Can Tomatoes Lower Stroke Risk?

Eating tomatoes and tomato-based foods appears to be associated with a lower risk of stroke, a new study indicates.

Tomatoes are rich in the antioxidant lycopene.

Researchers checked blood levels of lycopene in more than 1,000 Finnish men, aged 46 to 65 at the start of the study, and then followed them for an average of 12 years. During the follow-up period, 67 of the men had a stroke.

Overall, men with the highest lycopene levels were 55 percent less likely to have a stroke (11 of 259) than those with the lowest levels of the antioxidant (25 of 258). When the researchers focused only on strokes caused by blood clots, they found that men with the highest lycopene levels were 59 percent less likely to have a stroke than those with the lowest levels.

The investigators found no association between stroke risk and blood levels of the antioxidants alpha-carotene, beta-carotene, alpha-tocopherol and retinol, according to the report published in the Oct. 9 issue of the journal Neurology.

"This study adds to the evidence that a diet high in fruits and vegetables is associated with a lower risk of stroke," study author Jouni Karppi, of the University of Eastern Finland, said in an American Academy of Neurology news release. "The results support the recommendation that people get more than five servings of fruits and vegetables a day, which would likely lead to a major reduction in the number of strokes worldwide, according to previous research."

Another expert agreed on the need for a healthful diet.

"This study demonstrated a direct relationship between higher concentrations of lycopene in the blood and a decreased incidence [of more than 55 percent] of stroke," said Dr. Rafael Ortiz, director of the Center for Stroke and Neuro-Endovascular Surgery at Lenox Hill Hospital in New York City. "Smokers had decreased levels of lycopene. Lycopene is an antioxidant, reduces inflammation, improves immune function and prevents platelet aggregation and clot formation."

Ortiz added that "the study proves that people should have a diet rich in fruits and vegetables [especially tomatoes] and avoid smoking in order to decrease the chance of having a stroke."

However, while the study found an association between higher blood levels of lycopene and lower risk of stroke, it did not prove the existence of a cause-and-effect relationship.

Certain Eye Injuries in Kids May Indicate Child Abuse: Study

By Randy Dotinga
HealthDay Reporter

Physicians can use eye examinations to figure out whether infant and toddler head injuries were caused by accidental injury or child abuse, suggests a new study that adds to existing evidence on this method of detecting abuse.

At issue is the bleeding in the retina that can occur as a result of a head injury. The authors of a study released Monday report that they were able to confirm 93 percent of child-abuse cases by examining hemorrhages in the retina.

Study lead author Robert Minns, a pediatric neurology professor at the University of Edinburgh, in Scotland, said the findings could play an important role in court proceedings involving alleged child abusers. "Clinicians can now be more precise in their (evaluation) of abusive head trauma to infants and young children based on their retinal findings during eye examination," he said.

It's long been difficult for physicians to determine whether a child with a head injury was deliberately injured -- as in the condition known as shaken baby syndrome -- or was hurt in an accident. To make things more complicated, "there are a minority of doctors who believe that children cannot be injured by shaking, or that one cannot prove that they were injured by shaking," Minns said.

In the big picture, he added, "the challenge is to make a secure diagnosis to ensure the child's subsequent safety and to prevent further injury from any abuse."

Eye doctors have long known that child abuse can lead to bleeding in the retina, which sits in the back of the eye. "A retinal bleed results when fine blood vessels of the eye tear after being injured by the force of an injury," said Dr. Fizan Abdullah, a children's trauma surgeon and associate professor of surgery and international health at Johns Hopkins University School of Medicine and Bloomberg School of Public Health, in Baltimore.

But it's been a challenge for researchers to definitively link retinal injuries to abuse as compared to accidental injuries. In the new study, researchers examined the medical records of 114 children with head injuries, 79 boys and 35 girls, who were treated at the Royal Hospital for Sick Children Edinburgh.

They found that a certain kind of retinal injury -- in the middle layer of the eyes -- was more common in children who were thought to have been abused. The researchers found that 93 percent of children who were abused had more than 25 of these injuries.

By contrast, Minns said, the injuries in cases not linked to abuse were more likely to be in other areas of the retina. The bleeding linked to abuse may occur because the injuries repeatedly cause the head to rotate, he said.

Retinal imaging is used to locate the bleeding.

Dr. Brian Forbes, an associate professor of ophthalmology at Children's Hospital of Philadelphia, put it this way: "The repeated to-and-fro motion associated with a shaking injury likely has a progressive tearing effect."

Forbes, who's familiar with the study findings, said they're consistent with other research. "I believe all young children of whom there are suspicions of having been abused should be evaluated by an ophthalmologist," he said.

The study appears online Oct. 8 and in the November print issue of the journal Pediatrics.

Doctors Say Steroid Shots for Spine Are Usually Safe

Millions of people get steroid shots in their backs to relieve pain. Now they are probably wondering if it’s safe.

In 23 states, hundreds, possibly thousands, of back-pain patients are being warned to watch for symptoms of meningitis because of a custom-mixed steroid solution that may have been contaminated with fungus. Five people have died and more than 40 others have fallen ill.

Doctors who do these injections say they are extremely safe when done correctly with sterile drugs. And many doctors stick to medications approved by the Food and Drug Administration instead of relying on generally less-regulated “compounding pharmacies” like the Massachusetts company implicated in the outbreak.

“If I was a patient, I would definitely be concerned,” said Dr. Michael Schafer, an orthopedic specialist at Chicago‘s Northwestern Memorial Hospital.

He said Northwestern gets steroids from federally regulated pharmaceutical companies. And in almost 40 years of experience, he has never had a patient develop an infection from these shots.

He and others say patients should ask their doctors if their medications come from compounding pharmacies, which custom-mix and repackage creams, solutions and other drugs.

In fact, some doctors who rely on such places are rethinking that.

Dr. Michael Drass of Allegheny Pain Management, a clinic in Altoona, Pa., said he has pulled all drugs that came from the New England Compounding Center off his shelves — as the government has urged physicians to do — and is re-evaluating whether to rely on compounding pharmacies for the medicines he uses to treat patients.

“I’ve been doing this for 15 years now, and I’ve done 50,000 injections over that course of time, and I’ve never seen or heard anything like this. It’s a real eye-opener for us in the medical practitioner community,” Drass said.

He said he has relied on the New England pharmacy and others like it because they sometimes have medications he can’t get elsewhere, sometimes because of drug shortages.

Cost can also be a factor. Some of these suppliers charge less than big pharmaceutical companies. Some clinics that use compounding pharmacies say they are a good source of preservative-free steroids, which are less likely to cause a nerve-related complication.

The injections are a common treatment for sciatica, which is pain from a slipped or ruptured disk that often radiates down the legs, and for spinal stenosis, an age-related narrowing of the spine sometimes caused by arthritis. It results in pain or weakness, usually in the neck and lower back.

Doctors often recommend injecting steroids into the spinal column for patients who don’t get adequate pain relief from aspirin, ibuprofen or other common medicines that reduce inflammation. The injections also are often used when physical therapy doesn’t work, or for patients whose pain is too great to even try physical therapy or other remedies.

“The worst complication is it may not work,” Schafer said he tells patients.

Patsy Bivins of Sturgis, Ky., is worried about the two steroid injections she got in her lower back in August to treat chronic pain from stenosis and fibromyalgia. She got a call Thursday from the outpatient center where she was treated, warning that she may have been given the tainted drug.

“Before I got the shots I was really suffering,” Bivins said. “It did help some. But now I don’t know what to do.” She added: “When I got the call I thought, `Here’s another thing.’ I don’t need nothing else wrong with me, especially that.”

Doctors use a needle about 3 inches long to inject the drug into what is known as the epidural space surrounding the spinal cord.

Patients are typically middle-age or older. Often, three injections are given over a few weeks, in pain clinics, surgery centers or hospitals. Such treatments can cost several hundred dollars and last about 10 minutes, and patients can go home afterward. The effects may last for several months or longer, but patients often return for repeat treatment after a year.

The drug involved in the outbreak, methylprednisolone acetate, is among the steroids commonly used in the procedure. Batches of the drug from other sources have not been implicated so far.

Some patients swear by the treatments, but the scientific evidence is mixed. Some studies have found the injections work no better than dummy medicines, while others have found benefits.

The injections work best for younger patients with fairly recent pain rather than chronic, debilitating pain that has lasted for several years, said Dr. Steven Cohen, an associate professor of anesthesiology at Johns Hopkins medical school.

Pill Instead of a Needle May Soon Be Option for RA

Studies Show a New Kind of Drug Works at Least as Well as a Current RA Biologic and Is Effective as a Stand-Alone Treatment

A new pill may soon offer people with rheumatoid arthritis an alternative to the injections and intravenous infusions that many rely on to treat their disease.

The drug, tofacitinib, is a twice-daily pill that works by turning down the body's immune attack on its own joints and organs. It works in a slightly different way than currently available treatments for rheumatoid arthritis, or RA.

"It's pretty important and pretty exciting, and some have described it as a biologic drug in a pill," says Jeffrey R. Curtis, MD, MPH, director of the Arthritis Clinical Intervention Program at the University of Alabama at Birmingham. Curtis worked on early trials of the treatment, but was not involved in the current research.

Biologics have revolutionized the treatment of RA, but they must be taken by injection or IV infusion. They are made from natural sources that use a biologic method, instead of a chemical method, to make them.

A pair of studies published in the New England Journal of Medicine show that the treatment works at least as well as Humira, an older biologic. Tofacitinib also reduced the number of swollen and painful joints in about twice as many patients compared to a placebo pill. That was true whether or not it was used in combination with methotrexate, the standard initial treatment for the disease.

The studies included a total of more than 1,300 people with RA. Significant improvements in physical function were seen as early as the second week on the drug.

