Saturday, June 30, 2007

Probiotics in mother's milk

bifidobacterium longum
Why is breast milk best for a baby? One of the reasons is the optimal mix of all nutrients. One more reason has been found by functional food scientists in Finland: Bifidobacteria of various species, mainly Bifidobacterium longum (see picture). Bacteria of this type are also called probiotics, they are widely used in functional food that is designed for better health.

Details: The Finnish scientists have analyzed breast milk by two methods of genetic fingerprinting: polymerase chain reaction and real-time polymerase chain reaction. They have found the following Bifidobacteria: Bifidobacterium longum, Bifidobacterium animalis, Bifidobacterium bifidum and Bifidobacterium catenulatum.

Bifidobacteria are one of the main components of human gut flora. They aid in digestion, help to fight bad bugs and keep the immune system working well without going allergic. The beneficial bugs in breast milk allow the baby to quickly build up a strong gut flora which gives it the best protection against diseases. And mama certainly will be happy when baby does not cry from colic caused by bad digestion.

Photo credit: Mark Schell, University of Georgia, Athens, GA

Friday, June 29, 2007

Listen to your partner - for heart's sake

tension in couple
It is not always easy. For instance, you think all is okay with you but your partner says that you are angry. He or she may be right. It is not uncommon that people can judge others better than themselves. This is particularly true for negative traits such as anger or hostility.

The fact that a partner's view is often more accurate than one's own has recently been shown in an unexpected way, that is, in a medical study about personality and heart disease at the university of Utah. We all have heard that anger is bad for the heart, and this study has been undertaken to test it again because not all studies come to this conclusion. Three hundred married couples have been asked about how they rate anger and hostility traits in themselves and in their partners, and the calcification of their coronary arteries have been assessed.

The interesting point is that self-rated anger and hostility did not show any influence on the early sign of heart disease. But partner-rated anger and hostility was clearly linked to a higher degree of artery calcification.

This finding has much in common with one that I have reported earlier: Open hearts live longer. If you are open to accept your partner's view, you are likely to know yourself better and probably to overcome anger and hostility. First of all you will have a better marriage, but as a second effect you also will do your heart a favour.

Photo credit: flickr.com/photos/36879130@N00/420029642/

Thursday, June 28, 2007

Heart attack signs different in women

woman heart patient
Chest pain is the leading of seven heart attack warning signs - but only in men. (Do you know the six other warning signs? Test yourself with my Heart Attack Health Quiz!)

Women often feel things going wrong in the chest, but: «It was not chest pain, really, I can't explain it.» This is a typical answer that emerged in twelve tape-recorded interviews with female patients after a heart attack at the University of Bristol. Background of this study is the fact that fewer women than men seek medical help before or after a heart attack.

It seems that the warning sign catalog must be re-written for women. The diffuse chest feelings in women are more difficult to interpret than the typical chest pain in men. The more important are the early warning signs that may show up weeks in advance, as described in a study with more than five hundred women of Arkansas. Women often report unusual fatigue, sleeplessness and shortness of breath one month before a heart attack. During the attack, short breath, weakness and fatigue are the most frequent symptoms; more than forty percent of women report no chest pain.

Related post: Women's hearts safe to beat faster

Photo credit: flickr.com/photos/seventh_avenue_suzette/355420772/

Wednesday, June 27, 2007

Take your chance after a cancer diagnosis

x-ray
Most people who are told to have cancer do not change their lives, according to a telephone survey in more than two thousand cancer patients and healthy persons: They continue to smoke, they do not consume five fruits or vegetables per day, and only half of them are physically active at least once a week. Only seven percent of the cancer patients meet all three requirements of a healthy behaviour. The self-reported health behaviours of cancer patients do not differ from those of healthy persons.

In other words, opportunities are missed. One of the reasons may be the misbelief that it is «too late» to change things. Nothing could be more wrong. If body and mind have to fight cancer, best possible support is required. It is like a boxing match where cancer has won the first round. But no boxer gives up a fight without being k.o. Many come back in the next rounds and win at last.

Photo credit: http://www.flickr.com/photos/fujur/109165757/

Tuesday, June 26, 2007

What the birth order IQ study tells us

smart sibs
The story has been in the mass media all over the world: First-born children are smarter (by 3 IQ points on average) than their younger siblings, and this is due to psycho-social rather than biological causes. The findings are based upon tests in 240,000 Norwegian young men.

Some of the blogs I read have commented on this. I agree with Clark Bartram who points out that a difference of two or three IQ points is completely meaningless for individuals. As far as I got it, this is also the opinion of the study authors. Janet D. Sternwedel comments the study from a parenting view and Suzanne E. Franks raises the question if results gained from men may be applied to women as well.

Large numbers make things different

If I undergo an IQ test today and get x points, it is very likely that I get x+3 or x-3 points a week later. Such tests never can be as accurate as physical measures, and my mind fitness will change from day to day. Therefore, if a study would tell me that I gain three IQ points, I just would shrug my shoulders and ask, so what?

But with two hundred thousand persons tested, things are quite different. The up and down deviations are nullified by the law of large numbers. A difference of 3 IQ points no longer is a matter of chance, but becomes significant if it is based upon a large number of tests.

What does it mean for individuals?

When statistics, based upon large numbers, has found an IQ difference of 3 points to be significant, for me, as an individual, this difference has gained no additional meaning. I still shrug my shoulders because I am not the average of two hundred thousand men.

The real point is not the IQ difference (which is meaningless) but the effect that is causing such a difference. If I understand this effect and if I manage to make best use of it, things may become meaningful.

It is self-teaching that matters

For me, birth order is quite irrelevant in this study. Not only is it a given fact that we cannot change, but the study itself came to the conclusion that only certain aspects of birth order play a role. If an elder sib dies, the IQ of the younger will rise, the study has found. Thus, it is not birth order but the social role in the family that has an influence on intelligence.

