Polycystic Ovary Syndrome Raises Pregnancy Complications Risk

New research published on bmj.com this week claims that women with polycystic ovary syndrome (POS) are more likely to have problems with pregnancy even if they are undergoing fertility treatment.
Approximately 5 to 15% of women who are of reproductive age suffer from polycystic ovary syndrome, a common disorder in which small cysts typically develop around the edge of the ovaries. The symptoms consist of irregular periods, ovulation problems, weight gain and excessive hair growth, with those affected by the condition being more likely to seek fertility treatment.
The Swedish researchers urge for better monitoring of women suffering from polycystic ovary syndrome during pregnancy and childbirth as they are at a greater risk of giving birth prematurely, develop diabetes and pre-eclampsia. Researchers previously believed, that these outcomes were explained by assisted reproductive technology although this is not the case.
Researchers from the Karolinska Institutet and Karolinska University Hospital in Stockholm, Sweden decided to examine the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome. They accounted for maternal characteristics and fertility treatment.
The researchers evaluated nationwide data, which included information on 3,787 births amongst women suffering from polycystic ovary syndrome and 1,191,336 births of women without the condition by measuring the risk of adverse pregnancy outcomes, including pregnancy-induced diabetes, pre-eclampsia, premature birth, still-, and neonatal death as well as poor health in newborns.
Adjustments were made for variables, such as maternal characteristics, including age and body mass index, socioeconomic factors and fertility treatment such as IVF.
The findings revealed, that women diagnosed with polycystic ovary syndrome were more often obese and more often used assisted reproductive technology, such as IVF treatment compared to women without the condition.
The researchers discovered a strong association between polycystic ovary syndrome (POS) and pre-eclampsia. Women with POS had a 45% higher risk of developing pre-eclampsia and were more than twice as likely to give birth prematurely and/or to develop pregnancy induced diabetes.
They also discovered that babies whose mothers suffered from POS had a greater likelihood of being large at their gestational age and tended to develop asphyxia during labor.
In summary, the study revealed that a diagnosis of polycystic ovary syndrome was linked to increased risks of adverse pregnancy outcomes and that increased use of assisted reproductive technology or maternal characteristics, such as advanced age or being overweight or obese did not attribute to the outcomes.
In a concluding statement the researchers say:

"These women may need increased surveillance during pregnancy and childbirth. Future research would benefit from focusing on glucose control, medical treatment and hormonal status among women with polycystic ovary syndrome during pregnancy."

Professor Nick Macklon from the University of Southampton writes in an accompanying editorial, "It is clear that women with polycystic ovary syndrome should be considered "high risk" obstetric patients and that midwives, general practitioners, and obstetricians should monitor these women as such."

However, in his opinion:

"more evidence is required to support the use of currently used interventions designed to reduce perinatal risk, and this requires a greater understanding of the different polycystic ovary syndrome phenotypes and the underlying mechanisms by which this common condition alters pregnancy outcomes."

Written by Petra Rattue

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Smoking Pot Might Up Depression Risk in Vulnerable Teens

Smoking Pot Might Up Depression Risk in Vulnerable Teens

Smoking marijuana increases the risk of depression in youngsters who are genetically susceptible to the mental health disorder, according to a new study.
About two-thirds of the population have the variant of the serotonin gene (5-HTT) that increases vulnerability to depression, said the researchers at Radboud University Nijmegen in the Netherlands.
They analyzed five years of data collected from 428 families with two adolescent children each. The youngsters provided yearly information about their behavior and depressive symptoms.
The study found a strong association between marijuana use and an increase in depressive symptoms among those with the gene variant.
"The effect is robust. It still remains, even if you take into account a series of other variables that could cause the effect, such as smoking behavior, alcohol use, upbringing, personality and socioeconomic status," the researchers said in a university release.
"Some people might think that young people with a disposition for depression would start smoking cannabis as a form of self-medication, and that the presence of depressive symptoms is therefore the cause of cannabis use. However, in the longer term that is definitely not the case. Although the immediate effect of cannabis may be pleasant and cause a feeling of euphoria, in the longer term we observe that cannabis use leads to an increase in depressive symptoms in young people with this specific genotype," the researchers said.
The study appears online in the journal Addiction Biology.
-- Robert Preidt

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Certain After-Stroke Treatments May Boost Outcome

Certain After-Stroke Treatments May Boost Outcome

Stroke patients function better physically and are less likely to die if they undergo treatment that pays special attention to fever, high blood sugar and swallowing problems, new research suggests.
"Clinical leaders of stroke services can adopt this strategy with confidence that their outcomes will improve," Sandy Middleton, a professor at the Nursing Research Institute at St. Vincent's & Mater Health in Sydney, Australia, and colleagues wrote in the report in the Oct. 12 online edition of The Lancet.
The researchers noted that patients who recover in units devoted to stroke care often experience fever (20 to 50% of patients), high blood sugar (up to half of patients) and problems swallowing (37 to 78% of patients) within the first few days of a stroke. These conditions "are not yet universally well managed," the study authors indicated.
In the study, Middleton and colleagues randomly assigned patients at 19 stroke units in New South Wales, Australia, to different types of treatment. Some followed existing guidelines, while others adopted new protocols involving monitoring of fever and high blood sugar plus treatment for the conditions. Nurses also underwent special training to treat swallowing problems in the patients.
Within 90 days, 42% of the 558 patients in the group that received the special treatment were dead or considered to be dependent, compared with 58% of the 449 patients who received the existing treatment, the investigators reported.
Patients who received the special treatment also scored better on a test of their physical functioning, the results showed.
Commenting on the study, Dr. James S. McKinney, assistant professor of neurology at the University of Medicine and Dentistry of New Jersey, said the results are "astounding."
"Stroke patients should be cared for at designated stroke centers that implement treatment protocols, such as those described by the authors," said McKinney, who had no role in the study. "It has never been more apparent that the type and quality of hospital stroke patients are admitted to impacts their recovery and functional outcome."
-- Randy Dotinga