The studies didn't follow patients long enough to show whether tofacitinib might slow the physical destruction of the joints as other disease-modifying anti-rheumatic (DMARD) drugs do.

Both studies were paid for by Pfizer, the company that hopes to market the drug.

The FDA is weighing whether or not to approve tofacitinib, which works in a new way by blocking Janus kinase (JAK) enzymes inside cells. These enzymes help to control the chemical messengers that ramp up the immune response. Because the drug acts earlier in the immune response than most biologics, it has broader effects in the body.

Having a broader action sometimes makes a medication very powerful, but it can also increase the drug's potential for side effects since it affects more processes that take place downstream.

In the current studies, common side effects included upper respiratory tract infection, headache, and diarrhea. Tofacitinib was also linked to reduced white blood cell counts. White blood cells help the body fight infections.

And, patients taking the drug were more prone to viral and bacterial infections. Two patients on the highest doses of it developed tuberculosis.

Patients taking tofacitinib also had increased levels of LDL, the "bad" cholesterol. That's concerning since having RA roughly doubles a person's risk for heart disease.

"We don't know what it means if your cholesterol goes up a lot but inflammation goes down. Is that bad for the heart or the brain? Is it neutral? Is it good? We don't know," Curtis tells WebMD.

While those side effects are concerning, many other drugs that are already approved for RA have similar risks, Curtis says.

In May, a panel of advisors voted that despite the risks, the FDA should approve the drug. The agency was set to make its decision on the drug this month. But last week, the drug's manufacturer, Pfizer, announced that regulators had asked for more information and said they expected that the FDA's decision to be delayed.

Pfizer has not revealed how it will price the drug if approved, but it is expected to be expensive. The company said in a statement that it is committed to helping patients get access to the medication should it become commercially available.

If approved, tofacitinib is expected to be a blockbuster, generating sales of more than $1 billion a year, according to EvaluatePharma.

How much money it makes will depend on how doctors use it. Much of that will ride on the labeling the FDA might require. The agency could say that it should only be used in combination with methotrexate, for example. Or it could say that it should only be prescribed after other medications have failed.

"Will I use it in every patient? Probably not because I will still start with methotrexate," says researcher Roy Fleischmann, MD, a rheumatologist with the Metroplex Clinical Research Center in Dallas.

Fleischmann says it makes sense to start with methotrexate because it's a much less expensive drug. But he says for the roughly two-thirds of RA patients who don't respond to methotrexate or can't tolerate it because of side effects like mouth sores and hair loss, "I wouldn't hesitate to use this" as a stand-alone medication before trying a biologic.

Fleischmann has accepted grants and consulting fees from Pfizer. He was paid by the company to conduct the studies.

But other experts think that how the drug should be used is still an open question.

"Will this drug get added to methotrexate? Will [it be a] substitute for methotrexate? Will it be used before a biologic or after a biologic failure? That will depend on experience, on talking to other doctors, on seeing what the insurance companies allow us to do," says Richard Furie, MD, a rheumatologist who is chief of the division of rheumatology at North Shore Long Island Jewish Health System in New York.

Other experts agree.

"While this is a pretty exciting drug because this is a new biologic pathway -- it's not just a 'me too' drug -- it does have issues with respect to, frankly, our total lack of understanding about who might be best suited to take it," Curtis says.

Why Sex Doesn’t Gross You Out When You’re Aroused

Getting turned on overrides women's natural disgust response, a study suggests, making them more willing to do things they otherwise wouldn't Dimitri Vervitsiotis / Getty Images

If you think about it, sex is actually sort of disgusting, what with all the sweat, saliva, fluids and smells. So much so that a group of researchers from the Netherlands got to thinking, How do people enjoy sex at all?

According to their small new study, people — at least women — may be able to get over the “ick” factor associated with sex by getting turned on. Sexual arousal overrides the natural disgust response, the researchers found, and allows women to willingly engage in behaviors that they might normally find repugnant.

The study, conducted by scientists at the University of Groningen, involved 90 women who were randomly assigned to one of three groups. One group watched a “female friendly” erotic video; another watched a video of high-adrenaline sports like skydiving or rafting, designed to be arousing but not sexually so; and the third group watched a neutral video clip of a train.

Afterward, all the women were asked to perform 16 tasks, most of them icky, like drinking from a cup with a bug in it (the bug was fake), wiping their hands with a used tissue, eating a cookie that was next to a live worm or putting their finger in a tray of used condoms.

(MORE: The Ancient Sexual Revolution that May Have Spurred Human Monogamy)

The researchers found that the women who watched the sexually arousing video rated the unpleasant tasks as less disgusting than did their counterparts who were not sexually aroused. They were also more likely to complete more of the tasks, suggesting that sexual arousal not only dampens the disgust response but also influences how much women are willing to do.

That helps explain why so many people keep having sex, despite the inherent messiness of it, the researchers said. “The findings indicate that both the impact of heightened sexual arousal on subjective disgust and also on disgust-induced avoidance will act in a way to facilitate the engagement in pleasurable sex,” the authors wrote. Previous studies suggest that sexual arousal has the same effect on men.

“I think this study is interesting in that it helps support the idea that sexual arousal lowers inhibitions and often enables one to participate in activities that they might normally find disgusting or off-putting,” Dr. Ian Kerner, a sexuality counselor and author based in New York City who was uninvolved with the study, told ABC News.

(MORE: Penis Size: It May Be Written in the Length of His Fingers)

The findings may also shed light on conditions involving sexual dysfunction. Lack of sexual arousal may interfere with healthy sex by failing to dampen the disgust factor, the authors said. Essentially, if women are not appropriately aroused before sex, they may find it even more repulsive and increasingly start to avoid it. Low arousal can also render women physically unable to enjoy sex, the authors said:

As a result, this could lead to problems with sexual engagement, and lack of vaginal lubrication, which in turn could increase friction and cause problems such as pain with intercourse. It is thus possible that in extreme cases the woman might acquire negative associations with sex and might start to avoid sexual intercourse altogether.

The authors call for further research among larger groups, including participants suffering from sexual dysfunctions.

The study was published in the journal PLoS ONE.

MORE: What the U.S. Can Learn from the Dutch About Teen Sex

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6 Breathing Exercises to Relax in 10 Minutes or Less

Overworked, underslept and feeling the pressure? There are plenty of ways to find calm, without investing in a four-hand spa massage. All you need is a pair of lungs, your breath and 10 minutes or less.

Don’t wait until fight or flight kicks in before minding your breath. Controlled breathing not only keeps the mind and body functioning at their best, it can also lower blood pressure, promote feelings of calm and relaxation and help us de-stress.

While the effects of breathing techniques on anxiety haven’t yet been studied at length (at least not in a controlled clinical setting), many experts encourage using the breath as a means of increasing awareness, mindfulness or, for the yogis among us, finding that elusive state of Zen. To get to the bottom of the breath work, Greatist spoke to breathing expert Dr. Alison McConnell, yoga instructor Rebecca Pacheco and psychologist Dr. Ellen Langer. But follow closely: breathing easy isn’t quite as easy as it sounds.

From the confines of a bed, a desk or anyplace where negativity finds its way, consider these six breathing techniques to help keep calm and carry on.

1. Sama Vritti or “Equal Breathing”

How it’s done: Balance can do a body good, beginning with the breath. To start, inhale for a count of four, then exhale for a count of four — all through the nose, which adds a natural resistance to the breath. Got the basic pranayama down? More advanced yogis can aim for six to eight counts per breath with the same goal in mind: calm the nervous system, increase focus and reduce stress, Pacheco says.

When it works best: Anytime, anyplace — but this is one technique that’s especially effective before bed. “Similar to counting sheep,” Pacheco says, “if you’re having trouble falling asleep, this breath can help take your mind off the racing thoughts, or whatever might be distracting you from sleep.”

Level of difficulty: Beginner

2. Abdominal Breathing Technique

How it’s done: With one hand on the chest and the other on the belly, take a deep breath in through the nose, ensuring the diaphragm (not the chest) inflates with enough air to create a stretch in the lungs. The goal: Six to 10 deep, slow breaths per minute for 10 minutes each day to experience immediate reductions to heart rate and blood pressure, McConnell says. Keep at it for six to eight weeks, and those benefits might stick around even longer.

When it works best: Before an exam, or any stressful event. But keep in mind, “Those who operate in a stressed state all the time might be a little shocked how hard it is to control the breath,” Pacheco says. To help train the breath, consider biofeedback tools such as McConnell’s Breathe Strong app, which can help users pace their breathing wherever they are.

Level of difficulty: Beginner

3. Nadi Shodhana or “Alternate Nostril Breathing”

How it’s done: A yogi’s best friend, this breath is said to bring calm and balance, and unite the right and left sides of the brain. Starting in a comfortable meditative pose, hold the right thumb over the right nostril and inhale deeply through the left nostril. At the peak of inhalation, close off the left nostril with the ring finger, then exhale through the right nostril. Continue the pattern, inhaling through the right nostril, closing it off with the right thumb and exhaling through the left nostril.

When it works best: Crunch time, or whenever it’s time to focus or energize. Just don’t try this one before bed: Nadi shodhana is said to “clear the channels” and make people feel more awake. “It’s almost like a cup of coffee,” Pacheco says.

Level of difficulty: Intermediate

4. Kapalabhati or “Skull Shining Breath”

How it’s done: Ready to brighten up your day from the inside out? This one begins with a long, slow inhale, followed by a quick, powerful exhale generated from the lower belly. Once comfortable with the contraction, up the pace to one inhale-exhale (all through the nose) every one to two seconds, for a total of 10 breaths.

When it works best: When it’s time to wake up, warm up or start looking on the brighter side of things. “It’s pretty abdominal-intensive,” Pacheco says, “but it will warm up the body, shake off stale energy and wake up the brain.” If alternate nostril breathing is like coffee, consider this a shot of espresso, she says.