The main difference between firstborns and the rest is how they learn. Firstborns are pioneers who have to find their own way which may be hard but rewarding; the younger always have the example of the elder sibs that may guide them. Firstborns learn by teaching themselves and the younger ones - which seems to have a measurable effect on intelligence.

The message I get from this study is: Teach your kids how to think their own way, how to ask their own questions, how to find their own answers, and their IQ may rise by even more than three points.

Conflict of interest: I am a firstborn of seven siblings which may influence my view of this study.

Photo credit: flickr.com/photos/ericasimone/302288448/

Health Blog Carnival Watch 1:2

Grand Rounds 3:40
The theme of this week's edition is inspiration and is presented as a multi-authored scientific publication. Wandering Visitor has undertaken this research in order to find out what driving forces are behind medical bloggers, and to better «get to know» all the people behind these blogs. A well-done and well-presented research. Conclusion: Health blog authors «find inspiration from the most unexpected sources – from those closest to the heart to those thousands of miles away. From cannibalism to wielding a blade.»
June 25, 2007 at Wandering Visitor

Medicine 2.0: The second edition
This carnival is about Web 2.0 (the interactive web) and its use in medicine - for professionals as well as for patients. This is a new and exciting emerging field, and this carnival keeps tabs on it. I the second edition Bertalan Mesko presents thirteen posts from Twitter in hospital to patient education videos on YouTube, the Google plans in the health domain, the use of podcasts, and many more.
June 24, 2007 at Scienceroll

Skeptics Circle 63
The importance of being skeptic in health issues comes from the fact that the distinction between science and pseudo-science, between good medicine and quackery is not always easy. That's why I include this carnival here. Many of its posts, presented by Robert McCormick, are health related (malaria as a quack cure of HIV, the autism and mercury debate), and others go beyond (UFOs, creationism), reaching into the realm of science and philosophy.
June 21, 2007 at Relatively Science

Monday, June 25, 2007

Sleep sex beyond wet dreams

hot in bed
May I tell you something about sex that you probably never have expected to know and therefore never were afraid to ask? In my earlier days as a medical writer I have been a sexology columnist for a German magazine and I have read as many publications in the field as I could reach. But I never have come across something like the following.

Of course every woman and every man has wet dreams, at least in some periods of life. Such wet dreams may also involve masturbation of some kind without being (fully) awake. Up to this point everything seems normal and far from being subject of sexual pathology. But researchers of the Minnesota Regional Sleep Disorders Center have found in the medical literature a number of cases that showed «real sex» at sleep. This sleep sex behaviour shows the same spectrum as daytime sex: intercourse with a consenting partner, with or without orgasm, but also sexual assault and rape. Let it be understood: The active partner has been asleep. In some cases the sexual arousal was so high that the researchers refer to them as sexual seizures or ictal orgasms.

The ugly face of sleep sex is that roughly every third case is violent and that the victims often are minors. In 85 percent of the cases with «consenting» adult partners the sex-sleepers suffered from adverse physical or psycho-social outcomes, but 15 percent reported having felt pleasure. By the way, pleasure was more frequent in the partners who had sex with the sleepers.

Due to the frequency of negative outcomes, sleep sex is treated as a disease. The therapy involves tranquilizer (Clonazepam) and nasal ventilation (CPAP) in most cases. But I suspect that some of the sleep sex patients would prefer to stay sick.

Read more: Sleep sex stories at sleepsex.org, an article about sleep sex or sexsomnia at Wikipedia.

Photo credit: flickr.com/photos/bigfatrat/198479445/

Saturday, June 23, 2007

Stroke does not strike where lab predicts


If you want to know your future health, you may go to a medical checkup where your blood and urine is taken and analyzed in a lab. You may just as well read the tea leaves if you are a woman after menopause under hormone therapy and want to know more about your stroke risk. This is the surprising outcome of the Women's Health Initiative trials where more than twenty-seven thousand women have been examined with a follow-up of more than five or six years on average. The women have taken either hormone or placebo (double-blind), their blood has been analyzed, even for stroke-promoting genes, and all stroke events during follow-up have been recorded.

The intriguing outcome: Some lab values (so-called biomarkers) that were thought to predict a higher stroke risk did exactly the opposite and lowered the stroke risk in combination with hormones. Hormones in turn are thought to increase the stroke risk in women by about forty percent. In other words: A risk factor combined with another risk factor lowers the risk. The authors of the study are so puzzled that they conclude this «may be due to chance». You better read the tea leaves then.

What are biomarkers good for?

The idea of biomarkers is early detection of a disease before it has evolved. The concept is somewhat similar to risk factors but is confined to factors that can be detected by physiological measures (such as blood pressure) or by analysis of body liquids (cholesterol, sugar and the like).

There is an ongoing debate about the usefulness of biomarkers. Big business such as lipid-lowering drugs is based upon biomarkers. This business may be at stake if it turns out that improving the biomarkers does not safe lives.

Another biomarker case is calcified plaques in the arteries that increase the risk of a heart attack. Women after menopause have less plaques when they take hormones. But other studies have shown that estrogen supplements increase the risk of a heart attack. This brings the study authors to the conclusion that «estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways». In other words, they strongly warn against relying on the plaque biomarker.

The case of population studies

In epidemiology, biomarkers are often used as ersatz outcomes if researchers cannot wait until their subjects fall sick or die. The flaw of this method is a dilution problem. If for instance a certain diet has been shown to lower cholesterol by x percent and other studies have shown that in the lowest quartile of cholesterol the risk of a heart attack is y percent lower than in the highest, it cannot be concluded that the diet will lower the risk of a heart attack.

If this sounds too complicated, just imagine billiard balls that are made of sand-filled rubber. If the first ball hits another, the second ball will move, but not very far and if it hits a third ball, this latter may not move at all. Conclusion: Be sceptic when biomarkers are used in population studies.