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Regular Exercise Seems to Guard Against Migraine

Regular Exercise Seems to Guard Against Migraine

 Exercise can prevent migraines just as well as drugs or relaxation techniques, a new study from Sweden suggests.
"Our conclusion is that exercise can act as an alternative to relaxations and [the migraine drug] topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines," study lead author Emma Varkey, a physiotherapist and doctoral student at the Sahlgrenska Academy, University of Gothenburg, said in a university news release.
In the study, Varkey and colleagues evaluated 91 migraine patients over the course of three months.
One-third of the patients were asked to exercise for 40 minutes three times each week. Another third of the participants performed relaxation techniques and the final third were prescribed topiramate. The researchers also followed up with the patients three and six months after the treatments ended.
The study, published in the current issue of the journal Cephalalgia, found that the patients in all three groups experienced fewer migraines. The study authors said exercise was just as effective in preventing migraines as the medication and the relaxation techniques.
One expert agreed that physical activity can be key to migraine prevention.
"The study clearly shows the importance of an exercise program," said Dr. Robert Duarte, director of the Pain Center at The North Shore-Long Island Jewish Health System in Manhasset, N.Y. "Exercise is another form of relaxation and is well known to cause a release in endorphins, the body's own pain-reducing substances. Migraine patients should be strongly advised to introduce an exercise program as part of their migraine prevention program."
But, Duarte added that patients "should see a primary medical doctor before starting an exercise routine."
-- Mary Elizabeth Dallas

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Folate and Colon Cancer Risk

Here's more good news about diet and cancer: a, recent large study shows that people whose diets included the most folate were 30 percent less likely to develop colon cancer than were those whose intake of this nutrient was low. Researchers from the National Cancer Institute looked at data from diet surveys that reflect the effects of fortification of food with folic acid (a synthetic form of folate) instituted in the late 1990s.

They found the lowest risk of colon cancer among individuals whose folate intake was highest (at least 900 micrograms per day) compared to those who got less than 200 mcg daily. The investigators were also looking for links between high levels of folate and higher risks of colon cancer, but found no evidence of a connection. However, this study couldn't rule out the possibility that those who get too much folate through the combination of supplements and fortified foods might be at increased risk for colon cancer, as some other studies have suggested. The findings were published online on August 3 by the American Journal of Nutrition.

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The Pill Alters How Women Select A Partner

Women who chose their partner while on the contraceptive pill tend to be satisfied with their stable relationship, but less so regarding sexual satisfaction, compared to those who chose their men while not on the pill, researchers reported in Proceedings of the Royal Society B. The researchers added that the ones who were on oral contraceptives (OC) when choosing their mate had relationships that lasted on average two years longer than the other women's.

Dr. Craig Roberts, of Stirling University, Scotland, said:

"Our results show some positive and negative consequences of using the pill when a woman meets her partner. Such women may, on average, be less satisfied with the sexual aspects of their relationship, but more so with non-sexual aspects.

Overall, women who met their partner on the pill had longer relationships - by two years on average - and were less likely to separate. So there is both good news and bad news for women who meet while on the pill. One effect seems to compensate for the other."

At the moment of forming a partnership, 1,514 females were on no type of hormonal contraception, while 1,005 used combined oral contraceptives. Those on other forms of hormonal contraception, such as progestogen-only pill, implants and injection were excluded from the study.

Of the 2,519 remaining volunteers, 1,761 were still together with their first child's biological father. Of the 758 who were no longer with the biological father, 734 had separated or formally divorced (both termed in this study as separated), the remaining 24 whose partners had died were excluded from the study.

The women's average age was 37.7 years. 1,200 of them were from the USA, 999 from the Czech Republic, 159 from the UK, 98 from Canada, and 43 from other countries.

Of the 1,761 women whose relationships were ongoing, the researchers detected some considerable differences between those who had been using OC (oral contraceptives) and those who had not when they met their partner.

Those on OC when choosing their partner had a lower score on sexual arousal compared to the other women. The same was found when asked about their sexual attraction to their partner, and his sexual adventurousness.

The authors also found that those on OC when choosing their partner tended to have improved sexual satisfaction with time.

However, those who had been on the pill when selecting their partner scored better on other (nonsexual) aspects of their relationship, such as financial provision, or the partner being a good father.

The OC women scored better on nonsexual aspects of their relationship, such as the partner being a good father

The authors wrote:

"Although the results of this initial analysis are consistent with predictions generated by a body of laboratory studies (reviewed above) that suggest that OC use might alter mate preferences, it is possible that some or all of these effects could alternatively arise as a result of between-group differences that are unrelated to mate choice and any disruptive effects of OC.

For example, a lower sexual satisfaction score among the OC women might be because of differences in attitudes towards uncommitted, short-term relationships.

In a previous study, Dr. Roberts had found that women's preference for men's body odor changed when they were on the pill. Women on the pill were found to prefer men who were genetically similar, while those not on the pill preferred the smell of genetically different males. At the time the researchers suggested that perhaps when on the pill women would choose different men than they would normally choose.

Dr. Roberts wrote:

"Women tend to find genetically dissimilar men attractive because resulting babies will more likely be healthy. It's part of the subconscious 'chemistry' of attraction between men and women.

