HEALTH MAGAZINE

A deficiency of B-vitamins may cause vascular cognitive impairment, according to a new study. Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University used an experimental model to examine the metabolic, cognitive, and microvascular effects of dietary B-vitamin deficiency. Their findings appear in the August 26, 2008 issue of Proceedings of the National Academy of Sciences (PNAS).


?Metabolic impairments induced by a diet deficient in three B-vitamins -folate, B12 and B6- caused cognitive dysfunction and reductions in brain capillary length and density in our mouse model,? says Aron Troen, PhD, the study?s lead author. ?The vascular changes occurred in the absence of neurotoxic or degenerative changes.?


Troen, who is an assistant professor at Tufts University?s Friedman School of Nutrition Science and Policy, explains, ?Mice fed a diet deficient in folate and vitamins B12 and B6 demonstrated significant deficits in spatial learning and memory compared with normal mice.? Troen and colleagues observed similar but less pronounced differences between normal mice and a third group of mice that were fed a diet enriched with methionine.

With close monitoring and a few standard precautions, nearly all children with known or suspected vaccine allergies can be safely immunized, according to a team of vaccine safety experts led by the Johns Hopkins Children?s Center. Writing in the September issue of Pediatrics, the multicenter research team offers pediatricians a step-by-step tool for quickly identifying children with allergic reactions to vaccines, and a much-needed guide, they say, to safely immunize those who are allergic.


Serious allergic reactions to vaccines are extremely rare ? one or two per million vaccinations, according to some estimates ? but when they happen, such episodes can be serious, even life-threatening, making it critical for pediatricians to instantly spot true allergic reactions and differentiate them from more benign nonallergic responses, investigators say. It is also crucial that pediatricians design a safe immunization plan for children with confirmed vaccine allergies. Children who have had one allergic reaction are believed to be at a higher risk for future reactions, typically more serious than the first.


?We cannot reiterate enough that the vaccines used today are extremely safe, but in a handful of children certain vaccine ingredients can trigger serious allergic reactions,? says Robert Wood, M.D., lead author on the paper and chief of pediatric Allergy and Immunology at Hopkins Children?s. ?For the most part, even children with known allergies can be safely vaccinated.?

One aspect of aging that?s usually fixable is cloudy vision due to cataracts.


In an otherwise healthy eye, cataract removal results in improved vision 95 percent of the time, according to the September issue of Mayo Clinic Health Letter.


Cataracts are common. By age 65, about half of all Americans have developed some degree of lens clouding due to cataracts. Diagnosed during an eye exam, cataracts develop slowly and may not hamper vision much at first. But when cataracts affect the quality of life?interfering with driving or reading?it?s time to consider surgery, the only treatment. 

Severe and frequent headaches, especially in people who don?t typically have headaches, warrant a visit to the doctor.


The headaches could be a symptom of vasculitis?blood vessel inflammation. Vasculitis is an autoimmune disease, where the body?s immune system mistakenly attacks healthy tissue. Depending on the type of vasculitis?there are more than a dozen?the disease can disrupt blood circulation and, in some cases, cause death, according to the September issue of Mayo Clinic Health Letter.


In addition to headache, symptoms might include fever, fatigue, weight loss, muscle and joint pain, appetite loss, and numbness or weakness. Often, the exact cause of vasculitis isn?t known, although some forms can be linked to infections such as hepatitis B and C, as well as certain medications. 

With summer ending and school underway, parents are transitioning from hearing their children moan about not being able to swim everyday, to their child complaining about homework, their new teachers or being in a different class than their friends. Many parents also begin to hear more complaints of tummy aches and headaches as a result of returning back to school.