Photo credit: flickr.com/photos/sonson/370521046/

Friday, June 22, 2007

A weight loss lesson from Mexico


Why do people gain too much weight? Why do they get obese? In my opinion, understanding the reasons is the first of many important steps in weight loss. Let's have a look at Mexican schoolkids. They may teach us a lesson.

More than seven hundred schoolchildren of Mexico City have been surveyed by questions about their food supply and by measuring their body mass index (BMI). It came out that children at the first level of the 5-level famine scale are at double risk of obesity compared to the zero famine level.

The first famine level is not yet famine but is called food insecurity: In a still cohesive social system the food prices are unstable, seasonal shortages occur and reversible coping strategies are taken to overcome the situation.

The result of the Mexican study is easy to understand. As soon as fear of starvation begins to emerge, an old survival reflex is set to action: Eat as much as you can, get as many calories as you can afford, buy cheap fatty cereals and sweets. The same survival reflex is also responsible for the yo-yo effect because it is turned on by a strict low-calorie diet, signalling stress and food insecurity to body and mind.

Less stress, less weight

Now let's flip the coin. Its positive face tells us that it must be easier to lose weight if we get rid of food-related stress. Eat slowly: The longer it takes, the more is your body «convinced» that it has got enough. Savour your food: Sensations are important, and the more units of them you get from a given amount of food, the less food will be required to satisfy this need. Select high quality food: This makes it easier to eat slowly and to savour plus it will give your body most of the nutrients it needs, again with smaller amounts of food.

In other words, do exactly the opposite of someone who is in danger of a famine. And this goes beyond food. Be ready to waste your energy by going for sports regularly.

Wikipedia: Food security, famine scales

Photo credit: flickr.com/photos/kafkan/497278464/

Test websites for quackery

quackometer result for med journal watch

Andy Lewis (quackometer.net) has developed a simple but useful tool to analyze quackery content of websites. It uses an algorithm based on keywords frequently used by quacks, such as «wonder», «healing» or «naturopath», commercial terms such as «shipping» or «products», the absence of skeptical terms like «placebo», «flawed», the use of promotional terms and many more. The algo compares the count of these terms against thresholds and calculates a quackery index with the international quackery unit of a Canard. The maximum is 10 Canards, and stories with 5 or 6 Canards may even be found in newspapers like Daily Mail or The Scotsman.

Today, Med Journal Watch has a quackery level of 0 Canards (check here), but keep your eyes and mind open and do not rely on the verdict of a robot. If you find a website that you suspect to be quackish, you can test it here.

About quackery: Quackwatch definition, Quackery at Wikipedia

Thursday, June 21, 2007

The fit way of Alzheimer's prevention

woman with crutch
Few things are for sure. One of these is that you and me have got older today since yesterday, and that this process is adding more risk for certain diseases. Beyond fifty years of age, Alzheimer's disease is becoming more and more of a concern for many people, me included. We see our memory get weaker, inevitably, and we begin to ask questions about early warning signs and the like. But these are not my story today.

My story is about what we can do best against memory decline of the Alzheimer's type. I have found a body-and-mind study that takes us on the negative side of the issue. But every coin has two faces which allows us to take a positive lesson out of it.

At Rush Alzheimer's Disease Center, a long-time study has been undertaken: More than eight hundred elderly persons have been assessed every year for frailty, cognition and Alzheimer's symptoms. During three years of follow-up, eleven percent of the persons developed Alzheimer's disease - in close relation to frailty. Each additional one tenth of a point in the seven point frailty scale increases the risk of Alzheimer's by more than nine percent.

Now let me do some math. A tenth of a frailty point equals 1.43 percent. I compare this to the 9 percent in Alzheimer's risk increase. I calculate Alzheimer's by frailty and get a leverage factor of 6.3 which tells me that a bit more frailty equals six times more Alzheimer's risk.

The speed of fitness decline is even more important with a risk increase of twelve percent for every one-tenth of frailty change per year. The authors of the study conclude that frailty and Alzheimer's disease may share similar causes. This is the negative side. But I prefer to see things the positive way.

Take home message: Less frailty is equal to more fitness and is most likely equal to a lower Alzheimer's risk. And fitness is something we can improve by an active lifestyle.

Photo credit: flickr.com/photos/chinasixty4/273894973/

Tuesday, June 19, 2007

Online health survey proven valid

Medical knowledge is changing so fast these days that it is impossible to follow without using the World Wide Web. Its resources may be used in two ways: as a database for retrieving what is known and as a research tool for gaining new knowledge.

1. The WWW as data base

yahoo healthA group of Danish prostate cancer specialists, after having tested several search strategies, has put up this top ten list of online cancer resources:

1. Yahoo Health,
2. Doctor's Guide,
3. The National Electronic Library for Medicines,
4. CancerPage,
5. Medscape,
6. MedlinePlus,
7. HealthAndAge,
8. CancerConsultants,
9. EurekAlert,
10. Oncolink.

Yahoo at top and Google nowhere is quite a surprise to me. My forecast: In ten years or so we may find the first cancer science blog in the top ten.

2. The WWW as research tool

Online surveys are fast, but are they reliable enough for medical research? Most studies on risk factors, nutrition, stress, drug use and many more public health issues are done by classical, slow and very expensive surveys such as the 2004 Behavioral Risk Factor Surveillance System (BRFSS), the 2003 National Health Interview Survey (NHIS), and 2001-2002 National Health and Nutrition Examination Survey (NHANES).

All these surveys have gathered the national smoking prevalence (20.9%, 21.5%, 24.5%) and, in a new study, serve as a gold standard. Against this, the current smoking prevalence (24.0%) from Harris Poll Online (HPOL) have been compared. The online value is well in the range of the classical surveys. The authors conclude: «Online surveys may be useful for public health surveillance of the US population.» (One of the authors is affiliated with Harris Online.)