Similarly, women's preferences subconsciously change over time so that during non-fertile stages of the menstrual cycle they are more attracted to men who appear more caring and reliable - good dads.

The hormonal levels of women using the pill don't alter much across a month and most closely reflect those typical of the non-fertile phases of the menstrual cycle. It seems that our preferences are shaped by these hormonal levels, so preferences of women on the pill don't change around ovulation in the way seen in normally-cycling women.

(conclusion) Choosing a non-hormonal barrier method of contraception for a few months before getting married might be one way for a woman to check or reassure herself that she's still attracted to her partner. "

Written by Christian Nordqvist

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Taking The Myths Out Of Pudendal Nerve Entrapment Surgery

Imagine someone with chronic pelvic pain or genital pain so severe that sitting, having sex, or holding a job becomes impossible. Unable to maintain normal relationships, this person may lose hope and fall into despair because no one understands. Finally, the patient is given a diagnosis of pudendal neuralgia due to possible pudendal nerve entrapment (PNE) that may require surgery; but for patients with PNE, making a decision about pudendal nerve decompression surgery can be very confusing. While some physicians recognize the value of PNE surgery, it is not unusual for patients with PNE to be told that surgery will not help them and that they will have to learn to live with severe pelvic pain for the rest of their lives. Many patients who are considering PNE surgery have exhausted conservative treatments such as physical therapy, medications, or nerve blocks, and are still living in serious debilitating pain. Hearing conflicting opinions from health care providers may leave a patient who has chronic genital pain wondering where to turn. More educational information is needed to dispel some of the myths related to surgical treatment of PNE.
Myth # 1

Surgery should not be considered an option for people with PNE because it is too risky and its efficacy has not been established.
There continues to be disagreement in the medical world as to whether surgery should be an option for patients with pudendal neuralgia. In some instances patients are worse after surgery, and in approximately one-third of patients, there is no improvement.(2) Naturally, these patients continue to seek medical treatment after surgery which may cause some health care providers to question the efficacy of PNE surgery. Some post-operative patients who have had ligaments cut during surgery have reported developing sacroiliac joint dysfunction, piriformis syndrome, levator ani muscle spasm, and coccyx pain after pudendal nerve surgery. Other patients have reported new problems such as penile/clitoral numbness or pain in areas they did not experience before.
Despite the risks, according to publications in peer reviewed literature and anecdotal evidence from numerous patients, surgery can often bring significant relief in a patient's pain levels, and many patients experience dramatic improvements that allow them to resume a normal life. The challenge for the diagnostician is to determine which patients are most likely to have a positive outcome, but to date (September 2011), there is no test proven to offer 100% accuracy.(3) History and physical examination remain important in the diagnosis. Traditionally, pudendal nerve blocks have been used as a tool to diagnose a possible entrapment,(4) but there are occasional reports of patients who have become permanently worse from pudendal nerve blocks. While still used by some physicians, the value of a pudendal nerve motor latency test (PNMLT) in the diagnosis of pudendal neuropathy has not been established.(5) Recently, a special type of 3 Tesla Magnetic Resonance Imaging (MRI) has shown some promise in locating specific sites of entrapment. When a patient is deemed to be a possible surgery candidate based on the clinical exam, history, PNMLT, 3 Tesla MRI, and response to nerve blocks, the patient, in consultation with physicians, then faces the decision of which type of PNE surgery to choose.

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Myth #2

There is a "best" approach or protocol for pudendal nerve decompression surgery.

The pudendal nerve lies deep in the pelvis, and accessing all sites of possible entrapment presents a challenge to the surgeon. There are five basic approaches to pudendal nerve decompression surgery, but there is no consensus in the medical community as to which approach is best because there are several possible sites of entrapment. The transgluteal approach is the most widely used approach to pudendal nerve decompression because it offers the surgeon the best visualization of the nerve at the most common sites of entrapment.

1. Perineal Approach

The first pudendal nerve decompression surgeries were recorded by Shafik in 1994(6) and were performed for the treatment of erectile dysfunction (ED) using a transperineal approach in which a para-anal incision was made and the inferior rectal branch of the pudendal nerve was followed to the pudendal (Alcock's) canal. A slit was made in the canal to release the pudendal nerve, and six of the seven patients had a subsequent improvement in erectile dysfunction. In a later publication,(7) Shafik reported success in the treatment of vulvodynia, using a similar surgical approach.

Since then, Beco(8) and de Bisschop(9) have published results of perineal surgery, and both have reported that a majority of patients have significant improvement in pain levels. With the perineal approach, a small incision is made in the perineum, and part of the nerve can be accessed without ligaments being severed, although access to the ligaments at the ischial spine, a common site of entrapment, is limited and requires a rectoscope.

2. Trans-Gluteal (TG) Approach

In 1998 Robert, et al(10) published on results of 150 transgluteal surgeries in which the pudendal nerve is accessed via an incision in the gluteal muscle and the sacrotuberous ligament. He reports that 45% were cured and an additional 22% improved. Robert describes several sites of entrapment along the course of the pudendal nerve including at the "ligamentous pinch" between the sacrotuberous and sacrospinous ligaments, at the piriformis muscle, the falciform process of the sacrotuberous ligament, or in the fascia of the obturator internus muscle at the Alcock's canal.

Robert's team published the results of a randomized controlled trial in 2005,(11) reporting that after one year, 70% of the surgical group were improved versus 13% of the non-surgical group.

Popeney, et al(12) published results of 58 cases of PNE surgery in 2008, reporting that in using the transgluteal approach as described by Robert, 60% of patients had greater than 50% improvement.