Level of difficulty: Advanced

5. Progressive Relaxation

How it’s done: To nix tension from head to toe, close the eyes and focus on tensing and relaxing each muscle group for two to three seconds each. Start with the feet and toes, then move up to the knees, thighs, rear, chest, arms, hands, neck, jaw and eyes — all while maintaining deep, slow breaths. Having trouble staying on track? Anxiety and panic specialist Dr. Patricia Farrell suggests we breathe in through the nose, hold for a count of five while the muscles tense, then breathe out through the mouth on release.

When it works best: At home, at a desk or even on the road. One word of caution: Dizziness is never the goal. If holding the breath ever feels uncomfortable, tone it down to just a few seconds at most.

Level of difficulty: Beginner

6. Guided Visualization

How it’s done: Head straight for that “happy place,” no questions asked. With a coach, therapist or helpful recording as your guide, breathe deeply while focusing on pleasant, positive images to replace any negative thoughts. Psychologist Dr. Ellen Langer explains that while it’s just one means of achieving mindfulness, “Guided visualization helps puts you in the place you want to be, rather than letting your mind go to the internal dialogue that is stressful.”

When it works best: Pretty much anyplace you can safely close your eyes and let go (e.g. not at the wheel of a car).

Level of difficulty: Intermediate

While stress, frustration, and other daily setbacks will always be there, the good news is, so will our breath.

Reactive Arthritis

Reactive arthritis involves inflammation of joints (arthritis), eyes (conjunctivitis), and the genital, urinary, or gastrointestinal systems.Reactive arthritis can occur after genital (venereal) infection or bowel infection (dysentery).Reactive arthritis shares many features with psoriatic arthritis, ankylosing spondylitis, and the arthritis of Crohn's disease and ulcerative colitis.Reactive arthritis can affect the joints, the spine, the eyes, urinary tract, mouth, colon, and heart.There is no single laboratory test for diagnosing reactive arthritis. The HLA-B27 genetic marker is commonly found in the blood.Treatment of reactive arthritis is directed toward the specific body area(s) inflamed or affected.

Reactive arthritis is a chronic form of arthritis featuring the following three conditions: (1) inflamed joints, (2) inflammation of the eyes (conjunctivitis), and (3) inflammation of the genital, urinary, or gastrointestinal systems.

This form of joint inflammation is called "reactive arthritis" because it is felt to involve an immune system that is "reacting" to the presence of bacterial infections in the genital, urinary, or gastrointestinal systems. Accordingly, certain people's immune systems are genetically primed to react aberrantly when these areas are exposed to certain bacteria. The aberrant reaction of the immune system leads to spontaneous inflammation in the joints and eyes. This can be confounding to the patient and the doctor when the infection has long passed at the time of presentation with arthritis or eye inflammation.

Reactive arthritis has, in the past, been referred to as Reiter's syndrome (a term that has lost favor because of Dr. Hans Reiter's dubious past, one of enthusiastically embracing Nazi politics and medical abominations). In addition, Reiter's syndrome would refer to a specific type of reactive arthritis limiting inflammation to eye, urethra, and joints.

Reactive arthritis most frequently occurs in patients in their 30s or 40s, but it can occur at any age. The form of reactive arthritis that occurs after genital infection (venereal) occurs more frequently in males. The form that develops after bowel infection (dysentery) occurs in equal frequency in males and females.

Reactive arthritis is considered a systemic rheumatic disease. This means it can affect other organs than the joints, causing inflammation in tissues such as the eyes, mouth, skin, kidneys, heart, and lungs. Reactive arthritis shares many features with several other arthritic conditions, such as psoriatic arthritis, ankylosing spondylitis, and arthritis associated with Crohn's disease and ulcerative colitis. Each of these arthritic conditions can cause similar disease and inflammation in the spine and other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to inflame the spine, these conditions are collectively referred to as "spondyloarthropathies."

Reviewed by Jerry R. Balentine, DO, FACEP on 10/4/2012

Henoch-Schonlein Purpura

"I was diagnosed with Henoch-Schonlein purpura when I was 18, so about six years ago now. It was in the autumn months, which is when it is more prevalent. I initially suffered from a viral infection. Later that week, I developed pains in my abdominal area, and then came down with the meningitis-like rash. I was in the hospital for three weeks. All the symptoms described, I have had. However, I am or was one of the few who got renal failure as a result. It is believed to be chronic and not end stage. However, I am on continuing medication as a result. The thing I have found as a result of my diagnosis, is that I can't eat spicy food or red meat. My metabolism has slowed to a point that I am more prone to putting on weight than I used to be. This is one of those diseases that puzzle even the most genius of specialists. Bar the diet, I still get to live a relatively normal life."

Henoch-Schonlein purpura is a particular form of blood vessel inflammation called vasculitis.Henoch-Schonlein purpura frequently follows an infection of the throat or breathing passages, but it can be induced by certain medications.Henoch-Schonlein purpura causes skin rash, pain in the abdomen, and joint inflammation (arthritis).The treatment of Henoch-Schonlein purpura is directed toward the most significant area of involvement.The prognosis for patients with Henoch-Schonlein purpura is generally excellent.

Henoch-Schonlein purpura (HSP) is a form of blood vessel inflammation or vasculitis. There are many different conditions that feature vasculitis. Each of the forms of vasculitis tends to involve certain characteristic blood vessels. HSP affects the small vessels called capillaries in the skin and frequently the kidneys. HSP results in a purplish skin rash (most prominent over the buttocks and behind the lower extremities) associated with joint inflammation (arthritis) and sometimes cramping pain in the abdomen. Henoch-Schonlein purpura is also referred to as anaphylactoid purpura.

HSP occurs most often in the spring season and frequently follows an infection of the throat or breathing passages. HSP seems to represent an unusual reaction of the body's immune system that is in response to this infection (either bacteria or virus). Aside from infection, drugs can also trigger the condition. HSP occurs most commonly in children, but people of all age groups can be affected, including adults.

Fresh Blood as Good as Older Blood for Preemie Transfusions: Study

By Steven Reinberg
HealthDay Reporter

When premature babies need blood transfusions, older blood appears as good as "fresh" blood, Canadian researchers report.

The researchers found no difference in outcomes, either with complications or death, between the two. Fresh blood has been stored for a week or less; blood is typically kept and used for a month or more.

"The current transfusion [guidelines] for neonates shouldn't change," said lead researcher Dean Fergusson, from the Ottawa Hospital Research Institute.

There have been pressures recently to use only fresh blood for newborn transfusions, he explained, although "it's largely based on shaky data from less robust studies. We have done a clinical trial showing absolutely no difference between the way things are normally done versus a fresh-only group."

People assume that "fresh is better," Fergusson said. This assumption was based on what appears to be deterioration of red blood cells as they age, making them less able to carry sufficient oxygen to the cells of the body, he explained.

"What happens is ... the red cells come back to life and do deliver oxygen as soon as they are transfused," he said.

Fergusson was surprised by the result. "I went into this thinking fresh would be better," he said.

These results should be reassuring to patients and doctors, but especially to blood banks, Fergusson said.

"We currently shelve blood for 35 to 42 days," he said. "If we had to change the system to less than seven days, the number of donors would go through the roof and the wastage would go through the roof."

Fergusson said he expects this finding will be upheld in ongoing clinical trials with cardiac surgery patients, cancer patients and elderly patients, where the use of older blood has also been a topic of debate.

The report was published online Oct. 8 in the Journal of the American Medical Association, to coincide with the annual meeting of the AABB (formerly the American Association of Blood Banks), in Chicago.

To find out whether transfusing with fresh blood was better than older blood, Fergusson's team randomly assigned almost 380 underweight premature newborns who needed transfusions to receive blood stored for a week or less or blood stored for two weeks or more.

Among these infants, the researchers looked for any major illness or death.

They found almost 200 infants had a major illness or died. Of these, 99 were in the group receiving fresh blood and 100 were in the group receiving older blood.

Specifically, there were 146 infections in the group given fresh blood, and the same number in the group given older blood. These similarities were for confirmed infections, and in the rates of bacterial, fungal and viral infections as well, the researchers found.

Complications from infections such as pneumonia, meningitis and osteomyelitis, an inflammation of bone or bone marrow, also were similar between the groups, they noted.

One expert agreed that the current blood-donation system doesn't need to be changed, but added that the study doesn't definitively answer the question about the benefit of fresh versus older blood.

The current standard treatment for infants is to use blood that is less than 28 days old, said Dr. Hernan Cruz, academic director of the neonatal intensive care unit at Miami Children's Hospital.

"Most of the babies in the standard group were transfused with blood that was not that old -- an average of 14 days," Cruz said. "That makes the conclusion a little weak. Whether there is a benefit of using fresh blood versus old blood is still a debate."

Gout Management Is Focus of New Guidelines

Educating gout patients on diet, lifestyle choices and treatment objectives is among the recommendations in new guidelines to help patients and doctors fight the painful disease.

Gout, which affects nearly 4 percent of American adults, is one of the most common forms of inflammatory arthritis. Acute gout attacks can be debilitating and reduce patients' quality of life.

Diagnosed cases of gout in the United States have risen over the past 20 years and now affect 8.3 million people.

The American College of Rheumatology funded a collaborative effort among U.S. researchers to develop the new guidelines that educate patients in effective methods to prevent gout attacks and provide doctors with recommended treatments for long-term management of the disease.

Gout is caused by elevated levels of uric acid, which lead to the formation of crystals that are deposited in joints, resulting in excruciating pain and swelling.

Evidence suggests that increasing rates of gout may be due to factors such as high blood pressure, obesity, metabolic syndrome, type 2 diabetes and extensive use of two types of diuretics -- thiazide and loop -- to treat cardiovascular disease.

The guidelines were published Sept. 28 in the journal Arthritis Care & Research.