And poor old Mousetrapper concludes that soon he will have to watch even more public health survey studies.

Wikipedia: Behavioral Risk Factor Surveillance System

Health Blog Carnival Watch 1:1

Welcome to the first edition of my new series of posts. There are so many excellent health blog carnivals around that I more and more have been pushed to watching them too. As the number of blogs is growing at an incredible speed, orientation and guidance in this jungle is more welcome than ever. Google is fine but only a robot. Top bloggers are better blogosphere guides. And blog carnivals are the best medium to this purpose, they will become even more important in the future.

Grand Rounds 3:39
Grand Rounds is the mother of all health blog carnivals. It gives you a weekly round-up of the world's best health-related posts. Geena, hosting GR the fourth time, has unleashed her inner advice columnist Henrietta the Health Care Worker. Whatever your problem may be, ask Henrietta and she will help you with the right link. In a very thoughtful manner which shows her long-time expertise, she answers questions about virtually every problem in life up to the point where Fedup in Fresno loses his patience and says, enough, tell me something I don't know. And I can tell you there is more than Med Journal Watch to give you surprising news!
June 18, 2007 at codeblog

Gene Genie #9
The theme of this edition is Genetics 2.0 (the term refers to the second generation of genetics analogue to Web 2.0). Peer in and watch genetic scientists discuss their hot topics which are also hot (and readable) for non-scientists. Lisa E. Lee presents nine selected posts of different kind. Her comment on my post: «Last year, nutrigenomic testing was declared not-ready-for-prime-time. Med Journal Watch is keeping tabs on the research and crafting a vision of the future.»
June 18, 2007 at DNA Direct Talk

Brain Blogging #11
In this semi monthly carnival that aims to review posts «related to the brain and mind that go beyond the basic sciences into a more human and multidimensional perspective», Shaheen Lakhan presents a bunch of twenty-one very interesting posts about disorders, memory and cognition, personal stories, self awareness, spirituality, state of the mind, studies (where my post more sleepy, more risky has been included), and therapy. Enjoy!
June 16, 2007 at Brainblogger

Carnival of Healing #90
This weekly round-up of personal blog posts on the topics of holistic health, wellness, spirituality, and self empowerment presents fourteen posts about looking younger, the meanings of existence, managing conflicts, the self-perspective, chronic illness and the end of life, body and mind issues (including mine on open hearts), warning signs and much, much more.
June 16, 2007 at OptimistLab

Monday, June 18, 2007

Health web users are not dummies

whiz kid
Who reads my stuff? And does she or he get my message? Like all serious bloggers I constantly have this in mind when I am writing and overhauling my drafts. In my opinion, underrating of your readers is the worst thing you can do as a blogger. Of course I am trying to break down to a lay-person level what I find in medical journals. But the facts are holy. I may take some complications out but never fall below certain limits. I always have a scientist in mind who peers over my shoulder. Thus, reading my stuff is not always easy.

In every post I link to sources that often demand an university degree. This holds not only for my PubMed links but also for many Wikipedia links. So every reader has his own choice of level: He may click or he may not.

To my pleasure, my view has been supported by a recent study about consumers' ability to comprehend health information. It came out that consumers do not prefer online health information written on a lower grade reading level. Such a low level does neither improve the perceived trustworthiness nor truthfulness nor completeness of the given information. And, to my surprise, it does not improve the readability either.

Photo credit: flickr.com/photos/shylah/138690399/

Sunday, June 17, 2007

Pediatric Grand Rounds 2:5



Welcome to volume two, number five of Pediatric Grand Rounds. The order of presentation is not by rank but follows a logical thread, trying to give every post its best neighbourhood possible. Last is certainly not least. But of course I begin with my favorite.

Intensive emotions

This editor's pick has not been picked but has picked me. A strong piece of writing, flowing directly from heart, unbraked by case shift key, after a long sleepless night shift in a pediatric intensive care unit. Sasha Cornell at Girl MD tells us how it feels living the myth of sisyphus in a sad reality of dying children.

The same sisyphus feelings, in a setting that could not be more different, are evoked by Tara C. Smith at Aetiology, telling us that Sierra Leone takes one step forward banning marriage at age eleven ... and a half step back in still allowing female genital mutilation in girls what often causes death by sepsis. More than half a step back, I sisyphously would say.

In face of such drama, our problems here seem to be luxury: Stress caused by too much work and by kids who refuse to comply. Stacey B. Stryer at her Revolution Health blog tells us why parents often behave like kids and what can be done against adult temper tantrums.

For our next section we take a step back to intensive care...

Starting life too early

Neonatal Doc has found himself in the midst of the heat fueled by advocates of all kind with fixed opinions about resuscitation of preemies with very low gestational age and with Down Syndrome. The answers to such questions cannot be easy, and there are still the parents who have their own opinions.

Sextuplets have a very difficult start, and their chance of having a normal life depends mainly on gestational age and weight at birth. Judy at Tiggers don't Jump gives an accurate but chilling clinical assessment of the prospects of two sets of sextuplets that were born recently.

Parents of preemies are often told not to worry and that all will be just normal. Stacy of The Preemie Experiment, in response to a reader question, says that some neonatologists and the mass media whitewash the facts and that parents should be told the inconvenient truth about the consequences of prematurity.

Now let's turn to the nutrition that is supposed to be the most natural for newborns...

Breastfeeding

We still are at intensive care, though. Laura at Adventures in Juggling is a nurse in such a unit, and she constantly needs to be all things to all patients and their families. But then suddenly she discovers that she is two in one simultaneously: a breastfeeding saboteur and a breastfeeding tyrant!

Even with a baby born on term there may be problems. Christina at A Mommy Story tells us about the double frustration of having a first baby who refused the breast and a second one who never can get enough milk.