Based on Vleeming's research demonstrating the importance of the sacrotuberous (ST) ligament in stabilizing the sacroiliac joint,(13) some physicians who wish to preserve the integrity of the ST ligament to prevent possible post-operative pelvic instability offer a modified TG approach that spares the ST ligament or replaces it with cadaver tendon as described by Hibner.(14) Some surgeons make a vertical instead of a horizontal cut in the ligament and suture the ligament after the nerve is decompressed.

3. The Trans-Ischio-Rectal-Fossa (TIR) Approach

In the TIR approach as described by Bautrant in 2003,(15) a small (5 cm) incision is made in the posterior wall of the vagina in women or between the anus and scrotum in men. The sacrospinous ligament is accessed by dissection of the ischio-rectal trench and pushing aside the rectum. In most cases the sacrospinous ligament is sectioned to release the nerve between the ligaments at the ischial spine. With this approach, access to the sacrotuberous ligament is limited, requiring an endoscope. Bautrant reported that at 6 months, 66% were asymptomatic or satisfied with their improvement, and at one year this number increased to 86%.

4. The Laparoscopic Trans-Peritoneal Approach

Possover published results of using a laparoscopic approach for Alcock's canal decompression surgery and reports success in 15 out of 18 patients.(16) Using the laparoscopic approach as described by Possover allows neurolysis of the sacral plexus, focusing primarily on the proximal and medial portions of the pudendal nerve.

5. The Dorsal Nerve Approach

In 2005 Hubry, et al(17) described a possible site of entrapment distal to the urogenital diaphragm at the dorsal branch of the pudendal nerve. Recently, several surgeons have begun performing nerve release surgery on the dorsal nerve of the penis and clitoris, but as of September 2011, no results have been published on this approach.

Myth #3

PNE decompression surgery is like any other surgery. If you have not improved soon after surgery, the procedure should be considered a failure.

Unfortunately, it can take many months for nerves to heal, and autonomic, motor, and sensory function may never be complete.(18) During the recovery period, patients may require significant amounts of pain relief medication for an extended period of time while healing takes place. For unsuccessful surgeries, patients will require pain control for indefinite periods of time.

Considerations before Choosing PNE Surgery

It is easy to see why patients with pudendal neuralgia agonize over the decision as to whether to opt for pudendal nerve decompression surgery and which surgery approach to choose. Having spoken with hundreds of pudendal neuralgia patients, I believe there are two key considerations that must be remembered when deciding on PNE surgery.

1. Has the patient tried conservative therapies first (unsuccessfully), and has his or her illness taken away abilities to function, to enjoy life, and to have normal relationships?

2. Is the patient fully informed as to the advantages and disadvantages of each surgical approach, of the risks involved, and thereby mentally prepared for the possibility of an unsuccessful outcome?

Patients undergoing PNE surgery desperately need the non-critical support of family, friends, and health care providers. If the procedure is not successful, they don't need to hear "you should not have done that." They just need someone to give them hope and help them in their search for a way to silence the pain.

Written by: Violet Matthews, RN, BSN, Secretary, Health Organization for Pudendal Education

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Foods That Lower Breast Cancer Risk

The latest on links between breast cancer and diet suggests that consuming an abundance of vegetables, fruits and legumes may help women cut their risks of one type of breast cancer. After 26 years of following more than 86,000 nurses in the U.S., researchers have reported that those whose diets were rich in plant foods, while low on meat, sodium and processed carbohydrates had a 20 percent lower risk of developing estrogen-receptor-negative breast cancer, malignancies that account for about 25 percent of all cases. Here, breast cancer cells lack receptors for estrogen. When estrogen receptors are present, as they are in most cases of breast cancer, treatment can include tamoxifen and other drugs to "block" estrogen's access to cells, thus reducing the risk of recurrence. No drugs are currently available to reduce the risk of recurrence of estrogen receptor negative breast cancer. The dietary findings were published online August 10 by the American Journal of Epidemiology. In other news, a study performed with mice published in the August/September issue of Nutrition and Cancer showed that breast cancer risk dropped significantly when the animals' regular diet included walnuts in an amount that would translate to about 2 ounces a day for humans. Neither of these findings proves that eating vegetables - or walnuts - are directly responsible for the reported risk reductions, but suggest that follow up studies are worth pursuing.
My take? While there's no surefire dietary strategy to prevent breast cancer, we do know that women who gain weight as adults are at higher risk, as are women whose diets include the most meat (compared to women who eat little or no meat). In addition to watching your weight and eating less meat, I also recommend avoiding alcohol (drinking can raise your risk), eating lots of cruciferous vegetables, which give you protective phytonutrients, exercising regularly, which can help lower your risk of many diseases, and avoiding the long term use of estrogen replacement therapy at menopause.

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Estrogen May Prevent Younger Menopausal Women From Strokes

Estrogen may prevent strokes in premature or early menopausal women, Mayo Clinic researchers say. Their findings challenge the conventional wisdom that estrogen is a risk factor for stroke at all ages. The study was published in the journal Menopause.
Researchers combined the results from a recent Mayo Clinic study with six other studies from across the world and found that estrogen is protective for stroke before age 50. That is roughly the average age when women go through menopause.
"We were very surprised because these results were unexpected," says study author Walter Rocca, M.D., an epidemiologist and neurologist at Mayo Clinic. "The old idea that estrogen is always a problem in the brain has to be corrected." Estrogen can be a problem in older women, he explains, but in younger women, estrogen may be important to protect the brain from strokes.
The study has implications for women who experience premature (before age 40) or early menopause (before age 45) from natural causes or from ovary removal. Women in these groups should consider taking estrogen up to approximately age 50 to prevent stroke, Dr. Rocca says.
Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. According to the American Stroke Association, these types of strokes account for 87 percent of all stroke cases.
Co-authors of the study include: Brandon Grossardt, M.S.; Virginia Miller, Ph.D.; Lynne Shuster, M.D.; Robert Brown, Jr., M.D.