The psychological term for school-induced illnesses a child may develop when he or she is trying to dodge school is School Avoidance, or School Refusal. Symptoms include nausea, fatigue, headaches and abdominal pain. According to Lori Crosby, Psy.D., Associate Professor, Pediatrics, Cincinnati Children?s Hospital Medical Center, even if children start to complain about stomach aches and other ailments, parents should still send their child to school unless they have symptoms of fever or a contagious illness. ?It would probably be helpful to schedule a visit with the child?s pediatrician to rule out a ?true? medical problem, which may give the parent the confidence to send their child when in doubt,? said Dr. Crosby.


Approximately 1-5 percent of children in the United States suffer from School Avoidance. An article in the American Family Physician states that School Avoidance/Refusal should be considered when a student will not go to school and experiences emotional distress of physical symptoms. 

The gooey, golden stuff that builds up inside your ears should stay there, according to national guidelines on earwax removal released today.


?[Earwax] is not intrinsically evil stuff, and consequently does not have to be removed merely because it?s present,? said Peter Roland, an ear, nose and throat doctor at the University of Texas Southwestern Medical Center at Dallas. ?In fact, it serves a function and so if you don?t need to take it out, you should just leave it alone.?


Roland chaired a panel of doctors in charge of the new guidelines for earwax removal issued by the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF). The guidelines are intended to serve two purposes: to determine under what circumstances earwax needs to be removed, and to give doctors the scoop on which removal methods work best. 

In a collaborative study at the University of California, San Diego, investigators from neurosciences, chemistry and medicine, as well as the San Diego Supercomputer Center (SDSC) have investigated how proteins involved in neurodegenerative diseases such as Alzheimer?s and Parkinson?s disease interact to form unique complexes. Their findings explain why Alzheimer?s patients might develop Parkinson?s, and vice versa. The new and unique molecular structures they discovered can now be used to model and develop new drugs for these devastating neurological diseases. Their findings will be published in the September 3 issue of Public Library of Science (PLoS) ONE on September 4, 2008.


The team, led by Eliezer Masliah, M.D., professor of neurosciences and pathology in the UC San Diego School of Medicine, found that ?fatal? or abnormal interactions among the a-synuclein protein (?-syn, involved in Parkinson?s disease) and Abeta amyloid (A?, which leads to the plaques associated with Alzheimer?s disease) interact and form unique ?hybrid? complexes. These hybrid abnormal protein interactions result in combined neurodegenerative diseases.


?Clinically, we knew that having one neurological disease, such as Alzheimer?s, put patients at risk for another neurological disease in combination with it, for example, Parkinson?s disease or frontotemporal dementia. But as doctors and scientists, we didn?t understand why this occurred until now,? Masliah said.

As if things weren?t tough enough for premature babies who have tubes down their throats and noses to survive, once the tubes are removed, they are often unable to take nourishment orally ? that is, suck.


But 20 tube-fed preterm infants with respiratory distress syndrome treated with the NTrainer, a therapeutic device patented by the University of Kansas, rapidly learned to suck far better and transitioned to oral feeding faster than a control group of babies with the syndrome.


Respiratory distress syndrome, also known as hyaline membrane disease, is a common condition of prematurity, particularly in the youngest infants, because babies? lungs are too immature to survive outside the womb without the help of a ventilator and/or oxygen. Overall, it is the seventh leading cause of death among infants younger than one year, fifth for African-American and third for Hispanic infants.

Blood pressure in low-birth-weight children younger than 3 years of age not only can be measured but should be, researchers at UT Southwestern Medical Center have found.


The findings appear in the September issue of Pediatrics.


Blood pressure has not been screened routinely in children with very low birth weights because the measurements were viewed as not feasible or unreliable in infants and toddlers; however, evidence has shown that low-birth-weight infants might develop hypertension later in life. 

Elderly people who take a cholesterol drug after a stroke or mini-stroke lower their risk of having another stroke just as much as younger people in the same situation, according to research published in the September 3, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.


?Even though the majority of strokes and heart attacks occur in people who are 65 and older, studies have found that cholesterol-lowering drugs are not prescribed as often for older people as they are for younger people,? said study author Seemant Chaturvedi, MD, of Wayne State University in Detroit, MI, and a Fellow of the American Academy of Neurology. ?These results show that using these drugs is just as beneficial for people who are over 65 as they are for younger people.?