"The [Arthritis Care & Research] gout guidelines are designed to emphasize safety and quality of therapy, and to reflect best practice based upon medical evidence available at this time," lead investigator Dr. John Fitzgerald, acting chief of the rheumatology division at the University of California, Los Angeles, said in a journal news release.

"Our goal is that these guidelines, along with educating gout patients in effective treatment, will improve adherence, quality of care and management of this painful and potentially chronically debilitating condition," he said.

Mouse Study Sheds New Light on How Memories Are Stored

 

 During sleep, and even under anesthesia, part of the brain behaves as if it's remembering something, new animal research suggests.

The finding about the entorhinal cortex -- which is involved in learning, memory and Alzheimer's disease in humans -- challenges conventional theories about memory consolidation during sleep, the University of California, Los Angeles researchers said.

For the study, which was performed on mice, the researchers measured the activity of single neurons from three parts of the brain involved in memory formation in order to identify which brain region was activating other areas of the brain and how this activation was spreading.

The investigators discovered that the entorhinal cortex has what is called persistent activity, which is believed to be involved in working memory when people are awake, such as remembering a phone number or following directions.

"The big surprise here is that this kind of persistent activity is happening during sleep, pretty much all the time," study senior author Mayank Mehta, a professor of neurophysics, said in a UCLA news release. "These results are entirely novel and surprising. In fact, this working memory-like persistent activity occurred in the entorhinal cortex even under anesthesia."

Persistent activity in the entorhinal cortex during sleep may be a way to unclutter memories and delete information that was processed during the day but not needed, which results in important memories becoming prominent and readily accessible, Mehta suggested.

The findings are important because people spend one-third of their lives sleeping, and a lack of sleep causes various health problems, including learning and memory problems, Mehta said. The researcher also noted that Alzheimer's disease starts in the entorhinal cortex and these patients are known to have sleep problems.

However, experts point out that results from animal research are not necessarily applicable to humans.

The study was published online Oct. 7 in the journal Nature Neuroscience.

Final Countdown: 5 Training Tips for the Last Weeks Before a Big Race

It’s October, which means it’s race season. Many runners are amping up their training for big runs this fall, including the New York City marathon in early November and various half-marathons leading up to it.

Loyal Healthland readers know that we’ve been following three of our TIME staffers, who have been training all summer to run half-marathons this month. Our first contender is Liz Grover on TIME’s Imaging Desk, who is running her first half-marathon on Sunday, Oct. 7, in Staten Island, N.Y. “My ultimate goal isn’t to kill myself running this half-marathon, but finish knowing I can run another,” she says.

That’s the right attitude, and there are some key final-week training techniques that can help runners like Grover cross the finish line in their fastest time — but safely. For advice, we enlisted Robert Forster, founder and CEO of Phase IV and Forster Physical Therapy, who works with professional American athletes and several Olympic medalists, including London 2012 gold medalist sprinter Allyson Felix.

(MORE: It’s Not Too Late to Start: Tips for Training for a Distance Run)

Forster met with Grover and immediately recommended that she practice tweaking her step count (see below), even during her final training week. “Running correctly will prevent injuries and improve your run overall,” he advised. Perfecting form is vital, and so are these five other tips from Forster for runners on their last leg of race training:

1. Taper your training workload. If you’ve been training successfully so far, Forster says it’s better to be fully recovered than to sneak in hard workouts at the very end. You’re last long run — which is about 10 miles for a half marathon and more than 15 for a full marathon — should be done three weeks before a full marathon and 10 days before shorter races. This allows your body to recover fully and reap the fitness gains from the long-run training.

About three weeks from race day, Forster recommends reducing mileage by 25%, then cutting back to 50% the following week, and then running 25% of your usual mileage in the final week. Your last few weeks of training should have shorter workouts with more “speed play,” like increasing your pace for a mile at a time during runs. “Be sure to be well rested for race day,” says Forster. “There’s no fitness value to be derived from hard training the last five days before your run. There’s just not enough time for recovery.”

(MORE: How to Cross-Train: 5 Alternative Workouts for Runners)

2. Work on running mechanics. “It’s never too late to improve mechanics and your economy of motion,” says Forster. In your last weeks of training, focus on these three form cues:

Arm swing: Elbows should be bent slightly less than a right angle, and remain steady. All movement should be hinged at the shoulder as you swing your arms at your sides. “Think about scraping the ground with your elbows to keep from raising your shoulders towards your ears,” says Forster.Knee rise: Lead your leg swing with your knees by lifting them a bit higher than usual.Increase stride frequency: Count your steps while running, preferably on a treadmill with a visible time display. Count each foot strike for 10 seconds. The goal is to get as close as possible to 30 steps every 10 seconds. After a 10 minute warm-up, increase your step frequency for one minute at a time without increasing your pace or treadmill speed. Then go back to your “old” style and recover for one to two minutes and repeat.

(MORE: The Perfect Playlist: How Your iPod Can Help You Run Harder and Faster)

3. Develop your nutritional plan: As you complete your last few longer runs, play around with meals to figure out which foods you tolerate best.  This way, you can plan your ideal dinner and pre-event meal. “If solid foods don’t sit well with you, investigate the best shake or meal replacement drink you can tolerate without GI distress, like bloating, gas and cramps,” says Forster. And, remember, have your pre-race meal 90 minutes before the start of the event so you have adequate time for digestion.

4. Replace your shoes, if they’re in rough shape: Replace your running shoes if they’re broken down. Examine the wear patterns on your old shoes and twist each shoe from toe to heel. Bend each shoe at the forefoot to compare the rigidity against a new pair of the same model shoe. You will be able to tell if your shoes have lost their support function. Before using your new pair on long runs, Forster recommends breaking them in by wearing them for a few hours each day for two or three days and during short runs.

(MORE: Eat Like A Champ: The Best Foods For Runners)

5. Practice starting slow: On race day, you want to avoid getting too caught up in the excitement and running too fast in the beginning. Practice starting at a pace at least 30 seconds slower than your overall race pace goal. “If you feel good after the first few miles or at one third of the race, pick up the pace and try to hold it with good form,” says Forster. “Your race mantra should be: arm swing, knee rise and quicker steps. When you feel fatigued, swing your arms harder and they will bring you home.”

Nobel Prize Goes to Briton, Japanese for Stem Cell Work

British researcher John Gurdon and Shinya Yamanaka of Japan won this year’s Nobel Prize in physiology or medicine on Monday for discovering that mature, specialized cells of the body can be reprogrammed into stem cells — a discovery that scientists hope to turn into new treatments.

Scientists want to harness that reprogramming to create replacement tissues for treating diseases like Parkinson’s and diabetes, and for studying the roots of diseases in the laboratory.

The prize committee at Stockholm’s Karolinska Institute said the discovery has “revolutionized our understanding of how cells and organisms develop.”

Gurdon showed in 1962 — the year Yamanaka was born — that the DNA from specialized cells of frogs, like skin or intestinal cells, could be used to generate new tadpoles. That showed the DNA still had its ability to drive the formation of all cells of the body.

In 1997, the cloning of Dolly the sheep by other scientists showed that the same process Gurdon discovered in frogs would work in mammals.

More than 40 years after Gurdon’s discovery, in 2006, Yamanaka showed that a surprisingly simple recipe could turn mature cells back into primitive cells, which in turn could be prodded into different kinds of mature cells.

Basically, the primitive cells were the equivalent of embryonic stem cells, which had been embroiled in controversy because to get human embryonic cells, human embryos had to be destroyed. Yamanaka’s method provided a way to get such primitive cells without destroying embryos.

“The discoveries of Gurdon and Yamanaka have shown that specialized cells can turn back the developmental clock under certain circumstances,” the committee said. “These discoveries have also provided new tools for scientists around the world and led to remarkable progress in many areas of medicine.”

Just last week, Japanese scientists reported using Yamanaka’s approach to turn skin cells from mice into eggs that produced baby mice.

Gurdon, 79, has served as a professor of cell biology at Cambridge University’s Magdalene College and is currently at the Gurdon Institute in Cambridge, which he founded. Yamanaka, 50, worked at the Gladstone Institute in San Francisco and Nara Institute of Science and Technology in Japan. He is currently at Kyoto University and also affiliated with the Gladstone Institute. Yamanaka is the first Japanese scientist to win the Nobel medicine award since 1987.

“From now on, I’d like to make a contribution to society in a real sense. I feel a great sense of responsibility,” Yamanaka said at a news conference in Japan. “I want to use our medical breakthrough for medical purposes.”

Choosing Yamanaka as a Nobel winner just six years after his discovery was unusual. The Nobel committees typically reward research done more than a decade ago, to make sure it has stood the test of time.

In 2010, the Nobel Prize in physics went to two researchers whose discoveries were also published six years earlier. In 2006, two American scientists won the medicine prize eight years after their work was published.

Prize committee member Juleen Zierath said Gurdon and Yamanaka’s discoveries, which also earned them a Lasker award for basic research in 2009, could hold “immense potential,” including in developing treatments for Parkinson’s disease and in making cells that produce insulin. However, she added that therapeutic implications are still far away.

The idea of reprograming cells has also been put to work in basic research on disease, through an approach sometimes called “disease in a dish.”

The reprogramming allows scientists to create particular kinds of tissue they want to study, like lung tissue for studying cystic fibrosis, or brain tissue for Huntington’s disease. By reprogramming cells from patients with a particular disease, they can create new tissue with the same genetic background, and study it in the lab. That can give new insights into the roots of the problem.

In addition, that approach allows them to screen drugs in the lab for possible new medicines.

Experts welcomed the announcement, praising the duo for their groundbreaking and influential discoveries in a field riddled with ethical debates.

“Everyone who works on developmental biology and on the understanding of disease mechanisms will applaud these excellent and clear choices for the Nobel Prizes,” said John Hardy, professor of Neuroscience at University College London. “Countless labs’ work builds on the breakthroughs they have pioneered.”