The Lactivist presents a carnival about the importance of fathers in breastfeeding and Black Breastfeeding Blog addresses the fact that black mothers get less accurate advice for breastfeeding than white mothers.

Breastfeeding makes babies grow, they become toddlers, then kids, and then ...

Growing older

Even chronically ill children, thanks to a better medicine, survive more and more and reach adult age. As positive as this is, it raises new problems, as Clark Bartram at Unintelligent Design points out: They grow out of the pediatric domain where they have got best care, and this transitioning care makes them lose what had worked best for them. A serious downside of medical success.

In coming of age, ill and healthy makes just one difference. Gender makes another, and not a small one. Boys do it their own way: Men do not cry and seeing a doctor is sissy. Nancy L. Brown at Healthline discusses why teen boys are reluctant to seek healthcare and what can be done about it.

And girls do it their way, too. Sandy at Junkfood Science, as ever, has fresh food for critical thinking. Public health messages, in her opinion, do more harm than benefit when they hit the wrong target. She links to a piece with shocking pictures of girls misled towards anorexia. Warning: Visiting pro ano sites puts you at risk of an eating disorder, as far as I remember a study. This said: Click by and make your own opinion!

Another girl issue is brought up by Signout at Scienceblogs: Children having children. Abortion sucks - I admit this title made me hesitate at first because I do not agree with most people who publicly claim that abortion sucks even if I personally find that abortion sucks. But then I realized that it was posted at one of the Scienceblogs (on the unintelligent design side) and I was not surprised to be told things that suck even more than abortion.

We are already in the midst of our next section, and we got more...

Hot topics

The Autism Omnibus hearings have begun (background: the Thiomersal controversy), a flood of legal cases of families blaming vaccines to have caused autism in their children. Orac at Respectful Insolence gives an excellent and comprehensive overview of this issue, warning from a tsunami of pseudo-science spilling over the proven facts: When you don't have scientific evidence, tug on the heartstrings!

Treatment Online, in Perspectives on Autism «Epidemic», points out that the definitions of this disease have expanded, thus increasing the number of cases by (over)diagnosis.

Book author Arthur Allen has noticed that the anti vaccination zeitgeist has reached Hollywood meanwhile, spreading mercury fears even more.

When quackery issues hit the mass media, other topics that ought to be hot are in danger of being forgotten. Primary immunodeficiency is such a case, presented by Bertalan Mesko at Scienceroll. He makes himself an advocate of giving babies a chance to survive. An effort that is worth being supported.

Neurofibromatosis, a rare tumor in children, is another such case. Walter at Highlight Health reviews a conference that just has been held about the subject. The sad story is that the funds for research against this disease have been heavily cut. If you want this to be changed, feel free to click the donation link at the bottom of Neurofibromatosis and The Children's Tumor Foundation.

In hot debates, the two dimensions of our next section often intermingle...

Fantasy and reality

Chris Chatham at Developing Intelligence presents fascinating research outcomes about the blur between fantasy and reality in children. The crucial points are: What did I say? What did I hear? What did I do? What did I watch others to do? Research tells us what is prone to be intermingled (and what is not) when we recall our childhood.

Expectations are another important domain of fantasy, and Bryan at Parenting Solved shows us the outcome of a human experiment that takes place all the time in his clinic: It depends on parental expectations, more than on reality, when parents say baby is better or not. And often mummy and daddy do not agree.

Life should not always be hard and serious. So enjoy our next section...

Quirky research

Let me present you two more favorites of mine. Both take up an issue that I have covered in my own blog - laughter (in June) and robot doll (in May), and it is interesting to see how a different angle of view or new sources add more knowledge and insight to a subject.

Shinga at Breath Spa for Kids wonders if you just can make your kids giggle to get them rid of eczema. This is no joke! She presents outcomes of Japanese studies that seem to support such a view, but in her opinion the studies are more fun than the outcomes. What she finds no fun at all is the poor provision of allergy services in her country. Read what she has to tell us about Laughter, Children, Babies and Eczema.

I just have learned that Robota, the Swiss robot doll, has got a British pal called Kaspar. Medgadget presents this little Pinocchio-like robot that is designed to teach autistic children social skills. Medgadget is quite optimistic about the benefits of such a robot. Just click by and form your own opinion!

Dr. Rob at Musings of a Distractible Mind comments on a toddler robot that has been developed by - oh, again these funny Japanese - scientists. Its purpose: a better understanding of human toddlers. Should we laugh or should we cry? Don't miss Rob's witty comments.

Now it is time to get back to the real purpose of medical science. This brings us to the last, small but very important section...

Health tips

Dr. Steven Parker at WebMD blog gives parents top 10 tips for a safe and healthy summer. Number ten I like most: Give your kids ice-cream. Check out if you know the nine others, they are very important!

But be aware that some health tips conflict with others. Dr. Gwenn at Pediatrics Now muses on the relative risks and possible shortcomings of various summer tips for children in no good deed goes unpunished. Her very thoughtful post is a must read for all who care for kids' health and safety.

Acknowledgements

This edition has been made possible by Clark and Shinga. What they do for Pediatric Grand Rounds is really great and cannot be valued highly enough. I am also indebted to all who submitted posts and, on behalf of our next host, to all who regularly submit to PGR. And thank you all, you members of the PGR family who link to PGR editions where your post has been included, and my special thanks go to the Friends of Pediatric Grand Rounds who link to us without having been included - too numerous to bee mentioned here.

This concludes PGR 2:5. It has been a pleasure to read and compile all these great posts. I hope you enjoyed my presentation. Look up the hosting schedule for future editions of Pediatric Grand Rounds. PGR 2:6 will be hosted by Shinga July 1, 2007 (submit here).

