overcome the snoring it causes

I’m always keen to learn of people’s subjective experience of a treatment or procedure that raises doubts about its usefulness. Many will have heard of the disorder known as obstructive sleep apnoea, whereby breathing is interrupted during the night. Its two main knock-on effects – stentorian snoring and chronic exhaustion – can be eased by surgery to the back of the throat.

But some sufferers are understandably not very enthusiastic at the prospect, so opt instead for a CPAP (continuous positive airways pressure) device, which involves wearing a face mask at night through which air is pumped to keep the airways open.

Last year, Danish medical researcher Peter Gotzsche – who likened his snoring to “the roar of a ferocious animal” before a kill – was keen to give it a try. “When it started, it blew me up like a balloon,” he writes in the British Medical Journal. “It was very unpleasant, and after a while my throat dried out.” He consulted the 100-page manual that came with the device, but was unable to locate the relevant passage that would allow him to turn the pressure down.

The following night was no better, at which point he decided to read the manual thoroughly. To his dismay, he found buried in the text a warning that there was no guarantee that the CPAP device might not be lethal.

“I decided any inconvenience of my condition did not justify the risk of dying of the treatment,” he said.

15 minute daily exercise is bare minimum for health

Just 15 minutes of exercise a day can boost life expectancy by three years and cut death risk by 14%, new research suggests. Experts in The Lancet say this is the least amount of activity an adult can do to gain any health benefit.

This is about half the quantity currently recommended in the UK.

Meanwhile, work in the British Journal of Sports Medicine suggests a couch potato lifestyle with six hours of TV a day cuts lifespan by five years.

The UK government recently updated its exercise advice to have a more flexible approach, recommending adults get 150 minutes of activity a week.

This could be a couple of 10-minute bouts of activity every day or 30-minute exercise sessions, five times a week, for example.

“You can get good gains with relatively small amounts of physical activity. More is always better, but less is a good place to start” said Prof Stuart Biddle, an expert in exercise psychology at Loughborough University

The Lancet study, based on a review of more than 400,000 people in Taiwan, showed 15 minutes per day or 90 minutes per week of moderate exercise, such as brisk walking, can add three years to your life.

And people who start to do more exercise tend to get a taste for it and up their daily quota, the researchers from the National Health Research Institutes, Taiwan, and China Medical University Hospital found.

More exercise led to further life gains. Every additional 15 minutes of daily exercise further reduced all-cause death rates by 4%.

And research from Australia on health risks linked to TV viewing suggest too much time sat in front of the box can shorten life expectancy, presumably because viewers who watch a lot of telly do little or no exercise.

UK exercise recommendations

Under-fives (once walking independently): three hours every dayFive to 18-year-olds: at least an hour a day of moderate to vigorous intensity physical activity, plus muscle strengthening activities three times a weekAdults (including over 65s): 150 minutes a week of moderate to vigorous intensity physical activity, plus muscle strengthening activities twice a week

She added: “We hope these studies will help more people realise that there are many ways to get exercise, activities like walking at a good pace or digging the garden over can count too.”

Prof Stuart Biddle, an expert in exercise psychology at Loughborough University, said a lot of people in the UK now fall into the category of inactive or sedentary.

He said that aiming for 30 minutes of exercise a day on pretty much every day of the week might seem too challenging for some, but starting low and building up could be achievable.

30% rise in negligence claims against NHS

Clinical negligence claims against the National Health Service have increased by almost a third over the past year, with an extra £100 million paid out to victims of medical blunders. Nearly 9,000 patients claimed for damages after allegedly suffering at the hands of doctors or nurses, figures from the NHS Litigation Authority show.

It paid out £863m to victims of accidents in hospitals and clinics, up from £787m the year before, after settling 5,398 cases.

But a quarter of this was spent on legal costs, with £200m going to claimants’ lawyers under the system whereby so-called “ambulance chasers” can charge up to £900 an hour to pursue claims.

The litigation authority’s annual report is scathing about the current regime, which it claims is driving the “rapid growth in claims numbers” rather than any increase in mistakes by NHS staff.

Under the “no-win, no-fee” system set up by Labour so poorer people could have access to justice, known as Conditional Fee Arrangements, claimants do not have to pay for lawyers upfront. But if they win cases, the lawyers can claim big “success fees” from the defendant.