Yamanaka deserves extra credit for overcoming fierce objections to the creation of embryos for research, reviving the field, said Julian Savulescu, director of Oxford University’s Uehiro Centre for Practical Ethics.

“Yamanaka has taken people’s ethical concerns seriously about embryo research and modified the trajectory of research into a path that is acceptable for all,” Savulescu said. “He deserves not only a Nobel Prize for Medicine, but a Nobel Prize for Ethics.”

Goran Hansson, the secretary of the prize committee, said he had reached both winners by phone before the announcement. He said they were looking forward to coming to Stockholm to collect the 8 million kronor ($1.2 million) award on Dec. 10.

The medicine award was the first Nobel Prize to be announced this year. The physics award will be announced Tuesday, followed by chemistry on Wednesday, literature on Thursday and the Nobel Peace Prize on Friday.

The economics prize, which was not among the original awards, but was established by the Swedish central bank in 1968, will be announced on Oct. 15. All prizes will be handed out on Dec. 10, the anniversary of prize founder Alfred Nobel’s death in 1896.

Last year’s medicine award to Canadian-born Ralph Steinman, American Bruce Beutler and French scientist Jules Hoffmann briefly created some confusion when it was announced that Steinman had died a few days earlier. Posthumous prizes are normally not allowed, but the award was left unchanged since the judges were not aware of Steinman’s death when they selected him as a winner.

Hope for Infertility Treatments: Scientists Make New Eggs from Mouse Stem Cells

Anthony Bradshaw / Getty Images

Japanese researchers have produced mouse eggs from stem cells that bred healthy offspring, a breakthrough that may one day help treat human infertility.

Researcher Mitinori Saitou and his team from Kyoto University in Japan used two different types of stem cells during their research: embryonic stem cells — a controversial technique since scientists must destroy embryos to cultivate them — and induced pluripotent stem (iPS) cells, which are adult cells, such as skin cells, that are reprogrammed to an embryonic-like state. Producing healthy eggs from iPS cells is potentially even more exciting than using embryonic stem cells, since iPS cells sidestep the ethical issues that plague those derived from embryos and because the resulting eggs would contain the same DNA as their donors.

Stem cell experts greeted the work with praise. “They’ve gotten to what was our Holy Grail, which is making eggs,” George Daley, a leading stem-cell scientist at Harvard, told NPR. “It’s like cellular alchemy. I mean, they can turn lead into gold here. They can turn skin cells or blood cells into eggs.”

(MORE: Ovary Stem Cells Can Produce New Human Eggs, Scientists Say)

In previous efforts, scientists — including the current group — have been able to create sperm and egg cells in the lab, but they weren’t able to produce healthy offspring from those cells. In the current study, published in the journal Science, the researchers first added growth factors and proteins to the stem cells to turn them into primordial germ cells. These cells were then combined with somatic cells from mouse ovaries to make “reconstituted ovaries,” which they transplanted into the mice. Four weeks later, the scientists removed them again, isolated immature egg cells from the ovaries and allowed them to mature in a dish. The mature eggs were fertilized with mouse sperm in a test tube and the resulting embryos were transferred into female mice, leading to the birth of healthy, fertile pups that went on to reproduce themselves.

It’s not at all clear whether the procedure would work similarly in humans, but the researchers if it does, it could revolutionize treatment for infertile couples and for older women who want children. “Now is the time for society to think about this,” Amander Clark, a stem cell scientist at UCLA, told the Los Angeles Times. “If we want to use stem cells to treat women who are older, we have to decide what the parameters are. Should this be available for women who are 40 to 50 years old? How about 50 and above? These shouldn’t be questions for scientists to decide alone.”

Indeed, such an advance would lead to a thicket of ethical questions: would you allow the use of tissues from a dead person to create new life, for example?

(MORE: Scientists Restore Fertility in Mice Using Lab-Generated Sperm)

The researchers said the lab-created egg cells led to healthy pups less frequently than did natural mouse eggs, which were also fertilized and transferred to female mice in a control group. Mice impregnated with embryos created via in-vitro fertilization with natural eggs produced healthy offspring 13% of the time, compared with 3.9% for eggs created from embryonic stem cells and 1.8% for eggs made using iPS cells.

Nevertheless, the advance sheds light on how precursor cells eventually develop into sperm or egg cells, a scientific understanding that could in itself aid infertility treatments. That’s encouraging for the many women who struggle with fertility: according to the U.S. Centers for Disease Control and Prevention, about 10% of America women have problems getting pregnant or staying pregnant.

Is Human Nature Fundamentally Selfish or Altruistic?

Human inclinations are not primarily selfish: kindness and altruism have been evolutionarily valued in mates, and even the youngest children often try to be helpful

Did selfishness — or sharing — drive human evolution? Evolutionary theorists have traditionally focused on competition and the ruthlessness of natural selection, but often they have failed to consider a critical fact: that humans could not have survived in nature without the charity and social reciprocity of a group.

Last week on Slate, evolutionary anthropologist Eric Michael Johnson explored the question against the backdrop of two cultural events in 1957 — the consequences of the rogue, selfish activities of a pygmy hunter in a Congo forest, who used the group’s collective hunting efforts to benefit only himself, and in New York City, the publication of Ayn Rand’s novel Atlas Shrugged, whose protagonist champions the author’s notion that human nature is fundamentally selfish and that each man “exists for his own sake, and the achievement of his own happiness is his highest moral purpose.”

Atlas Shrugged counts many politicians as admirers, perhaps most notably Republican vice presidential candidate, Paul Ryan, who cites the book as one of his main inspirations for entering politics and is known to give Rand’s books frequently to his interns.

(MORE: ‘Paradise Built in Hell:’ How Disaster Brings Out the Best in People)

So, does Rand’s theory comport with current evolutionary theory? The data is not exactly kind to her position. For example, Johnson describes an anthropologist’s account of the pygmy tribesman, Cephu, in the Congo who lived by the Randian ideal that selfishness is the highest morality. Cephu was part of the Mbuti tribe for whom “hunts were collective efforts in which each hunter’s success belonged to everybody else,” Johnson writes, detailing how the tribe “employed long nets of twined liana bark to catch their prey, sometimes stretching the nets for 300 feet. Once the nets were hung, women and children began shouting, yelling, and beating the ground to frighten animals toward the trap.”

It was a group effort, for most:

But one man, a rugged individualist named Cephu, had other ideas. When no one was looking, Cephu slipped away to set up his own net in front of the others.

Soon caught in this blatant attempt to steal meat, Cephu was brought in front of the whole tribe:

At an impromptu trial, Cephu defended himself with arguments for individual initiative and personal responsibility. “He felt he deserved a better place in the line of nets,” [the anthropologist Colin] Turnbull wrote. “After all, was he not an important man, a chief, in fact, of his own band?” But if that were the case, replied a respected member of the camp, Cephu should leave and never return. The Mbuti have no chiefs, they are a society of equals in which redistribution governs everyone’s livelihood. The rest of the camp sat in silent agreement.

Faced with banishment, a punishment nearly equivalent to a death sentence, Cephu relented.

He apologized, handed over his meat to the tribe and then, essentially, was sent to bed without dinner. As Johnson explains, selfishness is considered far from a virtue in such tribal groups, which still live in ways similar to our hunter-gatherer ancestors. Indeed, every such group ever studied has been found to idealize altruism and punish selfishness, in everything from their mythologies to their mating practices.

(MORE: How Economic Inequality Is (Literally) Making Us Sick)

Although Rand accepted that early human life was a collective effort, she failed to realize how this shaped our brains. In most societies, for example, a man like Cephu would be seen as the opposite of a good catch for a woman wanting a partner. A good mate — and one whose genes were likely selected for and passed on in our earliest evolutionary history — would have been a cooperative hunter, one who didn’t put his own goals ahead of those of the tribe. He would have been altruistic in battle too, particularly when warring with other groups. A selfish soldier, after all, is known as a coward, not a hero.

The evidence for altruism as a critical part of human nature isn’t limited to anthropology. Studies of 18-month-old toddlers show that they will almost always try to help an adult who is visibly struggling with a task, without being asked to do so: if the adult is reaching for something, the toddler will try to hand it to them, or if they see an adult drop something accidentally, they will pick it up.

However, if the same adult forcefully throws something to the ground, toddlers won’t try to retrieve it: they understand that the action was deliberate and that the object is unwanted. These very young children will even assist (or refrain from helping) with a book-stacking task depending on what they perceive to be the adult’s intention. If the adult clumsily knocks the last book off the top of the stack, the toddler will try to put it back; if the adult deliberately takes the last book off, however, toddlers won’t intervene. Even before kids are taught to chip in — perhaps especially before they are told it’s an obligation — children are less selfish than often presumed.

Another study found that 3- to 5-year-olds tend to give a greater share of a reward (stickers, in this case) to a partner who has done more work on a task — again, without being asked — even if it means they get to keep less for themselves. And those cries of “That’s not fair!” that plague sibling relationships: they’re not only selfish; they reflect children’s apparently innate desire for equity.

(MORE: The Upside of Gossip: Social and Psychological Benefits)

Fundamental tendencies toward altruism aren’t only seen in children, either. Worldwide, the aftermath of natural disasters are typically characterized by heroism and a sharing of resources — within the affected community and in others farther way — not selfish panics. During the terrorist attacks of 9/11, for example, there were no accounts of people being trampled rushing out of the World Trade Center towers; rather, those who needed assistance descending were cared for, and calm mainly prevailed. The same occurred after the earthquake, tsunami and nuclear meltdown in Japan in 2011. The cases in which people stampede or look out only for themselves tend to be rare and involve very specific circumstances that mitigate against helpfulness.