Photo credit: flickr.com/photos/o_caritas/512838893/

Friday, June 15, 2007

Genes may be the key to future diets

bacon ham eggs
Imagine you are overweight but love a double portion of bacon ham and eggs each morning. Today, every doctor will tell you this is no good because it puts you at risk of a heart attack. But in the future, such general advice may be outdated due to genetics. As we all know, general rules never apply to all people because all people are different. One main cause of these difference is the genes. So, after a screening of your genetic outfit, a future doctor may tell you: «No problem with bacon ham and eggs, eat as much as you like. Your (some cryptic letters and numbers you do not understand) locus (the place of that gene) tells me that you are not at risk from high cholesterol. But make sure you get enough selenium because your metabolism is not very effective in using it.»

Well, I admit that this vision is not reality. Not yet. But according to new research in nutrigenomics (the science of how genes and diets act together) personalized diet advice, based upon genetics, will be the future.

At the Genome Institute of Singapore, two gene loci (places) and their interactions with diet have been examined. For those who want to know the details: Peroxysome Proliferator Activated Receptor Alpha (PPARA) and Perlipin (PLIN, sorry, no Wikipedia entry, it is a gene involved in fat metabolism and obesity).

The Singapore researchers admit that there is still a far way to go and they invite the scientific community to challenge their findings.

(Picture by spo0nman @ Flickr)

Thursday, June 14, 2007

Breast self-exam proven effective

breast self-exam
Good news in the bad news: Women who are at risk of getting a more aggressive type of breast cancer are also most likely to detect the cancer by breast self-exam. This came out in a study where a hundred and fifty breast cancer patients have been diagnosed by different methods in the Netherlands.

A considerable amount of the risk comes from the genes: Women with an unfavourable variety of the BRCA1 gene are at a higher risk of getting a fast growing breast cancer type. But these women also have the best odds of detecting the cancer by breast self-exam: More than fourty percent of cancers have been detected by the women themselves, without a mammogram.

Conclusion: Mammograms have also proven to be effective in this study. But breast self-exam is a very important method to detect more cancers, above all in women of highest risk.

Wikipedia: Breast cancer and the breast cancer genes BRCA1 and BRCA2.

(Picture by briantologist @ Flickr)

Wednesday, June 13, 2007

More sleepy, more risky

sleepy
When it gets harder and harder to keep the eyes open, possible rewards become more attractive whereas possible losses become more and more irrelevant. This has been shown in two experiments with young healthy volunteers in Singapore. Thus, sleepy persons are not only prone to slow reactions, for instance in traffic and other situations where full alertness is demanded. They also take more risks which puts them even more to danger.

The subjects had to perform a gambling task that involved taking risks and expecting rewards. While they were performing the task, their brain has been scanned. In a sleepy state, the brain regions that handle positive expectations were more activated as soon as a risky choice has been made, and the regions responsible for loss prevention turned down. In a second experiment, the choice has been made by a computer and the subjects only watched the outcome. Even then, without active gambling, the positive outcomes evoked more activation of the brain than the negative ones.

Conclusion: Sleepiness has a double threatening impact on decision making, raising positive expectations and lowering the fear of danger.

(Picture by Luna Cruz @ Flickr)

Tuesday, June 12, 2007

Open hearts live longer

hugging
Do you allow yourself to cry in front of others? Do you feel okay if someone tells you that you are a great person? Are you able to speak to a person who has negative feelings about you? If you answer with yes these and more questions of this kind, you may be more likely to live longer.

Such an open attitude has been found to prolong life in a sample of about a thousand heart patients in Durham, North Carolina. Various personality traits have been assessed by a test (NEO PI) that is widely used in psychology and that has been proven as reliable. This test measures six different facets in the openness dimension: Openness to fantasy, aesthetics, feelings, actions, ideas, and values.

About fifteen years after the test roughly half of the patients have died, most of them from heart disease. A relation of their fate to the earlier test results shows that two of the six facets of openness correlate with a longer life and a reduced heart risk: Openness to feelings and to actions. For instance, a heart patient is likely to live longer if he can deal with strong emotions of others as well as of his own, or if he is able to take action in a dilemma instead of just sitting there, thinking back and forth.

In contrast, you may be open to fantasy and beautiful things, to new ideas and to values which for sure will make you live a better life. But it will not, or only partially, influence your health, according to the Durham study. It seems to me that the heart is more influenced by the openness in the «gut dimension» than in the «head dimension». Sounds reasonable, as the heart is one of the inner organs.

Limits and meanings of this study

The study is about heart patients. It cannot be concluded that being open to feelings and actions will prevent healthy people from getting a cardiac disease although this is reasonable to assume.

Mens sana in corpore sano: A healthy mind in a healthy body, as the old Romans used to say. The key message is that this old wisdom has been proven right by science, and that new studies are adding more and interesting details to it.

Carnival of Healing at Optimist Lab
The 90th edition of the Carnival of Healing is up at Optimist Lab, presenting a weekly round-up of personal blog posts on the topics of holistic health, wellness, spirituality, and self empowerment. My post also has been included.

(Picture by Mundoo @ Flickr)

Grand Rounds up at Revolution Health

This week's collection 3:38 of the best posts of the medical blogosphere, presented by Val Jones at Revolution Health, comes in two ways: As a short release «down to the bones» and as extended release with her witty comments and introductions. The categories are: Happy posts, sad posts, hot topics, helpful tips, case reports, uncategorized. As a special tidbit she has added her own cartoons to many of the posts. Enjoy.

Monday, June 11, 2007

Heart Attack Health Quiz

paper and pencil
Most people in my country have only one third of minimal medical knowledge about heart attack, stroke, chronic obstructive pulmonary disease and HIV/AIDS, according to this survey. I guess that the situation in the United States, the United Kingdom or elsewhere in the world is not much better. And what about you?

This survey has brought me to the idea of launching a health quiz where you can test your basic medical knowledge. I start with heart attack, one of the leading causes of premature death:

A. What are the seven classical signs of a heart attack (myocardial infarction)?

B. What are the seven main risk factors for a heart attack?

Take a paper and a pencil and write down the answers. Then go to this page to check them.