The study involved 4,731 people age 18 and older who had a recent stroke or transient ischemic attack, or mini-stroke. The 2,249 people age 65 and older were in one group, with an average age of 72, and the 2,482 people under age 65 made up the other group, with an average age of 54. Within each group, about half of the people received the cholesterol-lowering drug atorvastatin and about half received a placebo. The participants were then followed for an average of four and a half years.

An ?unacceptably high? number of college students?roughly one in five in 2006?continues to smoke cigarettes, according to an American Lung Association report released Monday. The association says aggressive tobacco industry marketing on college campuses is largely to blame.


To gauge the current status of tobacco use and policies on college and university campuses, the American Lung Association analyzed published research, surveys and tobacco industry documents. Their findings are compiled in a report, ?Big Tobacco on Campus: Ending the Addiction.?


The report says that in 2005, the tobacco industry spent more than $1 million a day sponsoring events and giveaways targeting college students. In a recent survey of 119 colleges, students at 109 schools reported seeing tobacco promotions in on-campus events.

Children who are bilingual before the age of 5 are significantly more likely to stutter and to find it harder to lose their impediment, than children who speak only one language before this age, suggests research published ahead of print in Archives of Disease in Childhood.


The researchers base their findings on 317 children, who were referred for stutter when aged between 8 and 10.


All the children lived in Greater London, and all had started school in the UK at the age of 4 or 5.

Eukaryotic cells employ multiple strategies of checkpoint signaling and DNA repair mechanisms to monitor and repair damaged DNA. There are two branches in the checkpoint response pathway?ataxia telangiectasia-mutated (ATM) and ATM-Rad3-related (ATR). Many viruses are now known to interact with DNA damage sensing and repair machinery. These viruses have evolved tactics to eliminate, circumvent, or exploit various aspects of the DNA damage response of the host cell. Strategies include the activation of repair proteins or the targeting of specific cellular factors for degradation or mislocalization. Exploiting the activation of the DNA damage pathway by viral replication for the generation of antiviral drugs needs to be examined. In the human immunodeficiency virus (HIV), it has been clearly determined that the prevention of viral integration inhibits viral replication and promotes cellular apoptosis. Thus, the ATM-specific inhibitor ku55933 can inhibit HIV replication in primary T cells.


Despite the availability of a safe and efficient vaccine, chronic hepatitis B virus infection remains a major health problem worldwide. Interferon treatment is effective in only approximately one-third of the patients and produces considerable side effects. Long-term treatment with the second-generation nucleoside analogue lamivudine (lam) efficiently inhibits HBV replication with frequent viral polymerase mutations. We found that HBV infection triggered an ATR-dependent DNA damage response, resulting in increased ATR and Chk1 phosphorylation levels, however, ATR checkpoint signaling was blocked downstream of the p53-dependent pathway to evade apoptosis by p21 degradation. We have designed a strategy to select new drug targets that inhibit a cellular gene required for HBV replication or restore a response stalled by HBV in the ATR DNA damage pathway.


A research article to be published on August 28, 2008 in the World Journal of Gastroenterology addresses this question. 

Both higher fish consumption and longer breastfeeding are linked to better physical and cognitive development in infants, according to a study of mothers and infants from Denmark. Maternal fish consumption and longer breastfeeding were independently beneficial.


?These results, together with findings from other studies of women in the U.S. and the United Kingdom, provide additional evidence that moderate maternal fish intake during pregnancy does not harm child development and may on balance be beneficial,? said Assistant Professor Emily Oken, lead author of the study.


The study, which appeared in the September issue of the American Journal of Clinical Nutrition, was conducted by researchers from the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care and the Maternal Nutrition Group from the Department of Epidemiology at Statens Serum Institut in Copenhagen, Denmark. These findings provide further evidence that the omega-3 fatty acids found in fish and compounds in breast milk are beneficial to infant development.