Moreover, our stress systems themselves seem to be designed to connect us to others. They calm down when we are feeling close to people we care about — whether related to us or not — and spike during isolation and loneliness. Even short periods of solitary confinement can derange the mind and damage the body because of the stress they create. And having no social support can be as destructive to health as cigarette smoking.

Of course, none of this is to say that humans are never selfish or that we don’t have a grasping, greedy part of our nature. But to claim, as Rand does, that “altruistic morality” is a “disease” is to misrepresent reality.

Ketamine for Depression: The Most Important Advance in Field in 50 Years?

In a new review in Science, the authors call the identification of the anesthetic and “club drug” ketamine as a rapid treatment for depression “arguably the most important discovery in half a century” of research on the condition

In any given year, 7% of adults suffer from major depression, and at least 1 in 10 youth will reckon with the disorder at some point during their teenage years. But about 20% of these cases will not respond to current treatments; for those that do, relief may take weeks to months to come.

There is one treatment, however, that works much faster: the anesthetic and “club drug” ketamine. It takes effect within hours. A single dose of ketamine produces relief of depression that has been shown in studies to last for up to 10 days; it also appears to reduce symptoms of bipolar disorder and suicidal thoughts.  Now, a new research review published in Science calls the discovery of these effects of ketamine, “”arguably the most important discovery in half a century” of depression research.

Ketamine doesn’t work the way traditional antidepressants do. Many such drugs affect levels of the neurotransmitter serotonin in the brain, and while the idea that depression is caused by low levels of serotonin or an “imbalance” of other key neurotransmitters has been firmly fixed in the popular imagination, scientists have known for decades that it can’t be that simple. For one, antidepressant drugs change the brain’s neurotransmitter levels immediately, yet depression doesn’t lift for several weeks, a delay that could be potentially deadly.

Another theory is that depression is caused not by neurotransmitter problems per se, but by damage to brain cells themselves in key regions critical to controlling mood. This idea fits nicely with evidence that stress can cause depression, since high levels of stress hormones can cause an overrelease of a neurotransmitter called glutamate, which damages cells and affects exactly the same suspected areas. More support for this theory comes from the fact that all known antidepressants increase cell growth in these areas too, providing an alternate explanation for their therapeutic results.

At first, ketamine seemed to throw a monkey wrench into that neat idea, however. It didn’t seem likely that a drug could repair cells within hours, but new research explored in a review paper in the journal Science suggests just that. Ketamine rapidly spurs the growth of new synapses, the connections between brain cells, and is associated with “reversal of the atrophy caused by chronic stress,” the authors write.

Unfortunately, the hallucinogenic and often outright unpleasant effects of ketamine mean that it can’t be used in the same way typical antidepressants are, and fears about its potential for misuse also hamper its development. Researchers are frantically trying to develop compounds that have the same effects as ketamine without producing a “high.”

In the meanwhile, however, ketamine is already FDA approved, so there’s nothing stopping psychiatrists from trying it and patients from asking for access to it in emergency situations when all else has failed. However, it must be given by infusion and carefully monitored (nasal sprays are being developed and there is an oral form that has some effects, but is not optimally absorbed), and the drug impairs patients for hours. Still, it relieves depression for at least several days:  if there’s a choice between being entirely dysfunctional seven days a week or only out of commission for one or two, many people would accept that trade-off.

But while research on ketamine is ongoing, clinical use of the drug in the community remains rare. Fears about abuse continue to run high, though ketamine has never caught on as a major street drug. If the Science paper’s authors are right that ketamine’s effect on depression is a key advance  — and if the drug really holds similar promise for bipolar disorder — patients might want to consider pushing for greater access. Ketamine is off patent, so no drug maker is likely to do so.

5 Things You Need to Know About Fungal Meningitis

More than 100 cases of fungal meningitis and eight deaths have been reported so far. Here's what you need to know about the infection

In its most recent tally, the U.S. Centers for Disease Control and Prevention (CDC) confirms 105 cases of rare fungal meningitis and eight deaths in patients who received epidural steroid injections to treat back pain.

The CDC reports that the illness has been seen in nine states — Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia — stemming from three contaminated lots of methylprednisolone acetate injections produced by New England Compounding Center (NECC).

Federal health investigators and state officials are looking closely at the Framingham, Mass., facility where NECC made more than 17,000 potentially tainted steroid injections — which are believed to have been tainted with two types of fungus, Aspergillus and Exserohilum, during manufacturing — and shipped them to 75 clinics in 23 states. NECC has since recalled all of its products.

(MORE: Meningitis Outbreak Grows, Highlighting Dangers of Compounding Pharmacies)

The CDC estimates that about 13,000 patients may have been exposed to the contaminated steroid injections, and clinics are continuing to reach out to all patients who may have been affected. In Ohio, health officials are even mobilizing sheriff’s offices to locate people who may have been exposed, Reuters reports. “If that means knocking on doors, then that’s what they will do,” Beth Bickford, executive director at the Association of Ohio Health Commissioners, said in a statement.

The CDC expects to see additional infections, but says that far fewer than the number of people exposed to the contaminated injections will become ill.

“Since we are still unfortunately in the early days of this investigation, it is anticipated that new cases will come to light over the next several weeks,” says Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University Medical Center. “This is an ongoing story and there may be new twists of which we are of the moment unaware. There will probably be new information every day in the foreseeable future.”

Here are the five things you should know about fungal meningitis and how it’s treated:

1. How is fungal meningitis typically contracted?
First, patients should be aware that fungal meningitis is extremely rare and not contagious. A variety of fungi may cause meningitis; spores can be inhaled in the environment, from infected soil, or sometimes in a hospital setting. Meningitis develops when the fungus spreads through the blood to the spinal cord. Although anyone can get fungal meningitis, patients with weakened immune systems like those with AIDS or cancer are at higher risk, according to the CDC. Steroid drugs, such as those used by the patients who were infected in the current outbreak, can also reduce immunity, as can drugs taken after organ transplants and medications that treat rheumatoid arthritis and other autoimmune conditions. In general, epidural injections are considered safe and complications are rare.

2. What are the symptoms?
Meningitis is an inflammation of the brain and spinal cord lining, and fungal meningitis occurs when the membranes protecting the brain and spinal cord become infected with fungus. Symptoms of fungal meningitis include fever, headache, stiff neck, nausea and vomiting, sensitivity to light, weakness and numbness. Patients who may have received the contaminated injections should also look out for increasing pain as well as redness and swelling at the injection site. If the infection continues long enough without treatment, it may impact consciousness causing patients to lapse into a coma state, says Schaffner.

Aspergillus-related meningitis can also impact patient’s blood vessels, causing clots and bleeding as well as trouble speaking and maintaining stability. Schaffner warns these symptoms can often be mistaken as side effects of a small stroke. “This is the sort of information we are getting out to both patients and doctors. This way patients who have had these inoculations and appear as though they had a stroke can get tested for this fungal meningitis,” he says.

(MORE: Doctors Say Steroid Shots for Spine Are Usually Safe)

3. How is fungal meningitis diagnosed? 
If fungal meningitis is suspected, the most secure diagnosis is made with a lumbar puncture or spinal tap. The cerebrospinal fluid surrounding the brain and spinal cord is withdrawn and the examined under the microscope by the physician. The fluid is also sent to a laboratory where the fungus is isolated and grown. “This procedure can be done safely and efficiently with very little discomfort,” says Schaffner.

4. How is the infection treated?  
The infection is treated with antifungal medications administered in a hospital through an IV. Although bacterial meningitis can be treated within a week, fungal meningitis can take much longer, sometime longer than a month. “We have fewer antifungal drugs available and because this whole instance of fungal meningitis is so unusual, there is very little clinical experience,” says Schaffner. The two drugs used to treat fungal meningitis, amphotericin B and voriconazole, can also cause serious side effects like liver and kidney damage and must be monitored meticulously by physicians.

5. How is it different from bacterial or viral meningitis?
Bacterial and viral meningitis are more common than fungal meningitis. The bacteria and viruses that cause these other types of meningitis can be contagious, but they will not necessarily cause meningitis in those who are exposed or infected.

Symptoms of fungal meningitis present themselves much more slowly than those of bacterial meningitis. “Symptoms of bacterial meningitis come on quite suddenly and very prominently,” says Schaffner. “[In fungal meningitis] they kind of just ease on for the most part. The onset is not as dramatic and they become gradually more severe.”

Both Schaffner and the CDC recommend that any individual who received the injectable steroids and are experiencing symptoms to alert their doctor as soon as possible. Early diagnosis is crucial for the most effective treatment.

Study: Free Birth Control Slashes Abortion Rates

What would happen if women at risk for unintended pregnancies received the birth control of their choice — especially the more effective kinds — at no cost?

The national abortion rate would plummet, according to a study conducted by researchers at the Washington University School of Medicine in St. Louis and published in the journal Obstetrics & Gynecology on Thursday.

The researchers enrolled 9,256 women from the St. Louis region into the Contraceptive Choice Project between August 2007 and September 2011. The women were aged 14 to 45, with an average age of 25, and many were poor and uninsured with low education. Nearly two-thirds had had an unintended pregnancy previously. Participants were either not using a reversible contraception method or willing to switch to a new one.

(LIST: 8 Preventive Health Services that Women Start Getting for Free Today)

Researchers provided free, FDA-approved birth control to the women for three years. The women were given their choice of contraception, including oral birth control pills and long-acting reversible contraceptive (LARC) methods like implants and IUDs. The researchers specially briefed the participants on the “superior effectiveness” of LARC methods — the T-shaped IUD, or intrauterine device, has close to 100% effectiveness and can last five to 10 years, for instance — and 75% of women chose those devices over the pill, patch or ring.

Over the course of the study, which lasted from 2008 to 2010, women experienced far fewer unintended pregnancies than expected: there were 4.4 to 7.5 abortions per 1,000 women in the study, after adjusting for age and race — much fewer than the national rate of 19.6 abortions per 1,000 women and lower also than the rate in the St. Louis area of 13.4 to 17 abortions per 1,000 women.

