What is the magic sleep number?

Bill Clinton (former president). Tracy Morgan (actor). Cindy Lynn Baldwin (vehicle driver). What do these seemingly unrelated individuals in common? The answer is that everyone is sleep deprivation has suffered or been the victim of someone who has been deprived of sleep.

There is no doubt that we have all become too little sleep at some point in our lives. For some of us it is an isolated incident precipitated by a specific event such as a death in the family or an upcoming stressful meeting. However, there is evidence more that the United States is becoming a country of chronic sleep deficit citizens.

A recent report from the Centers for Disease Control and prevention of diseases, the percentage of adults who sleep less than six hours per night increased by 31% since 1985. It is likely a number of explanations for this. 

They include the growing demands of a 24-hour society, the increasing use of artificial lighting, new lifestyles that promote evening activities, and the widespread use of electronic devices such as laptops and tablets, smartphones devices. The latter are particularly unhealthy sleep because they emit light of blue wavelength, which negatively affects the natural sleep-wake your body and interfere with the cycle of sleep.

Negative health effects of sleep deprivation
There are important consequences of sleep deprivation. At individual level, poor sleep makes you more irritable and depressed, slows reaction time, and negatively affects the physical and mental performance. In fact, 18 hours of continuous wakefulness has the same negative effect on the time legally drunk reaction! (The driver of the truck that hit Tracy Morgan vehicle had been awake for 28 hours straight.)

Also, adequate sleep is necessary for optimal learning and memory. Experiments have shown that staying up all night affects learn new information. Therefore, the proverbial "night" practice, some of us when we were in school, probably exacerbated our test performance and did not help.

Chronic sleep deprivation also charged a toll. Week and a half 6 hours of sleep per night can have the same impact that staying awake for 24 hours straight. And just as important as the behavioral consequences of lack of sleep are the negative effects on health. It is now increasingly clear that sleep deprivation is a risk factor for hypertension, heart disease, diabetes, and - not surprisingly - death before. In addition, lack of sleep alters hormone levels that control appetite, which causes increased hunger and a greater tendency for weight gain. Therefore, the sleep deficiency is a risk factor for obesity!

At least 7 hours of night ZZZS 
For both acute and chronic lack of sleep is bad for your health, the CDC Healthy People 2020 objective includes a sleep deficit reduction. However, the objective does not say exactly how much sleep you need. To remedy that omission, the American Academy of Sleep Medicine and Sleep Research Society, the two leading professional organizations in the fields of sleep medicine and research, issued a joint declaration on consensus.

According to current data, adults should aim for at least seven hours of sleep per night for optimum health, and getting less than 6 hours of sleep is associated with poorer health outcomes. At the same time, there is insufficient evidence to determine whether get between 6 and 7 hours of sleep per night is bad for health. A similar document to the National Sleep Foundation is largely came to similar conclusions.

Therefore, it is 7 hours, the number of sleeping magic? Perhaps. Future research could lead to improvements, but for now, must be the goal.

Can you do to be short of sleep for a few days? The answer is not simple. Many people do not get enough sleep during the week and then try to recover their lost sleep on weekends. In such cases, it is usually an improvement in mood and mental and physical performance after sleep "recovery".   
However, being able to reverse the effects of sleep deprivation on physical health is less certain. Recent observations indicate that lack of sleep can lead to persistent negative effects on heart rate and secretion of various inflammatory molecules. These can be risk factors for heart disease.

The remedy is simple
What can be done about sleep deprivation? The solution is simple: get more sleep. On a personal level, this means making better choices in lifestyle - for example, the choice to go to bed early at night instead of staying to watch TV at night. For institutions and employers, this means creating a work environment that values ​​results beneficial to have employees who are not sleep deprived: namely, fewer sick days employees, improving productivity and reduction in the use of health insurance benefits.

Although the recipe more sleep seems to be low cost, without expensive drugs needed, personal and logistical obstacles can be formidable. However, a target of at least seven hours of sleep a night can achieve. If a sufficient number of people, companies and institutions make sleep a priority with equal status to good nutrition and fitness, then our society will be healthier and more productive - objectives that any value. 
By: Stuart  Quan, MD.

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Get vaccinated against the flu, reducing the risk of death

Last year was a bad year for the vaccine against the flu. Hospitalizations for influenza peaked at nine, and prevent the vaccine against influenza in only 23% of all beneficiaries, against 50% and 60% of recipients of previous years.

Why vaccine against influenza, but in some winters and other works? The vaccine against influenza prepares the immune system to attack two proteins on the surface of the influenza virus, hemagglutinin (H) and neuraminidase (N). 

Different strains of influenza have different combinations of these proteins - for example, specific strains for vaccines against H3N2 and H1N1 recent are.Unfortunately, the flu virus is the response of microbiology Miley Cyrus can change in one year enough to be completely unrecognizable.