Steve Walker, chief executive of the NHS Litigation Authority , said: “We believe very strongly that a regime which allows success fees and the recoverability of After the Event (ATE) insurance premiums makes litigation so profitable that solicitors and so-called ‘claims farmers’ are drawn into the market thereby fuelling the rise in claims volumes we have experienced.”

However he added that the body is “delighted” that the Ministry of Justice is acting on the Jackson review of civil litigation costs, which recommended that success fees and ATE premiums should not be recoverable in no-win, no-fee cases.

At the same time the Government hopes to save millions every year by scrapping Legal Aid in cases of alleged malpractice.

The litigation authority’s report shows that in total it recorded 12,142 claims against NHS trusts in 2010-11 but expects only 4 per cent to go to court, as most will either be settled beforehand or dropped.

Of these, 8,655 were clinical claims, up from 6,652 the previous year, and 4,346 were non-clinical, up from 4,074.A further 22,364 claims were still open at the end of the financial year.

The authority – funded partly by trusts and partly by the Department of Health directly – paid out £729m under its main clinical scheme and a further £134m under claims relating to incidents that took place before 1995.

This was an increase on £651m under the current scheme and £136m under the old schemes recorded in 2009-10.

A further £47.9m was paid out in non-clinical cases.

However these figures do not only include compensation paid to patients, staff and members of the public but legal costs as well.

The costs claimed by claimant lawyers continue to be significantly higher than those incurred on our behalf by our panel defence solicitors. This continues to be a major concern.

“The availability of Conditional Fee Agreements (CFAs) and the continued increase in their use by claimants in clinical negligence claims has also meant that claimants’ costs are almost invariably disproportionate, often significantly, to the amount of damages paid, particularly in low-value claims.

“In the 5,398 clinical negligence claims closed by us with a damages payment in 2010/11, we paid over £257m in total legal costs, of which almost £200m (76 per cent of the total costs expenditure) was paid to claimant lawyers.”

Alcohol advisory body stacked with drinks industry lobbyists

Drinks industry lobbyists now make up almost half the members of a key body tasked with advising ministers on alcohol policy, research papers show.
Seven out of 16 members of the Government and Partners Alcohol Working Group are from industry, up from just a couple last autumn.

Critics believe it is evidence that the Coalition is pandering to the interests of the drinks industry, potentially at the expense of the nation’s health.

Some nine million people in Britain suffer from the harms of alcohol in some, either directly or indirectly, while the cost to the NHS stands at £2.7 billion a year.

Don Shenker, chief executive of the charity Alcohol Concern, believed companies were being allowed a bigger say in “setting the agenda” under the Coalition.

Speaking of the changes to the working group “I can only imagine it’s because this government believes that the drinks industry has a big role to play in shaping policy, in setting the agenda.

“And so they have extended the invitations to a larger set of people from the drinks industry.”

However, Anne Milton, the Public Health Minister, claimed ignorance of the body.

She said: “I think we have a communications problem in Whitehall because you know something that I have never heard of before.”

In opposition David Cameron talked tough on alcohol abuse, and the Conservatives’ manifesto said the party would ban off-licences and supermarkets from selling alcohol below cost price.

In January the Coalition announced that retailers would be banned from selling drinks for less than the value of duty and VAT.

But they will not have to take into account the cost of producing the drinks, meaning they will still be able to sell drinks at a net loss.

The Coalition has pursued an approach of working with industry, arguing it will be more effective than legislation.

However, in March eight organisations pulled out of the Coalition’s Public Health Responsibility Deal – including Alcohol Concern, the Institute of Alcohol Studies and the British Liver Trust.

They wrote to Andrew Lansley, the Health Secretary, saying the deal on alcohol – which includes voluntary agreements with industry – would not help reduce illness or deaths.

At the time Mr Lansley said imposing laws was often “costly” and they could “take years” to implement.

A spokesman for the Department of Health yesterday re-iterated that argument.

She did not deny that changes to the working group had been made.

The spokesman said: “We are committed to challenging the assumption that the only way to change people’s behaviour is through adding to rules and regulations.

Alcohol limits advice confusing

The advice on alcohol limits is too confusing according to Debbie Bannigan the head of the charity Swanswell. She says that ‘units’ mean nothing to many people – and the guidance should be clearer and easier to remember.

In this week’s Scrubbing Up, she says that to have a daily “safe” amount is misleading and that some people – including pregnant women and drivers – should be told “no alcohol is best”.