The effect of free contraception on the teen birth rate was remarkable: there were 6.3 births per 1,000 girls aged 15 to 19 in the study, compared with the national rate of 34.3 births per 1,000 teen girls.

(MORE: Which Birth Control Works Best? (Hint: It’s Not the Pill))

The findings come amidst contention over President Obama’s health-care law, which offers women FDA-approved birth control without a copay. As of August 1, contraception is covered for women signing up for new health insurance plans or renewing their existing plans.

“[C]hanges in contraceptive policy simulating the Contraceptive Choice Project would prevent as many as 41% to 71% of abortions performed annually in the United States,” the study’s authors wrote.

Nearly half of the more than 6 million pregnancies that occur each year are unintended, and about 43% of them end in abortion. Further, about 1 million births are unintended, costing U.S. taxpayers about $11 billion a year in associated expenses. Low-income women with less education are far more likely to have an unintended pregnancy than their wealthier, educated peers.

About half of unplanned pregnancies occur in women who are using no contraception; in other cases, women may be using short-acting contraception, like condoms or pills, which can fail if not used properly. In contrast, methods like IUDs, which are fitted into the uterus, or hormonal implants, which are surgically placed under the skin of the upper arm, can be placed and then forgotten about — no need to remember to refill a prescription or take a pill at the same time each day.

(MORE: What Got Lost in the Birth-Control Debate)

Women who choose long-acting contraception are more likely to stick with it as well: in the study, 85% were still using it a year later, compared with 35% of those choosing pills or other short-acting forms of birth control. “Because LARC methods have been shown to have higher continuation rates than other reversible methods, the number of adolescents and women using no contraception would decline, further decreasing the unintended pregnancy rate,” the authors conclude.

Yet American women use LARC methods at far lower rates than in other countries. In large part, that’s because of cost: upfront costs to implant an IUD, which requires a doctor visit, can total $500 to $1,000, for example. Over a decade, however, birth control pills can cost just as much. American doctors also tend not to recommend long-acting birth control to women as often as they do the pill or patch, though IUDs and implants may be up to 20 times more effective.

That’s why the American College of Obstetricians and Gynecologists is now urging doctors to recommend IUDs and implants as “first-line” contraceptive choices to their teen patients.

Nutella Truck’s National Tour Hypes a Not-So-Healthy Breakfast

Nutella for breakfast? What kind of nutty idea is that?

A pretty good one, Nutella’s Italy-based maker, Ferrero, thinks. A Nutella truck is crisscrossing the U.S. through Dec. 15, dishing out samples of the chocolate hazelnut spread as part of the company’s 12-city “breakfast tour.” Nutella USA says its spread contains no artificial flavors or preservatives, just a “wholesome” combination of hazelnuts, sugar, skim milk and “a hint of cocoa.”

Healthland finds the road trip surprising, especially after Ferrero settled a $3 million false advertising lawsuit in April; a California mom sued the company in February 2011 for spreading the claim, through TV ads and labeling, that Nutella was a balanced, nutritious option for breakfast. In her lawsuit, she said she “was shocked to learn” that Nutella “was the next best thing to a candy bar.”

Given that one serving (2 tablespoons) of the spread contains 200 calories, 11 g of fat — 3.5 g of which is saturated fat — and 21 g of sugar, it’s hard to believe anyone would be shocked to discover that Nutella’s not a health food. Nevertheless, as a result of the lawsuit, Ferrero agreed to change Nutella’s label, amend some marketing claims and revamp its TV ads and website.

(LIST: What’s the Healthiest Breakfast? Here’s What the Experts Say)

But the company still maintains that the sweet spread, “when used in moderation with complementary foods,” can be part of a balanced breakfast and a way to encourage kids to eat heart-healthy whole grains. A photo on the company’s Facebook page shows an English muffin with a smear of Nutella and strawberries on top, for example.

Then again, there is something to the idea of eating dessert for breakfast: in March, a study by Tel Aviv University researchers found that dieters who ate dessert — cake or cookies, for example — with their breakfast actually lost more weight than those who ate a low-cal, low-carb breakfast, because they were less hungry and had fewer cravings. Still, neither Healthland nor most nutritionists would recommend that the average person — who’s not taking part in a clinical trial — eat such high-fat, high-sugar items for breakfast every day.

Ferrero’s not the only corporation putting a healthy spin on its products. As more and more consumers demand natural, organic foods for their families, food makers are rushing in to satisfy the demand. But a lack of FDA guidelines for certain labeling claims — the use of the word “natural,” for instance — means that it’s easy for companies to stretch the truth. This summer, two California mothers sued General Mills for marketing its Nature Valley granola products as “100% natural,” even though the snacks contained some decidedly unnatural, highly processed ingredients: the sweeteners high fructose corn syrup and high maltose corn syrup, and the thickener maltodextrin, according to a July article in the New York Times.

(MORE: How to Choose a Healthy Breakfast Cereal)

Nutella, too, is one of the many foods that at first glance looks like it contains just a few simple ingredients, but that doesn’t mean it’s a health food. So, if the Nutella truck shows up near you this fall, treat the free sample as a dessert. But don’t call it breakfast.

Mixed Grades for New, Healthy School Lunch Rules

(ROTTERDAM, N.Y.) — One student complains because his cafeteria no longer serves chicken nuggets. Another gripes that her school lunch just isn’t filling. A third student says he’s happy to eat an extra apple with his lunch, even as he’s noshing on his own sub.

Leaner, greener school lunches served under new federal standards are getting mixed grades from students piling more carrots, more apples and fewer fatty foods on their trays.

(MORE: 9-Year-Old Food Blogger Takes On School Lunch)

“Now they’re kind of forcing all the students to get the vegetables and fruit with their lunch, and they took out chicken nuggets this year, which I’m not too happy about,” said Chris Cimino, a senior at Mohonasen High School in upstate New York.

Lunch lines at schools across the country cut through the garden now, under new U.S. Department of Agriculture nutrition standards. Mohonasen students selecting pizza sticks this week also had to choose something from the lunch line’s cornucopia of apples, bananas, fresh spinach and grape tomatoes, under the standards. Calorie counts are capped, too.

Most students interviewed in this suburban district near Schenectady seemed to accept the new lunch rules, reactions in line with what federal officials say they’re hearing elsewhere. Still, some active teens complain the meals are too skimpy. And while you can give a kid a whole-wheat pita, you can’t make him like it.

“I was just trying to eat it so I wouldn’t be hungry later on,” Marecas Wilson said of his pita sandwich served this week at Eastside Elementary in Clinton, Miss.

Though the fifth-grader judged his pita “nasty,” he conceded: “The plum was very good.”

Kim Gagnon, food service director in the Mohonasen district, said while students generally have been receptive to the fruits and vegetables, “we have noticed that kids are throwing it out or giving it to friends, leaving it on counters, so we haven’t quite gotten there yet.”

The guidelines approved by the USDA earlier this year set limits on calories and salt and phase in whole grains. Schools must offer at least one vegetable or fruit per meal. They can still serve chocolate milk, but it has to be nonfat.

The biggest update to federal school-food guidelines in 15 years might please parents who recall washing down cheeseburgers and tater tots with full-fat chocolate milk. In Pueblo, Colo., Megan Murillo said she feels more comfortable letting her first-grader, Sophie, eat cafeteria-prepared lunches knowing there are more vegetable and whole grains.

Reactions in schools so far this fall have been positive, according to Kevin Concannon, the USDA’s undersecretary for Food, Nutrition and Consumer Services.

“I don’t mind it because I always got the extra apple and fruit and veggies and all that,” said Anthony Sicilia, a senior at Mohonasen, who nonetheless was eating a Subway sub for lunch. “But I think it’s good because it actually forces kids to eat healthy.”

But new guidelines or no, many kids are still picky eaters.

In Clinton, Miss., the elementary students served flatbread roast beef sandwiches with grated cheese ate most of the meat but left large chunks of whole-wheat pita. Most plums were gnawed to the pits, and several salads were half eaten.

“I liked the meat but not this,” fifth-grader Kenmari Williams said, pointing to his pita. “Every time you eat it, you get something white on your hands.”

One thornier complaint is that the new lunches are too little for active teens now that the calorie range for high school lunches is 750 to 850. Rachelle Chinn, a freshman from Clarence, Mo., who plays softball, said school lunches are now so slight it once left her with a headache.

“The fruits and vegetables are good at first but once they wear off, I get hungry,” she said. “It’s just not enough to get me through the day.”

Her mom, Chris Chinn, now packs her protein-heavy snacks like peanut butter crackers and granola bars. Chinn, a critic of what she calls the “one size fits all” standards, said many athletes aren’t getting enough to eat. Similarly, Katie Pinke in Wishek, N.D., gave up on school lunches for her strapping freshman son Hunter and packs him meaty sandwiches.

Hunter is a 6-foot-5-inch, 210-pound football player who, based on his size and active lifestyle, needs more than 4,700 calories daily to maintain his weight. He said lunches topping out at 850 calories aren’t enough.

“I think it’s kind of ridiculous that people say how much we get to eat when there are a lot of kids that are big,” Hunter said. “When we can’t have our meat and bread, for a guy especially, it’s not fun.”

Concannon noted the calorie ranges are adjusted for age, increasing as students move from elementary to middle to high school. If some children need more, Concannon said, schools have the option of offering an afternoon snack or parents can send snacks from home.

“If you look at colleges in the United States, if you’ve ever looked at the tables where they’re feeding just the football players. Good God … If you emulated that, we’d all be wearing size 48 suits by our 20s,” he said. “You have to use common sense.”

And just weeks into the school year, it’s probably too early for final grades. In Mississippi, Keba Laird, child nutrition supervisor for the Clinton district, said she is phasing in the nutritional changes to help children grow accustomed to eating healthier.