Training in emotional intelligence could help medical residents and fellows become more sensitive toward their patients, according to a commentary in the September 10 issue of the Journal of the American Medical Association.


Patients are less likely to complain and more likely to have positive health results if their physician communicates well with them. For these and other reasons, medical schools include interpersonal and communication skills in their training programs. The JAMA article argues that medical education needs to delve even deeper to help doctors relate better.


The four components of emotional intelligence ? the abilities to perceive, use, understand and manage emotions ? are building blocks for interpersonal and communication skills. The challenge in medical education is to understand the psychology behind these skills and build programs to develop them, according to commentary authors Daisy Grewal., Ph.D., and Heather Davidson, Ph.D., of the department of medical education at Stanford University Medical Center.

Nicotine nasal spray won?t help teen smokers kick the habit, at least in its current formulation, new research published in Pediatrics suggests.


Adolescents who tried the spray complained of burning in their nostrils, a bad smell, and other side effects, leading them it stop using it or using it too infrequently to be effective, Dr. Mark L. Rubenstein and his colleagues from the University of California, San Francisco found.


?It?s actually one of the most effective forms of nicotine replacement in adults,? Rubenstein noted in an interview with Reuters Health. ?Usually the side effects are supposed to wear off during the first week.?

A study led by a team of education researchers from Mayo Clinic and published in the Journal of the American Medical Association (JAMA) concludes that Internet-based education generally is effective.


Lead author David Cook, M.D., an associate professor of medicine who practices general internal medicine at Mayo Clinic, worked with researchers from Mayo and McMaster University in Hamilton, Ontario. They reviewed more than 200 studies about Internet-based instruction. The researchers concluded that Internet-based instruction is associated with largely positive effects compared with no intervention. The research also showed that Internet-based instruction compared favorably to traditional methods.


?Our findings suggest that Internet-based instruction is an effective way to teach health care professionals,? says Dr. Cook. ?We now can confirm that, across a wide variety of learners, learning contexts, clinical topics, and learning outcomes, Internet-based instruction appears to be as effective as similar to traditional methods.?

Stroke patients spend most of their time asleep on their backs, which may contribute to a breathing problem called sleep apnea, according to findings reported in the journal Stroke.


Obstructive sleep apnea is a common problem in which soft tissues in the back of throat repeatedly collapse during sleep causing breathing to stop for brief moments. Snoring as well as excessive daytime sleepiness are common symptoms. The condition can be effectively treated with a small machine that blows air into the throat, preventing the tissues from collapsing.


?Sleep apnea is very common after stroke and is associated with poor outcome,? Dr. Devin L. Brown and colleagues from the University of Michigan, Ann Arbor, write. Sleeping on the back, also known as ?supine sleep,? is known to make the problem worse in the general population. 

Dialysis patients diagnosed with depression are nearly twice as likely to be hospitalized or die within a year than those who are not depressed, a UT Southwestern Medical Center researcher has found.


In the study, available online and in the Sept. 15 issue of Kidney International, researchers monitored 98 dialysis patients for up to 14 months. More than a quarter of dialysis patients received a psychiatric diagnosis of some form of depression based on a Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM IV).


This is the first reported link between adverse clinical outcomes in dialysis patients and depression made through a formal psychiatric interview based on the DSM-IV standards. More than 80 percent of the depressed patients died or were hospitalized, compared with 43 percent of non-depressed patients. Cardiovascular events, which previously have been linked to depression, led to 20 percent of the hospitalizations.

Young adults and men do not see themselves as susceptible to osteoporosis, according to a new study. In their minds, the risk of suffering from what many consider an older woman?s disease seems distant or slim. The problem: They are missing preventive measures that if taken now, could decrease their future danger of developing the disease.