Most people think they have a rough idea of “how much is too much?”, but ask them for specifics and they’re not sure. Who can blame them, when the measure that is used to define safe limits – ‘units’ – is so hard to understand?

While 82% of adults claim to know what a unit of alcohol is, 77% don’t know how many units are in a typical large glass of wine.

Ironically, ‘units’ become even harder to compute when we’ve had a drink, because the part of our brain that works that sort of thing out switches off.

And the concept of a daily safe amount may even encourage the idea that we should drink alcohol every day.

To add to the confusion, we’re bombarded with new “scientific” findings about alcohol.

In the last couple of months alone, we’ve been told that alcohol damages the DNA of unborn children beyond repair, but that it’s OK for pregnant women to have a couple of glasses of wine a week, which is pretty conflicting advice.

Reported health benefits from alcohol are rarely balanced with information about the risks, or the observation that the benefits can be achieved in other ways that don’t carry any significant risks at all.

It’s little surprise that people are confused about the impact alcohol can have on their lives.

But walk into any supermarket and you’ll be encouraged to buy alcohol.

My local supermarket’s “seasonal aisle” – one of the first things you see when you enter the store – has become a wine festival.

And the end of each aisle – the “impulse buy” space – is also stacked with cans of lager and cider, so selecting and purchasing alcohol is just part of the weekly shop rather than something that we have to think about doing.

The people who come to us for help are just like you and me, but they’ve found that their choice to drink alcohol has been riskier than they expected.

What can be done about it? Official guidelines could be clearer. Other public health messages are short and snappy, like ‘clunk-click every trip’ or ‘catch it bin it kill it’. We shouldn’t be afraid of setting clear guidelines and sticking to them”

They are designed to be simple and memorable, so we learn and apply them without trying.

Units don’t work this way, but a simple phrase like ‘one or two, once or twice’ gives us a simple yardstick that drinking one or two alcoholic drinks, once or twice a week, is a good limit.

Sometimes a clear, easy to understand and safe message is that no alcohol is best – for example, for children, in pregnancy or when driving.

Scientific evidence shows that even one drink can impair judgement when driving and that alcohol affects children disproportionately, especially before they are born.

A zero limit for drivers, pregnant women and children avoids confusion and helps us all to take responsibility.  We shouldn’t be afraid of setting clear guidelines and sticking to them.

With co-operation between drinks manufacturers, supermarkets and the government we can judge the risk of alcohol use for ourselves.

Not only can we reach the point where hospital admissions are going down instead of up, we can create a society that is free from problem alcohol use altogether.

Amy Winehouse was killed by alcohol- the UK’s favourite drug

Death by misadventure was the verdict at the inquest of Amy Winehouse, who died in July. On the afternoon of July 23, the day Amy Winehouse died at the age of 27, a friend rang me with the sad news, saying: “Shows just how deadly heroin is, doesn’t it?” I replied that heroin certainly can be dangerous but that far, far more people kill themselves with booze, with nothing added, than die of taking heroin.

Either they die of a slow disease, like cirrhosis of the liver, or the booze can kill them there and then by poisoning them, depressing their central nervous system until everything stops.

Why did it have to be so called illegal drugs that killed her?

As an example of acute alcohol poisoning, I mentioned (in a blog I wrote that day) the sudden death of Dylan Thomas: his post mortem pointed to “insult to the brain”, caused by alcohol. Supposedly, Thomas had drunk 18 straight whiskies, which is about 36 single measures of whisky in British terms.

Winehouse’s friends had spoken of her having been so drunk, earlier that week in July, that she couldn’t stand. Later her boyfriend, Reg Traviss, and members of her family made it clear she had not taken illicit drugs for some time.

Today the coroner has spoken: the poor singer’s blood contained 416mg of alcohol per decilitre*. “The unintended consequences of such potentially fatal levels,” said the coroner, “was her sudden and unexpected death.”

Professor Suhail Baithun, a Home Office pathologist, said people start losing their faculties at 200mg of alcohol per decilitre, and “when you have levels of 350mg, it is associated with fatalities”.

Why do we always assume illicit drugs are responsible in these sudden deaths? Sometimes they are, obviously. But I also think we blame drugs because they’re strange and frightening, and we don’t like to think of booze like that, we don’t like to think of it as deadly stuff.

Booze is supposed to be our friend, it’s part of our culture, it helps us to relax. Many of us couldn’t cope with life’s daily challenges without it. It is, in the words of those bossy health education campaigns of old, “our favourite drug”.