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Woman Gives Birth After Completing Marathon

27-year-old marathon runner Amber Miller was nearly 39 weeks when she completed the Chicago Marathon on Sunday, but instead of putting her feet up and having a good rest, she went straight to hospital to give birth: her contractions started within minutes of crossing the finishing line.

Miller, who lives in Westchester, a suburb of Chicago, described Sunday as "the longest day of my life". On that day she not only completed the 26.2 mile (42.16km) course, half running and half walking, in 6h 25m, she was also delivered of a healthy 7.7lb (3.5kg) daughter June, thus giving her one-year-old son, Caleb, a baby sister.

While recovering in hospital on Monday, Miller told the Associated Press in an interview that she was "crazy about running", and that doing the marathon that day "wasn't anything out of the ordinary" for her as she had been running regularly up to that point anyway.
Miller has been running for over 10 years. She had already signed up for the Chicago Marathon, her eighth, when she discovered she was pregnant. On the advice of her doctor she half ran and half walked it, drank lots of fluids and ate along the way.
She said she heard people cheering her, "Go pregnant lady!" which was a nice surprise as she had been expecting to hear negative remarks.
Although unusual it is not unheard of, for women to run long distance while pregnant. Miller ran the Wisconsin marathon earlier this year while 17 weeks pregnant, and she also ran the Indianapolis marathon in 2009 while pregnant with her son.
The current women's marathon world record holder, English-born Paula Radcliffe, trained while she was pregnant and went on to win the New York marathon in 2007 only 10 months after her baby was born. She won the Chicago marathon in 2002.
Although she took a season away from competition while pregnant, American long distance runner Kara Goucher kept up her training, running 80 miles a week at times.
The usual medical advice to women who want to continue running long distance while pregnant, is as long as you are fit and healthy and are already used to running long distance, then it should be ok. But as with all exercise during pregnancy, don't try anything new or anything your body is not used to.
There is little if any research on running during pregnancy, perhaps because, as Dr Rod Jaques, who advised British Triathlon Team at the British Olympic Medical Centre for 17 years until he stepped down in 2007, said in an article published in Runner's World in 2002, scientists would be hard pressed to find women willing to subject themselves to such experiments while pregnant.
Jaques, advises pregnant women to keep their heart rate at or below 140 bpm while running and to take plenty of fluids.
Other experts suggest avoid running in the heat, and never run to the point of exhaustion.
Another point to bear in mind is that pregnant women are at higher risk of injury because they have higher levels of relaxin, a hormone that relaxes joints and ligaments, so they should ease gently into a run and stretch properly afterwards.
Also, because the hips gradually get wider in pregnancy to prepare for birth, you have a higher chance of overpronating, where the feet roll excessively inwards. This can affect the biomechanics of the knee and hip, so it might also be a good idea to see a podiatrist and ask advice about fitting your shoes with extra cushioning or inserts to improve stability.
When asked if she had to do the day over, Miller said, "definitely again".
Written by Catharine Paddock PhD

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Valerian for Menopausal Sleeplessness

Valerian, an herb used traditionally for insomnia and anxiety, may help some menopausal women conquer sleeping problems. The latest news on this long-popular herb is that it improved sleep in 30 percent of women who received it during a study at Tehran University in Iran. Investigators there recruited 100 postmenopausal women to take two capsules of valerian or a placebo every night for a month. They found that 30 percent of the women who took the herb reported better quality of sleep - they were able to fall asleep faster and woke up less often than they had previously. Only four percent of the women in the placebo group reported these improvements. None of the women complained of side effects from the valerian. The study was reported in the September 2011 issue of the journal Menopause. When buying valerian look for products standardized to 1% valerenic acid. The usual dose is one to two tablets at bedtime or one teaspoon of the tincture in one-quarter cup of water. While side effects are rare, you can become psychologically dependent on valerian.

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High Chocolate Consumption Linked To Lower Stroke Risk In Females

Women who eat at least two chocolate bars each week appear to have a 20% lower risk of stroke, compared to females of the same age and weight who rarely or never eat chocolate, researchers from the Karolinska Institute, Sweden, reported in the Journal of the American College of Cardiology. The researchers explained that cocoa has flavonoids - powerful antioxidants that can suppress oxidation of bad cholesterol (LDL, low-density lipoprotein). LDL can cause stroke and other cardiovascular diseases.
As background information, the authors explained that several studies have clearly demonstrated that chocolate can be good for the cardiovascular system - the circulatory system which comprises the heart and blood vessels. The consumption of chocolate has been demonstrated to reduce diastolic and systolic blood pressure in randomized, short-term trials. Chocolate has also been shown to improve endothelial and platelet function, and to improve insulin resistance.

Chocolate typically comes in dark, milk and white varieties. Its brown coloration comes from cocoa solids

Susanna Larsson Ph.D. and team set out to determine whether chocolate consumption might have an impact on the risk of stroke. They used the population-based Swedish Mammography Cohort. 39,227 adult females had completed a questionnaire that asked 350 questions regarding lifestyle and diet factors.

Some participants were excluded from their list, such as those whose total energy intake values did not make sense, women with a history of stroke, coronary heart disease, stroke, or diabetes before baseline. The list was then reduced to 33,372 adult females aged from 49 to 83 years.