“We don’t want a revolt on our hands,” she said. “We want them to enjoy eating with us.”

 

Antidepressants in Pregnancy May Affect Babies' Language Development

 

MONDAY, Oct. 8 (HealthDay News) -- A common class of antidepressants, when taken during pregnancy, can affect aspects of language ability in the baby's earliest stages of development, a small new study suggests.

The study found that treating depressed pregnant women with serotonin re-uptake inhibitors (SSRIs) may speed up the baby's ability to focus on the sights and sounds of his or her native language.

"This study shows how maternal depression and its treatment can change the timing of language development in babies," said Janet Werker, professor of psychology at the University of British Columbia, in Vancouver, Canada, and senior author of the study.

Werker stressed that the study does not show that the "sped-up" development associated with pregnant mothers who took these antidepressants was necessarily beneficial to the infant's language learning process.

"In our culture we tend to think speeding things up is a good thing, but it's not necessarily so with infant language development," Werker said.

The study also found that depression during pregnancy not treated with medication may prolong an early stage of language development. The study appears Oct. 8 in the journal Proceedings of the National Academy of Sciences.

Serotonin is a hormone that regulates mood, appetite and sleep, and is thought to contribute to feelings of well-being and happiness. SSRIs raise the amount of serotonin available outside of cells, which increases the ability of nerve cells to transmit serotonin. SSRIs also are used to treat anxiety and eating disorders.

SSRIs include commonly prescribed antidepressants such as Prozac (Fluoxetine), Lexapro (escitalopram), Paxil (paroxetine) and Zoloft (sertraline).

The new research is the latest in a growing body of evidence showing that both depression in pregnancy and drugs taken to fight the disorder can affect fetal development, which can create a treatment dilemma for women and their doctors.

For example, another study, published in March in the journal Archives of General Psychiatry, showed that pregnant women taking SSRIs may be more likely to deliver infants with smaller heads.

Werker said the new research does not explain why only some infants are affected by either a mother's depression or by treatment with SSRIs.

The study followed three groups of pregnant women: those being treated for depression with SSRIs, those who were depressed but not taking the medications and others who were not depressed. Depressed women not on SSRIs were getting some form of non-drug therapy, Werker said.

The research involved two experiments. The first looked at 85 infants in the first year of life -- 32 from mothers who were not depressed during pregnancy, 21 whose mothers were depressed but not treated with SSRIs and 32 whose mothers were depressed and treated with SSRIs.

Measuring changes in heart rate and eye movement in response to sounds and video images of speakers of both native and non-native languages, the researchers assessed the infants' language development at 6 months and 10 months of age.

In the second experiment, 14 fetuses whose mothers were taking SSRIs and 20 fetuses whose mothers were not taking the medications were tested. The researchers measured how their heart rate changed in response to different sounds.

They found some significant differences in how infants responded to language differences and how fetuses responded to sound, when looking at whether their mothers were treated with SSRIs.

An expert who reviewed the new research said it had several limitations, however.

Among these was that the study did not identify whether the impact on language development might be long term, a common limitation of SSRI-related studies.

"If these effects are transient, does it really make any difference?" asked Victoria Richards, a pharmacologist and assistant professor at the Frank H. Netter School of Medicine at Quinnipiac University, in Hamden, Conn.

The study would have been more valuable if it had described the specific severity of depression in the study participants, revealed who had diagnosed the depression and on what criteria the diagnosis was based, and noted whether the SSRI was appropriately prescribed, Richards said.

It would have been interesting to assess whether women receiving behavioral therapy, rather than medication, for their depression had babies with delayed or more advanced language development, she said.

Richards explained that, for women, the decision about whether to take SSRIs during pregnancy can be complicated.

"The human body is so complex," she said. "When you're pregnant, it inherently changes the way drugs are handled by the body, and with a growing fetus, you have to weigh the risks and the benefits."

Women who are taking SSRIs and are pregnant or considering pregnancy should not stop taking the medications without talking with their prescriber, Richards said. She warned that there can be serious implications to suddenly going off this class of drugs.

Although the study found an association between antidepressant use in pregnancy and babies' language development, it did not prove a cause-and-effect relationship.

Health Highlights: Oct. 8, 2012

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Soda Vending Machines to Display Calorie Counts

Some soft drink makers are introducing new vending machines that display calorie counts to consumers.

The information will be on the buttons of the Coke, Pepsi and Dr. Pepper machines, which will also remind consumers that they can choose a low-calorie drink. The new machines will be introduced in Chicago and San Antonio municipal buildings in 2013 before being distributed nationally, the Associated Press reported.

Monday's announcement comes ahead of proposed new rules expected as early as next year that would require restaurant chains and vending machines to post calorie information.

"This would be an important step forward," said Mike Jacobson, executive director for the Center for Science in the Public Interest, which promotes safe food and nutrition. "Currently, people don't think about calories when they go up to a vending machine. Having the calories right on the button will help them make choices," he told the AP.

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Stem Cell Researchers Receive Nobel Prize

This year's Nobel Prize in physiology or medicine was awarded to two researchers for their work showing that mature, specialized cells can be reprogrammed into stem cells.

The findings by British researcher John Gurdon and Japanese researcher Shinya Yamanaka is being used by scientists to try to find ways to create replacement tissues for treating diseases such as diabetes and Parkinson's, and for laboratory research studying the causes of diseases, the Associated Press reported.

In announcing the award Monday, the prize committee said the two researchers' work "revolutionized our understanding of how cells and organisms develop."

In 1962, Gurdon showed that the DNA from specialized cells of frogs, such as skin or intestinal cells, could be used to generate new tadpoles. The findings showed that DNA still had its ability to drive the formation of all cells of the body, the AP reported.

In 2006, Yamanaka showed that a relatively simple process could turn mature cells back into primitive cells, which in turn could be coaxed into becoming different kinds of mature cells.

CT Scans of Kids in ER With Stomach Pain Skyrockets

The use of CT scans on children being brought to emergency rooms with abdominal pain has skyrocketed, new research reveals.

"CT scans among children coming to the ER with abdominal pain have gone off the charts," said study author Dr. Jahan Fahimi, an attending physician in the department of emergency medicine at Alameda County Medical Center Highland Hospital in Oakland, Calif. "We found that in 1998, probably in part as a result of fewer CT scans being available to doctors, less than 1 percent of these children underwent CT scans. But now, a decade later, that has gone up to 15 percent," he explained.

"That being said, there's been no change in the number of children coming in to ERs, or the proportion of the number of kids coming in with abdominal pain, or the number of kids that are being hospitalized," Fahimi noted. "And no change in the number of X-rays or ultrasounds being performed. So this does raise the question of why this is happening."

The finding could ring public health alarm bells, given increasing concerns in the medical community about how exposure to the kind of radiation emitted by such scans may boost cancer risk among these young patients.

Fahimi, who is also an assistant professor at the University of California, San Francisco, reports the findings online Oct. 8 and in the November print issue of Pediatrics.

To get a snapshot of current pediatric CT scan use, the team crunched numbers collected by the annual National Hospital Ambulatory Medical Care Surveys, spanning the period from 1998 to 2008. The survey paints a nationally representative portrait of all visits to most of the nation's emergency departments.

The authors focused specifically on those children under the age of 19 who showed up in an emergency department with a primary complaint of abdominal pain, including symptoms such as cramping, spasms and general discomfort.

The result: of the nearly 92,000 pediatric visits to emergency departments in the study period, 6 percent were found to have involved abdominal pain, and most of these patients were female adolescents and teens.

Yet despite the fact that the number of abdominal pediatric emergency department visits remained more or less stable across the study period, the team observed that, among all the diagnostic tools available to hospitals, only CT scan use went up dramatically.

"Now, while there are many possible reasons why this is the case, this study isn't designed to be able to tell us why," acknowledged Fahimi. "I can only postulate. But I have a hard time believing we are providing that much better care today than a decade back. I think it's likely that we've introduced a new technology into medical practice, made it widely available, and in many ways it's become a crutch of emergency medicine. Of course, people think we really need to evaluate these kids thoroughly. And CT scans can do that. But that might mean that there's now almost a knee-jerk reaction toward using this technology," he added.

"Whatever the reason, I am by no means saying that CT scans are a bad test or that parents should be fearful," Fahimi stressed. "In fact, they are very powerful tests that provide a lot of clarity. At the same time, in terms of radiation, we know that some long-term risk may exist. We don't yet know what those risks are in real terms, but there is that potential," he continued.

"So I think physicians really need to question, for every case coming in, whether a CT scan is truly needed," Fahimi stated. "And parents need to be involved in that discussion."

Dr. Marta Hernanz-Schulman, chairwoman of the American College of Radiology Pediatric Imaging Commission and a professor of radiology and pediatrics at Monroe Carell Jr. Children's Hospital at Vanderbilt University in Nashville, Tenn., said that "the best way to look at this paper is as a warning to make sure that we look at our own practice and we do not do CT scans that are not indicated." Hernanz-Schulman was not involved with the study.

"Parents should never be shy, and should always feel comfortable asking questions on behalf of their children in the ER," Hernanz-Schulman said. "And there always needs to be a justification for the procedure. That it's necessary, and that there isn't another procedure that would give you similar information without resorting to a CT scan," she added.

"On the other hand, if you need a CT you really should have it," she said. "Because an alternative can be much worse. For example, let's assume that all the potential risks are real, and you have a one in 'x' chance of developing cancer from a head CT. In that case, if you don't have anything wrong with you having a CT scan is a chance you didn't need to take. On the other hand, if you have a blood clot just outside the brain your chances of dying if you don't know about it are about 100 percent," she explained.

"So if you need a CT scan you should have one," Hernanz-Schulman added. "And people should not be so scared of the potential risks, risks which this study doesn't prove one way or another."