We prefer not to think about what it can be — a strong poison that kills in overdose.

*This has been expressed in most news reports as five times the drink-drive limit. In Britain the drink-driving limit is normally given in milligrams per 100 millilitres (one deciliter) of blood, or, most commonly, in micrograms per 100 millilitres of breath. The drink-driving limit is 80 milligrams of alcohol per 100 millilitres of blood. It’s certainly a lot of alcohol.

An apple or pear a day keeps strokes at bay

Eating lots of fruit and vegetables with white flesh may help to protect against strokes, says a study in the journal Stroke. But Dutch researchers say they do not know why people with a high intake of apples, pears, bananas or cauliflower reduce their risk of stroke by 52%.

The study followed more than 20,000 adults over 10 years.

Stroke experts said people should not be put off eating other colours of fruit and veg.

At the start of the study, carried out in The Netherlands, participants were asked to fill in a detailed questionnaire on diet and lifestyle for the previous year.

By using this information and tracking the health of participants over the next decade, researchers were able to examine the link between the colour of fruit and vegetables consumed and stroke risk.

The study found that a 25g per day increase in white fruits and vegetables was linked to a 9% lower risk of stroke.

Of the white fruit and veg eaten, over half was apples and pears. An average apple weighs 120g.

But no link was found between stroke incidence and green (dark leafy vegetables, cabbages and lettuces) orange/yellow (mostly citrus fruits) or red/purple fruits and vegetables.

Linda Oude Griep, lead author of the study and postdoctoral fellow in human nutrition at Wageningen University in The Netherlands, said more research was needed to find out why white flesh was important.

“It is difficult to say which nutrients are responsible in white fruits and vegetables. We know that apples and pears are high in dietary fibre, but there may be other explanations.”

She said it might be useful to consume considerable amounts of white-flesh fruit and veg to prevent strokes.

“Eating one apple a day is an easy way to increase white fruits and vegetable intake.”

Dr Sharlin Ahmed from The Stroke Association said the findings should not deter people from eating other colours of fruit and vegetables.

“All fruit and vegetables have health benefits and remain an important part of a stable diet. A lot more research is needed before the colour of our groceries alone is used to determine what health benefits they may have.”

“Everyone can reduce their risk of stroke by eating a healthy balanced diet that is low in saturated fat and salt, exercising regularly and ensuring that your blood pressure is checked and kept under control.”

Andrew Lansley condemned over HealthWatch scheme

Health secretary Andrew Lansley’s decision to launch groups designed to champion views of patients leads to complaints.
Andrew Lansley’s plans to put the patient at the heart of the NHS have been labelled as “confusing, vague and insulting”.

The health secretary pushed ahead with HealthWatch, the new body to champion patients’ views, despite ministers being forced to apologise and withdraw a consultation on the new watchdog. Ministers had conceded that their original plans had been conceived in haste and without proper consultation.

But Lansley announced that 75 local HealthWatch groups were in place. HealthWatch is supposed to replace local patient involvement networks, known as LINks, in 2012 – bringing “real local democratic accountability and legitimacy” to the NHS “for the first time in 40 years”.

Malcolm Alexander, chair of the National Association of Local Involvement Networks Members, said that, instead of increasing budgets to fund the new bodies, cash was being cut even though the government was asking local groups to take on a range of new responsibilities, such as promoting the integration of care and health services and improving choice for patients, without extra money.

Alexander said: “It’s pathetic. The consultation had a figure of £20,000, which was confusing and looked like a cut. Then that was withdrawn. Our figures show that networks are having their budgets cut this year by 24% on average.”

He said there was no start-up funding for local HealthWatch “pathfinder” groups and no ringfenced money in local authority budgets to run the new bodies.

The money for HealthWatch comes out of local council budgets, which are being cut by 30% over the next four years. “Our own research asked whether these new policies were evolution or abolition. It looks like abolition to us,” he said.

Sally Brearley, senior research fellow in patient and public involvement at King’s College London, who sat on the prime minister’s Future Forum which re-examined the health reforms, said she “shared the concerns”.

“There’s a lot of extra work to develop these new HealthWatch bodies and they are supposed to be monitoring the NHS as services are being cut and finances are under strain. It’s a real issue.”

A Department of Health spokesperson said the criticism was misleading.

“The government has not cut funding, and has no plans to do so – in fact, we retained the current level of funding at £27m, rising in line with inflation, for the spending review period.”