A self-administered food questionnaire was used to assess their chocolate intake. They were asked to indicate with what frequency they ate chocolate and 95 other foods during the previous 12-month period. The women were divided into 8 categories, ranging from no chocolate intake to at least 3 times daily.

During the 1990s, nine out of every ten Swedish women ate milk chocolate with a cocoa solids content of about 30%. Cocoa content of chocolates in Europe is generally considerably higher than in the USA.

They gathered data on first stroke occurrence from the Swedish Hospital Discharge Registry, dated from January 1st, 1998, to December 31st, 2008.

Events of stroke were classified as:

• Cerebral infarction (ischemic stroke)
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Unspecified stroke

They gathered dates of death from the Swedish Cause of Death Registry. They also collected data on incidence of atrial fibrillation.

Below is some highlighted data from their findings:

• During a follow-up period of 10.4 years, there were 1,549 strokes, of which 1,200 were cerebral infarctions (ischemic stroke), 224 were hemorrhagic strokes, and the remaining 125 were unspecified strokes.
• The women who ate the most chocolate (average 2.3 ounces per week) had the lowest risk of stroke, about 20% lower compared to those who rarely or never ate chocolate.

The authors found that their (large) study was broadly similar to previous smaller ones - with an inverse association between chocolate consumption and total stroke.
For risk to be significantly impacted, the authors add, chocolate consumption needs to be high. It was only the females in the highest quartile of chocolate consumption who had a significant drop in stroke risk.
Dark (plain) chocolate has a much higher concentration of cocoa, and consequently flavonoids than milk chocolate, and less sugar too, the authors wrote. They also warn against eating too much chocolate, because it has sugar, fats and many calories. Chocolate also contains caffeine.

The authors concluded:

"In summary, results from this cohort of women suggest that a high chocolate consumption is associated with a lower risk of stroke."

Written by Christian Nordqvist

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Blood Infection Costliest U.S. Hospital Condition: Report

Blood Infection Costliest U.S. Hospital Condition: Report

 Septicemia was the single most expensive condition treated in U.S. hospitals in 2009, with a cost of about $15.4 billion, according to a federal government report.
Septicemia is a life-threatening illness caused by blood infections with bacteria such as E. coli and methicillin-resistant staphylococcus aureus (MRSA).
The analysis of national data also showed that the number of hospital stays for septicemia more than doubled between 2000 and 2009, from 337,100 to 836,000 admissions. In 2009, septicemia was the sixth most common primary cause of hospitalization in the United States.
Complications from medical devices, implants or grafts were the leading cause of these admissions, accounting for 20% of the septicemia stays.
The report is published in the latest News and Numbers from the Agency for Healthcare Research and Quality.
In 2009, the in-hospital death rate for septicemia was 16%, more than eight times as high as for all other hospital stays, according to an agency news release.
Elderly patients accounted for more than half of all patients hospitalized for septicemia. Nearly 40% were 65 to 84, and about 14% were 85 and older. Patients 45 to 64 represented 27% of cases; nearly 11% of patients were 18 to 44, and only 1.6% were ages 1 to 17.
-- Robert Preidt

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Melanoma May Be More Aggressive in Kids

Melanoma May Be More Aggressive in Kids

Some children with melanoma are more likely to have invasive disease than adults with this potentially deadly type of skin cancer, a new study indicates.
The findings suggest that there may be biological differences between childhood and adult melanoma, said the researchers at the Johns Hopkins Children's Center in Baltimore.
They analyzed the medical records of 717 children and 1,368 young adults (aged 20 to 24) diagnosed with melanoma and compared sentinel lymph node biopsy results based on tumor size, tumor appearance and patient age. Sentinel lymph nodes are those that surround the tumor, and sentinel lymph node biopsy is the standard way to assess spread (metastasis) of the cancer and determine treatment.
Cancer cells were found in the sentinel lymph nodes of 25% of children and 14% of adults who had biopsies. Tumor thickness was the strongest predictor of lymph node metastases in both children and adults.
But children with tumors with a thickness of 1.01 and 2 millimeters were nearly six times more likely than young adults with same-thickness tumors to have cancer cells in sentinel lymph nodes.
The researchers also found that children younger than 10 were more likely to have distant metastases (spread of cancer beyond the immediate tumor site) and greater tumor thickness, compared with older children and young adults.
Regardless of age, patients with bleeding tumors or those with open sores were more likely to have metastases.
The study was published online Oct. 5 in the journal Cancer.
"Our finding is a powerful reminder that there's much about pediatric melanoma that we don't understand and that, just as is the case with other diseases, children are not small adults, but differ markedly in their response to disease," senior investigator Dr. John Strouse, a pediatric hematologist and oncologist, said in a Johns Hopkins Medicine news release.
Although still uncommon, melanoma diagnoses in children are increasing, and unprotected sun exposure, sunburns and indoor tanning are some of the known causes.
-- Robert Preidt

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Men Develop Diabetes With Less Body Fat Than Women: Study

Men Develop Diabetes With Less Body Fat Than Women: Study

 Men develop type 2 diabetes at a lower body-mass index (BMI) than women, and this finding helps explain why men have higher rates of diabetes in many parts of the world, researchers report.
They analyzed data from 51,920 men and 43,137 women in Scotland with diabetes and found that average BMI at diabetes diagnosis was 31.83 in men and 33.69 in women. This difference was most noticeable at younger ages, the researchers said.
The study was published online Sept. 30 in the journal Diabetologia.
The findings confirm the hypothesis that men have to gain less weight to develop diabetes, according to study leader Professor Naveed Sattar, of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow.
Fat distribution may explain why men develop diabetes with less weight gain than women. Men tend to have more fat in their abdominal regions and in their liver than women, while women have greater amounts of "safe" subcutaneous (beneath the skin) fat than men.
"It is worrying that men develop type 2 diabetes at a higher rate than their female counterparts. Research like this will help us understand reasons why and provide greater insight into what we can do to improve prevention of type 2 diabetes," Dr. Victoria King, head of research at Diabetes UK, said in a university news release.
-- Robert Preidt