How do you compare with others? Invite a friend to take part!

(Picture by gullevek @ Flickr)

Saturday, June 9, 2007

How the brain deals with words and digits

inferior frontal gyrus
What happens in the brain when you catch and understand a sentence or if you count a sequence of digits backward? New research with brain scanners has revealed that it depends on the details. That is, on how complex the sentences are. If the brain has to deal with an involved period, it treats it like a sequence of digits that has to be sorted and rearranged. This happens in the brain region coloured red in the picture: The lower front curl of the left side of the brain (inferior frontal gyrus) seems to be a multifunctional region where different kinds of tasks overlap.

This has been shown in a very interesting trial with fifty-eight patients suffering from various forms of dementia and other brain diseases. They had to perform two different tasks while their brains have been scanned by magnetic resonance (MRI). The first task was matching pictures with sentences, either simple or complicated. The second task was counting a given sequence of digits backward, for instance 7-8-9 has to be responded by 9-8-7.

The MRI scanner shows that the brain uses different regions for these two tasks - as long as the sentences are simple. But with more complicated sentences, the brain shifts this task over to a region on the left side of the brain where also the backward counting takes place. Obviously, the brain map is not a fixed landscape but alters its shape, depending on the kind of task. I wonder if we ever will be able to understand our own brain. It may well be impossible at all.

(Picture by Wikipedia)

Friday, June 8, 2007

Borage oil to keep fat down

borage
What is most important in weight loss? Some say you must lose as much weight as you can as fast as you can. Those are very likely to sell you products or diets. Be sceptic! Most experts do not recommend a fast weight loss because it is often the start of a yo-yo. If you ask me, I say that most important in weight loss is not to regain weight once you have lost it. Some even say that the real job begins when you have reached your dream weight.

You may not be ready to believe it, but oil may help you to prevent your body to store fat again, if you have been obese before and want to do everything to keep your weight down: Borage oil, pressed from seeds of the starflower (see picture), in a study with formerly obese Californians, has been effective in slowing down weight regain.

Fifty persons, after a massive weight loss, have been supplemented either with five grams of borage oil or five grams of olive oil daily. After one year, the persons in the borage oil group had regained two kilograms (four pounds) on average, much less than the more than eight kilograms (sixteen pounds) of the persons in the olive oil group. Unfortunately, this effect did not last over a longer period. One and a half years later, even with borage oil the weight regain has been six kilograms (twelve pounds) on average. The study authors say that the effect of borage oil is due to their content of essential fatty acids.

Conclusion: Borage oil may slow down weight regain in formerly obese but it is not sufficient as a single measure to prevent weight regain in the long run.

Wikipedia: Borage

Carnival of Dieting Tips
This post has been selected by the June 9th, 2007 edition of a very public diet at MiddleAgeShed, presenting ten more very interesting tips on dieting and weight loss.

(Picture by PurpleGecko @ Flickr)

Thursday, June 7, 2007

Drugs that shorten the end of life

nursing home
«I must ask his doctor», she said to me yesterday. «I am concerned about the drugs that they give him.» They are nurses and he is her father, living with dementia in a nursing home and often up at night when he is planned to sleep. Obviously, it is their plan, not his. The drugs are tranquilizers, and she wants to know exactly what tranquilizers and which are their side effects. This story came into my mind when I found a study stating that major tranquilizers shorten the life of nursing home residents with dementia.

In Canada, the effect of antipsychotic drugs, also known as neuroleptics or major tranquilizers, have been tested in more than fifty thousand older adults suffering from dementia. The patients have been selected from the population and have been compared pairwise - either new (atypical) drug versus no drug or new (atypical) drug versus old (typical) drug. Drug users were 30 percent more likely to die next month than non-users, and users of old drugs more likely than users of new drugs. The authors conclude that the drugs shorten the life of people with dementia though they admit that they were unable to take certain other risk factors into account.

Back to my story. He is often angry, she told me today. He shouted, they put me here, and there, and there, and there... His mind is too slow to understand what happens with him. I am going to call his doctor, she said. Good idea, I said. Ask him for the names of all drugs they give your dad.

Wikipedia: Antipsychotic

(Picture by pilaar39 @ Flickr)

Wednesday, June 6, 2007

Twelfth Healthy & Fit Family is up

Cindy, at Wisdom of Healing, presents a carefully selected bunch of posts in the 12th edition of the Healthy & Fit Family carnival that all «make a vibrant contribution to the next generation's well-being». You find comprehensive and very interesting posts about nutrition and, what I like most, about exercise for the young and the elder. Enjoy! Next edition will be hosted at Babylune. You can submit your posts here.

Pediatric Grand Rounds: Call for submissions

Submission has been closed. Thanks to all who have submitted posts.

For PGR 2:5 see Sunday, June 17th, 2007 on this blog. PGR 2:4 is hosted by Awesom Mom.

Tuesday, June 5, 2007

Laughter is the best medicine

laughter
This old saying has been supported by two new studies: Laughter can reduce the harm caused by type 2 diabetes and can improve the quality of milk in breastfeeding mothers.

Diabetes: In Japan, sixteen healthy persons and twenty-three patients with type 2 diabetes have watched a comedy show. Before and after the show, blood levels of a substance (prorenin) that has an adverse effect on the kidneys have been measured. In diabetic patients, the level of prorenin is higher than in healthy persons. After the show, the level was clearly lower in the patients. Thus, laughter helps to protect the kidneys against the harm caused by diabetes.

Breastfeeding: In another Japanese study, fourty-eight mothers of babies suffering from allergic eczema either have watched the Charlie Chaplin movie «Modern Times» or a weather information show. After the film, breast milk of the mothers has been collected and analyzed. In the milk of mothers who had watched the Chaplin movie a lot more of melatonin has been found; no such change happened with the weather show. Melatonin is a natural sleep hormone that has a soothing effect on babies. And even better: When the babies have been fed with humour-improved milk, they suffered less from allergies.