In the study of 300 Canadian men and women, researchers found significant age and gender differences in how people perceived their susceptibility to osteoporosis. Specifically, middle-aged and older women scored significantly higher than younger participants and men, suggesting that older women believe they are at greater risk.


?The low scores among younger people raise concerns for the approaching epidemic,? said Shanthi Johnson, Ph.D., lead study author and a professor at University of Regina. ?Given the aging population and the growing percentage of older women within that population, osteoporosis should receive more recognition.?

Minutes after having sexual intercourse with her boyfriend, a 35-year-old woman suddenly felt her left arm go weak. Her speech became slurred and she lost feeling on the left side of her face.


She was having a stroke. Doctors later concluded the stroke probably was due to several related factors, including birth control pills, a venous blood clot, sexual intercourse and a heart defect.


Doctors at Loyola University Medical Center describe the unusual case in the Journal of Stroke and Cerebrovascular Disease.

The time span in which treatment should be given for acute ischaemic stroke ? i.e. stroke caused by a clot or other obstruction to the blood supply ? can be lengthened. This according to a study from the Swedish medical university Karolinska Institutet, the results of which can bring about more effective and safer treatments for stroke sufferers.


In the event of acute ischemic stroke, treatment with ?clot-busting? drugs ? thrombolysis ? should be administered as early as possible. Failure to do so might leave the treatment doing harm than good since it increases the danger of haemorrhage. Prevailing praxis is for thrombolysis to be given only to patients who reach hospital within three hours after the onset of stroke.


However, an international study led by Professor Nils Wahlgren at Karolinska Institutet now shows that it is safe to administer the treatment up to four and a half hours after the stroke. 

In infancy, genes are the key influence on a child?s ability to deal with stress. But as early as 6 months of age, parenting plays an important role in changing the impact of genes that may put infants at risk for responding poorly to stress.


That?s the message from a new study by researchers at the University of North Carolina-Chapel Hill, Pennsylvania State University, the University of North Carolina-Greensboro, and North Carolina State University. It appears in the September/October 2008 issue of the journal Child Development.


The researchers looked at 142 infants who had been placed in a stressful situation?being separated from their mothers?when they were 3, 6, and 12 months old. They measured infants? heart rates while they were exposed to the stressor, isolating a cardiac response called vagal tone. Vagal tone acts like a brake on the heart when the body is in a calm state, but during a challenging situation, this brake is withdrawn, allowing heart rate to increase so the body can actively deal with the challenge.

Johns Hopkins scientists report success in significantly suppressing levels of the ?hunger hormone? ghrelin in pigs using a minimally invasive means of chemically vaporizing the main vessel carrying blood to the top section, or fundus, of the stomach. An estimated 90 percent of the body?s ghrelin originates in the fundus, which can?t make the hormone without a good blood supply.


?With gastric artery chemical embolization, called GACE, there?s no major surgery,? says Aravind Arepally, M.D., clinical director of the Center for Bioengineering Innovation and Design and associate professor of radiology and surgery at the John Hopkins University School of Medicine. ?In our study in pigs, this procedure produced an effect similar to bariatric surgery by suppressing ghrelin levels and subsequently lowering appetite.?


Reporting on the research in the September 16 online edition of Radiology, Arepally and his team note that for more than a decade, efforts to safely and easily suppress grehlin have met with very limited success. 

People with migraines may also be more likely to develop blood clots in their veins, according to a study published in the September 16, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.


In the condition, called venous thrombosis or thromboembolism, blood clots form in a vein, which can limit blood flow and cause swelling and pain. Those clots can then dislodge from the vein and travel to the heart and the lungs, which can be fatal.


For the study, 574 people in Italy age 55 and up were interviewed to determine whether they had a history of migraine or migraine at the time of the evaluation and their medical records were reviewed for cases of venous thrombosis. The arteries in their necks and thighs were scanned with ultrasounds to check for atherosclerosis, or hardening of the arteries.