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Eating Potatoes Can Help Lower Blood Pressure

Of course, the potatoes in question can't be French fries or chips or loaded with butter, cheese or all the other high calorie trimmings that sometimes come with spuds. But if you're partial to potatoes and enjoy eating them steamed or boiled, in moderation, they could be good for your blood pressure, even if you're already taking medication for hypertension. Researchers performing a small study (only 18 participants, mostly overweight or obese) at the University of Scranton reported the results of eating six to eight purple potatoes twice a day. After a month, average diastolic blood pressure (the bottom number) among the study group dropped 4.3 percent while average systolic pressure (the top number) fell 3.5 percent. Researcher Joe Vinson, Ph.D., noted that plain potatoes are not particularly fattening (a single one contains about 110 calories), and they're loaded with beneficial phytonutrients, which may be responsible for the blood-pressure lowering effect seen in his study. In a statement he noted that earlier research showed that potatoes contain a substance similar to ACE inhibitors, a group of blood pressure drugs.

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Dietary Supplements Linked To Higher Mortality In Older Women

A report in the October 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals 'Less is More' series reveals that consuming dietary supplements, such as iron and coppers, multivitamins and folic acids seems to be linked to a higher risk of mortality in older women - the exception appears to be calcium supplements.

According to background information in the article, the consumption of dietary supplements in the U.S. has substantially increased over the last 10 years.

The authors comment:
"At the population level, dietary supplements contributed substantially to the total intake of several nutrients, particularly in elderly individuals."

Jaakko Mursu, Ph.D., of the University of Eastern Finland, Kuopio, Finland, and the University of Minnesota, Minneapolis, and teams conducted a study to examine the link between vitamin and mineral supplements and the mortality rate in older women. Their study was based on data from the Iowa Women's Health Study in which a total of 38,772 women with an average age of 61.6 years self-reported their supplement use during 1986, 1997 and 2004 in a questionnaire.
15,594 women, i.e. 40.2% of all 38,772 participants who did the first survey in 1986 died over an average follow-up time of 19 years. According to the questionnaires, the consumption of supplements increased significantly between 1986 and 2004. Figures rose from 62.7% of women using at least one daily supplement in 1986 to 75.1% in 1997 and 85.1% in 2004 respectively.

The findings revealed that although most supplements were not linked to reduced total mortality in older women, numerous supplements nevertheless seemed to increase the linked mortality risk.

The researchers carried out adjustments and discovered that using multivitamins, vitamin B₆, folic acid, iron, magnesium, zinc and copper, were all linked to an increased risk of death in the study population, with the exception of calcium supplements, which appeared to reduce risk of mortality. Iron supplements demonstrated the highest link between supplement intake and mortality risk.
The authors noted that as the women aged throughout the study their response to iron dosages progressively increased the risk of mortality.
Researchers replicated the results for both iron and calcium supplements in a separate, short-term analyses with a follow-up at four, six and 10 years.

They conclude saying:

"Based on existing evidence, we see little justification for the general and widespread use of dietary supplements. We recommend that they be used with strong medically based cause, such as symptomatic nutrient deficiency disease."

Accompanying Commentary

Goran Bjelakovic, M.D., D.M.Sc., of the University of Nis in Nis, Serbia, and Christian Gluud, M.D., D.M.Sc., of Copenhagen University Hospital in Copenhagen, Denmark, discussed the study's findings in an invited comment stating that Mursu and his team:

". . . . add to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful.

Dietary supplementation has shifted from preventing deficiency to trying to promote wellness and prevent disease. Until recently, the available data regarding the adverse effects of dietary supplements has been limited and grossly underreported. We think the paradigm 'the more the better' is wrong. One should consider the likely U-shaped relationship between micronutrient status and health.

They concluded:

"We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population. Older women (and perhaps men) may benefit from intake of vitamin D3 supplements, especially if they have insufficient vitamin D supply from the sun and from their diet. The issue of whether to use calcium supplements may require further study."

Written by Petra Rattue

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Prunes for Strong Bones

Dried plums, also called prunes, seem to be really good for bones. Researchers from Florida State and Oklahoma State universities tested two fruits, dried plums and dried apples, on two groups of postmenopausal women. For a year, one group of 55 women ate about 10 prunes per day while a second group of 45 women ate 100 grams (about 3.5 ounces) of dried apples daily. All participants took 500 mg of calcium and 400 IU of vitamin D daily during the study. Afterwards, the women who ate the prunes had significantly higher bone mineral density in the spine and the ulna (one of two long bones in the forearm) than the women who ate the dried apples. The researchers said the difference was due in part to the ability of the nutrients in prunes to suppress the rate of bone breakdown, which tends to exceed the rate of new bone growth as we age. The study was published in the British Journal of Nutrition.