Wikipedia: Laughter, Laughter Yoga

(Picture by rebecca anne @ Plickr)

Grand Rounds up at Inside Surgery

Inside Surgery presents Volume 3, Number 37 of Grand Rounds in a very concise and clear fashion. What emerges under his sharp scalpel is a broad spectrum of health topics that are worth reading. Enjoy!

Monday, June 4, 2007

A new lab animal without sex

marbled crayfish
This marbled crayfish (Marmorkrebs) may become one of the new favourite animals for basic medical research. The reason: All animals are genetically identical. This has been suspected because all are female and produce their offspring without sex. There are no males at all. But even with such a mode of reproduction some variations in the genes are possible, depending on the exact mechanism by which the unfertilized eggs of this crayfish begin to divide and to form a new organism.

This mechanism and the genetic fingerprints of nineteen related animals have been analyzed at Humboldt University in Berlin. The researchers conclude that all offspring of a given marbled crayfish share in fact a hundred percent of their genes.

This is good news for all researchers who study the influence of the environment on organisms. If all genes are identical, any difference must be caused by the conditions of the environment, for instance a new drug that is to be tested. Of course, the marbled crayfish is very different from humans, but so are many other laboratory animals for basic research. Time will tell if this crayfish will really help us for a better understanding of our own genetics and for the development of better drugs.

Wikipedia: Marmorkrebs (in German). The species has been detected 1990 in a German aquarium shop. No English entry yet.

(Picture by J├╝rgen Schmidt)

Sunday, June 3, 2007

A fresh Austrian view on depression

depressed
A new, promising theory of depression has been developed at the university of Salzburg in Sigmund Freud's country: Depressed persons lose the ability to execute certain modes of behaviour and feel compulsed to execute other modes of behaviour all the time. They are aware of this imbalance but are unable to explain it. This loss of self-understanding is an important feature of depression.

I am going to present the details and then discuss the question of how these findings can be used to find new ways out of depression.

A body and mind model of behaviour

The psychologists at Salzburg have developed a catalog of 35 items that also include basic body reations. I find this very clever because depression very often hides itself behind body symptoms. They have asked 30 depressive patients and 30 healthy subjects: Has the frequency of the following behaviors changed during the last two weeks in comparison to normal? If so, how frequently do you do or feel the following.

The 35 items: Sleep. Vomit. Feel alert and focused. Feel greedy. Feel generous. Eat. Bowel urgency. Move around. Feel stiff (not able to move). Feel afraid. Feel happy. Deal with problems, situations, people. Avoid people. Perform sexual activity. Perform mental or intellectual activity. Drink. Urge to urinate. Quarrel. Feel peaceable. Feel like fighting. Feel resigned and non-resistant. Feel jealous. Feel indulgent. Work. Rest. Talk. Listen. Feel pleased. Feel annoyed or irritated. Laugh. Cry. Communicate with others. Seclude yourself. Feel cheerful. Feel sad.

The possible answers: Never. Less often. No change. More often. Always. Example: If you never feel afraid and this has not changed, you mark «no change».

Results: All of the thirty depressed patients but only two of the non-depressed had extreme positions (never, always) in their answers. Most of the depressed patients were unable to explain why this had happened to them.

Conclusions: The study authors suggest a new theory on depression, stating that extreme frequencies in modes of behaviour occur in depressed persons and that they are less likely than healthy persons to explain these extremes.

Finding new ways out?

The Salzburg model has been developed as a diagnostic tool that should allow to find out if a person is depressed or not. But I think the findings may also be used to cope with depression. If lack of self-understanding is a feature of depression and if you manage to understand yourself better, it may help you to reduce stress. You may still suffer, but maybe a bit less if you can explain why than if you have no idea about it.

Another point is the question of how you can try to influence yourself on the behaviour level. If you manage to change your behaviour in a way to get out of some extremes, you may curb the symptoms of depression and feel better than before. I am not sure if it will help but I think it is worth a try. My view is supported by a study showing that cognitive behavioural therapy is most effective in severe depression.

(Picture by ozlogy @ Flickr)

Friday, June 1, 2007

Useless vitamins against arthritis

vitamin pills
Vitamin merchants are very active online. They like to cite studies to tell you that vitamin X has been «proven» to be effective against disease Y or to prevent disease Z. But often these studies are of low quality and should not be trusted, as is revealed in this review for the case of arthritis: The effects of the antioxidant vitamins A, C, E, and selenium on several forms of arthritis have been tested in twenty clinical studies, but none of them showed a clear and positive result. Most of these studies are «weak», of «poor quality», and their results are «doubtful», the review authors conclude.

Search vitamin and arthritis with Google. When I did it today, I got more than a million hits. In four of the top ten, beneficial effects of vitamin A, C, E, or selenium are reported, and the first vitamin merchant shows up at position three.

Trust whom?

If one study reports an effect and another study denies it, the best we can do is to compare the quality of both studies: Number of cases, time span of the survey, selection criteria for the patients, control for confounding effects, statistical methods and the like. The quality standards of medical studies are generally accepted, and the study cited above has been published at Oxford University Press. This alone does not make it true, but at least trustworthy. Conflict of interest can also be ruled out because the study authors collaborate with a department of complementary medicine.

Get the best for your money

Instead of spending a lot of money on vitamin pills you may fare better with fruit, vegetables and other natural sources of vitamins and minerals. High quality food also has its price, but did you ever enjoy the swallowing of a vitamin pill? Plus it is very likely that nutrients from natural sources are better than from supplements, see my post on calcium.

A last word: If you have a vitamin deficiency or a higher vitamin need and you take vitamin pills by prescription, continue to take them.

(Picture by worldmegan @ Flickr)