Does your physician know when it is appropriate to refer you to a specialist to diagnose carpal tunnel syndrome (CTS)? Due to a high prevalence of CTS, and the number of other conditions that mimic symptoms of CTS, a team of researchers set out to develop an easy screening questionnaire to help physicians determine when it is appropriate to refer a patient for nerve conduction studies and needle electromyography (EMG) - the two electrodiagnostic tests, most commonly used to diagnose CTS.


The carpal tunnel is a small tunnel made of bones and ligaments in the wrist. The median nerve runs down the forearm through the tunnel into the hand on the palm side of the hand and provides feeling to the hand and fingers. The median nerve can become irritated by inflammation in this tunnel, which leads to carpal tunnel syndrome. CTS can be a result of many factors arising from work and lifestyle, health, injuries, and even genetic predisposition. The most common cause of CTS is repetitive hand motion. Common symptoms include tingling, numbness and pain in the hand, which are typically worse at night and can even cause people to awaken from sleep.


A simple seven item screening questionnaire was used to screen patients with possible CTS prior to referral for electrodiagnostic testing. The questionnaire was completed by 100 consecutive patients. Three key questions were found to predict the diagnosis of CTS: 

Surgical residents at a large teaching hospital who worked shorter shifts were less likely to make mistakes during gallbladder surgery, U.S. researchers said on Monday.


The study offers some of the first evidence that rules put into place in 2003 to limit hours worked by doctors in training resulted in better care for patients. Many doctors have argued that the limits interfere with the training of doctors but make no difference in patient care.


?We are actually surprised to find the outcomes improved,? Dr. Christian de Virgilio of the Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center said in a telephone interview.

New moms may be better able to return to their pre-pregnancy weight by exclusively breastfeeding their infants, according to new research.


?The practice of exclusive breastfeeding helps mothers lose the weight accumulated during pregnancy and do that faster compared to those who don?t practice exclusive breastfeeding,? Dr. Alex Kojo Anderson, of the University of Georgia in Athens, told Reuters Health.


Anderson and colleagues compared pre-pregnancy and at-delivery weight, with weight at 12 weeks after delivery, among 24 mothers, aged 19 to 42 years. Seventeen of these new moms exclusively breastfed their infants, while 9 mothers mixed-fed their infants using formula or a combination of formula and breastmilk. 

Although hand hygiene is an important method of hospital infection control, increasing the frequency of hand washing by doctors and other healthcare workers does not necessarily result in commensurate reductions in staphylococcal infections, according a new study.


?While it is undoubtedly the case that improved hand hygiene is beneficial, there is growing evidence that increased compliance may not yield the hoped-for results,? Dr. Kevin G. Kerr, of Harrogate District Hospital, and colleagues note in the latest issue of the online journal BMC Infectious Diseases. The results of several studies suggest that the ?law of diminishing returns? applies to hand hygiene, with the greatest benefits occurring with the first 20 percent of compliance.


Based on their research, Kerr and colleagues conclude that under most circumstances, it should be possible to prevent outbreaks of staphylococcal infection from occurring with a hand cleansing frequency of approximately 40 percent. 

New research highlighted at a symposium during an annual meeting for family physicians shows how nicotine withdrawal creates functional changes in the brains of smokers trying to quit causing cognitive performance deficits (such as ability to concentrate) that may make it more difficult to quit, and could be a driver of smoking relapse. Further, brain imaging technology shows that when treatment with the Commit® 4 mg nicotine lozenge is introduced, these symptoms of nicotine withdrawal can be reversed. This information is helping physicians better understand addiction and how treatment can help.


?The new research provides powerful new evidence as to why physicians need to intervene and help their patients understand and manage symptoms to help them quit successfully,? said Dr. C. Everett Koop, former U.S. Surgeon General and driving force behind the 1988 Surgeon General?s report entitled: The Health Consequences of Smoking: Nicotine Addiction. ?Physicians should use these new data as reasons to speak with their patients to help them better understand their addiction, including the serious impact of withdrawal and how proven treatments can help reverse nicotine withdrawal symptoms that impact the brain.?