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Chocolate and Your Heart

The latest news about chocolate is encouraging: an analysis of several studies involving data on more than 100,000 people suggested that those who reported eating chocolate regularly lowered their risk of heart disease by more than one-third. That may be cause for celebration among chocolaholics, but of course, there's a catch to it: the studies involved were all observational - that is, they all looked at chocolate consumption and health as reported by participants. The analysis didn't directly compare those who ate a set amount of chocolate per week with those who consumed a placebo (in this case, a chocolate look-alike and taste-alike), as would be required in a clinical trial to investigate chocolate's effects on the heart. What's more, the studies included reports of consuming chocolate in all its forms - dark, milk, in drinks, cookies and desserts. And it didn't specify how much chocolate study participants ate. Still, if the analysis has any merit, people who eat lots of chocolate regularly may find that they have healthier hearts than those who don't. The analysis, from England's University of Cambridge, was published August 29 in BMJ online.
My take? Chocolate is a source of polyphenols (the same type of antioxidants found in red wine). Stearic acid, the fat it contains, doesn't affect cholesterol levels, and studies have shown that flavonoids in dark chocolate help reduce the stickiness of platelets, cells that play an important role in blood clotting. As a result, blood takes longer to clot, reducing the danger of coronary artery blockages. Chocolate's polyphenols also appear to boost levels of HDL (the "good" cholesterol) and lower LDL (the "bad" cholesterol), at least in the lab. I recommend consuming good-quality dark chocolate that is at least 70 percent cocoa as a healthy snack, as long as you don't go overboard. An ounce or two a few times a week is good for you.

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The Clutches Of Panic: What Does It Do To Your Body

Panic attacks occur when a person experienced repeated periods of extreme panic. It could occur anytime or anywhere. Panic attacks typically last about 5 to 30 minutes. If left untreated, panic attacks may develop into phobias. These are some of the panic attack symptoms such as feelings of choking, chest pain or pressure, racing pulse, pounding heart, dizziness, breathlessness, throat constricting, breaking out into sweat, trembling or shaking, nausea, tingling or numbness in limbs, being in a dream sequence, insecurities, and nervousness.

As panic attacks are part of the resultant effect of fight or flight sequence, the body experience certain changes. The changes are good to get things done or to save yourself but in the long run, it will affect the mind and body in a negative way. The chemicals released into blood systems might cause the immune system to weaken and make you prone to sickness.

In order to prepare for fight or flight response, more blood will be pumped by the heart indirectly giving extra burden to it. For someone who is old or has a weak heart, these could indirectly contribute to factors causing heart attack. The muscles might tighten and give aching problems. Some might get gastric indirectly due to panic attack.

Many people response differently towards panic. Being able to control your own emotions and reining in panic attacks will allowed you to enjoy life to the fullest.

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Simple Solutions To Curing Panic Attacks

Some people think that if they have panic attacks, it would be the end of the world. The truth is, that is far from it. Panic attacks could be controlled through medication. However, that thought of being on medicine might cause more anxiety. Being on antidepressants does not mean that the attacks will stop. Trying to manage panic attacks are temporary solutions. However, it is important to be able to prevent panic attacks.

Panic attacks can come out of the blue and takes you by surprise. Taking drugs for panic attacks are an indirect way of temporary managing the problem. Being worried about your panic attacks or when it would come next can cause more stress and depression. It is obvious that panic attacks are caused by fear.

It is important to learn to do 3 things to prevent panic attacks. First of all, it is to stop panicking. Secondly, you must overcome the fear of another panic attack. Learning on how to stop panicking will help in this as you know that you can stop panicking in the next panic attack and your fear will dissipate. Thirdly, you will be able to eliminate anxious thoughts.

There are simple solutions to cure panic attacks. When in panic attack, breathe in a rhythmic pattern. Breathe deeply and slowly to help yourself relax. Give exercise a try when there is a panic attack. Go out for a walk and breathe in the fresh air to distract yourself and make you feel better. It is best to eat healthily with lots of vegetables and fruits to nourish your body. Sugar and caffeine are stimulants that can make your body feel good in a short while but in long run will make you feel tired and drained.

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Easy Tips For Dealing With On The Spot For Panic Attacks

One of the few solutions when trying to deal panic attacks is to take into consideration the thoughts that are going through in the mind. Some of the best solutions are giving yourself positive energy. It is easy to fall into depression and negative emotions but by motivating yourself with positive ideas, it might be the start towards recovery. These are easy steps to deal panic attacks on the spot:

1. Breath. Try breathing in a slow, deep breath. Inhale and exhale for at least 10 times. Your mind will feel much clearer and you will feel better.

2. Focus. If you think you are on a verge of a panic attack, try focusing on something else that is happier or keep yourself at peace. It might seem easy to say but with constant practice, this will help in the long run.

3. Be positive. Keep on repeating in your head that you are feeling fine and everything is great does help. Your mind will start believing and you will feel better in that situation.

4. Inform someone close to you that understand the situation you are going through. By telling them, indirectly you are unleashing the pent up panic attacks inside of you and it will dissipate naturally.

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Want to Lose Belly Fat? Start Moving

The belly fat you can see may not flatter your figure, but it isn't as harmful to your health as hidden belly fat surrounding internal organs deep in the abdomen. That's the stuff that boosts the risk of heart disease, diabetes and some kinds of cancer. Now, researchers at Duke University Medical Center have shown that the best way to lose this dangerous fat is with aerobic exercise. The Duke team compared aerobic exercise, resistance training (exercising with weights) and a combination of the two during an eight-month study with 196 overweight adults ages 18 to 90. They found that aerobic exercise burned 67 percent more calories than resistance training. It also had beneficial effects on known risk factors for diabetes and heart disease, including elevated liver enzymes, fasting triglycerides and fasting insulin resistance (here, the normal amount of insulin secreted is not sufficient to move glucose into cells - thus cells are said to be "resistant" to insulin's action). No such positive changes were seen in the resistance training group. The aerobic exercise performed in the study was equivalent to jogging 12 miles per week at 80 percent of maximum heart rate.

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