Regular checkups and cleaning can save money in the end by heading off problems early. Nevertheless, when times get tough and people start losing their jobs, preventive dental care can be one of the first things to go.


However, the correlation between rising unemployment and a drop in preventive dental care is not necessarily due to people being short of cash, according to a new study appearing in the online edition of Health Services Research.


?We see that high community-level unemployment exacts a psychological toll on individuals,? said lead study author Brian Quinn. ?Even for people who are working, or who have a working partner or spouse, there might be an impact if they?re stressed about themselves or their significant others losing their jobs.?

Teen smokers who volunteer for programs to help them quit are more hooked on tobacco than other teens who smoke, new West Virginia University research has found. The teens believe quitting is a good idea, but they aren?t fully confident they?ll be able to kick the tobacco habit.


What?s more, teens who volunteer for help are 60 percent more likely to use smokeless tobacco and more than 200 percent more likely to smoke cigars when compared with teen smokers nationally.


The conclusions, published in the journal Tobacco Induced Diseases, come from analysis of data involving almost 6,000 teen smokers who enrolled in Not On Tobacco (N-O-T) between 1998 and 2006. Developed at WVU, N-O-T is the most widely used smoking-cessation program for teens in the nation. 

During tough financial times, many people try to demonstrate their value at work by working harder and longer. But, if you don?t also make time to take care of yourself, success may come at a hefty cost: your health.


?Many people feel like they have to push themselves to unhealthy levels in order to succeed. But high-pressure jobs and long hours take a real toll on your immediate and future health,? says George Griffing, M.D., professor of internal medicine at Saint Louis University.


Whether you?re running for president, moving up the corporate ladder or juggling your family?s activities, it?s crucial that you take a break to care for yourself, he says. 

Extended treatment with Alzheimer?s disease drugs can significantly slow the rate at which the disorder advances, and combination therapy with two different classes of drugs is even better at helping patients maintain their ability to perform daily activities. Results from the first long-term study of the real-world use of Alzheimer?s drugs, published by researchers from Massachusetts General Hospital in the July/September issue of Alzheimer Disease and Associated Disorders, support a level of effectiveness that may not be immediately apparent to patients or their family members.


?There has been the impression that these drugs only work for some patients and for a limited amount of time,? says Alireza Atri, MD, PhD, of the MGH Department of Neurology, lead author of the current study. ?One of the problems in judging these drugs has been that patients naturally continue to decline, which can make them think the drugs have stopped working. But our study, which has some unique strengths, indicates that treatment does have long-term benefit.?


Two types of medications have received FDA approval for Alzheimer?s treatment. Cholinesterase inhibitors have been available since the mid-1990s and act by inhibiting the breakdown of the neurotransmitter acetylcholine. The drug memantine, which received FDA approval in 2003, is the first of a second class of agents that modulate the actions of the amino acid glutamate and is often used in combination with cholinesterase inhibitors (CIs). 

Contrary to public perceptions, foreign-born children are increasingly uninsured, rather than publicly insured, in the wake of immigration policy changes, according to a study by public health researchers at The Children?s Hospital of Philadelphia.


Despite a 1999 federal ruling that relieved immigrant families of a requirement to repay the U.S. government for Medicaid benefits, immigrant children did not increase their usage of publicly funded health insurance programs. The study authors said that these inequities in access to health care may hinder the ability of immigrant children to become productive future members of the American labor force.


Even after taking into account significant socioeconomic differences between U.S.-born and foreign-born children, the vast majority of immigrant children are much more likely to be uninsured, living in poverty, and have parents with less than a high school education, according to the study. The results, based on the analysis of data collected from 33,317 children for the 1997 to 2004 National Health Interview Survey, appear in the November 2008 issue of the American Journal of Public Health.

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