H and N proteins are genetic chameleons undergoing constant transformation. This process is called antigenic drift, and baffles regularly vaccine manufacturers, public health experts, and your immune system.

The development of new vaccines against influenza 
Most vaccines against influenza in the United States is made from chicken eggs, using production methods that date back to 1945. This heavy technique requires 6-8 months of waiting time to produce enough vaccine for the next flu season. Each February, the World Health Organization and the Food and Administration (FDA) do their best guess on which flu strains should be covered by the vaccine for next winter, according to a review of the circulating viruses flu more than 100 countries. But a lot can change in eight months, especially with the flu. Last year, the "drift" of the H3N2 flu strain does not match the vaccine strain, which explains the poor performance of the vaccine.

Researchers can build a better vaccine against the flu? You probably already have. The FDA has approved two alternatives to traditional egg-based vaccines. One of them, Flucelvax uses influenza virus grown in kidney cells originally obtained from a single cocker in 1958. The other, FluBlok, it is put by encouraging pumping insect cell large amounts of hemagglutinin, which is then purified and used in the vaccine. These methods may sound crazy, but appear to be safe and effective.

These new vaccines have several advantages:

They are safe for patients allergic to eggs. Like most vaccines against influenza is made from eggs, many people allergic to eggs can not be vaccinated against traditional flu.

They require a massive injection of hen eggs, and still could be made, even if a bird flu epidemic ended chicken farms.

They need less time to make egg-based vaccines, ie, vaccine production could quickly escalated into a pandemic influenza. This can also give the FDA more time to make your decision on which flu strains should go into the vaccine, which reduces the risk of inadequacy with the vaccine against the flu last year.

Scientists are also working on a universal vaccine against influenza, which might not be necessary to change each year. This vaccine exploits the fact that the M protein has two parts: a header area which is the part that is changing rapidly, and a stem region, the latter is more or less retained. Vaccine studies using small stem pieces have shown promising results in animals. Start test these vaccines in humans.

How the vaccine against influenza reduces the risk 
The CDC recommends that all US adults receive a vaccine against the flu every year. Although the current vaccine is not perfect, there are many good reasons for you to get it. The vaccine reduces the risk of contracting influenza, particularly as it coincides well with the dominant strains of flu.

The benefits of vaccination against the flu is particularly impressive in the elderly. If you are 65 or older, the risk of death is reduced by 48%. One reason for this risk is lower than the flu increases your risk of developing bacterial pneumonia, which is responsible for many hospitalizations and deaths. But these are not the only reason.

Inflammation is bad for your body and increases the risk of heart attack or stroke. If you've already had the flu all the way, and you remember how fever, aches, and I felt miserable, you know that the flu is very good for your body fill with inflammation. So, as expected, another benefit of the vaccine against influenza is that it reduces the risk of heart attack and stroke.

Most adults, including myself, receive the vaccine against influenza from chicken eggs. If you have an allergy to eggs, you should get Flucelvak or FluBlok place. If you are between the ages of 2 and 49 years old, you are eligible for the intranasal vaccine, which is inhaled rather than injected.  

Because this vaccine contains a live virus, should be avoided if you are pregnant, have a weakness, or are close to other people whose immune system weak immune systems. The intranasal vaccine can also cause wheezing, so you should avoid if you have asthma.
By: John Ross, MD, FIDSA,

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Why public schools should require the vaccination against HPV

If you live in Rhode Island, and their children go to public school, to be vaccinated against HPV human papilloma virus, or. This is a new requirement and not everyone likes.  

Opponents say the change that can get HPV through sex, contrary to infections such as measles and whooping cough can take if someone in the classroom and coughs on you. Why, they say, they should require the vaccine against HPV for school?

Because it could save lives, that's why.

HPV is the leading cause of cervical cancer. It is also responsible for many other cancers and genital warts. The vaccine, which can be given from the age of 9 years, is highly effective against HPV strains that cause problems, assuming that young people receive three doses.

However, we are not so great when it comes to making young people vaccinated. Some relatives HPV associated with sex and feel that their children are too young, even when they are in high school (despite polls consistently show that half of high school students have had sexual intercourse). Some parents are concerned for the safety of the vaccine; despite years of testing and millions of doses, unfounded abound about it being dangerous rumors. Once the parents are afraid, it is difficult to not fear. Since the vaccine is not usually required for school, they skip altogether.

There is also the simple fact that older children do not go to the doctor as often as young children, which means there is less opportunity to get young immune.

But if they had to do in school, they would have to come get vaccinated. And parents just could not postpone or avoid.

Following the outbreak of measles at Disney World, there has been much discussion as to whether vaccines should be mandatory for school attendance. For most parents, this is a non-issue; Most parents give their children all recommended vaccines at the recommended times. But there is a minority that do not, because they do not trust or do not feel they are necessary.

Vaccination is a medical treatment, and at first glance, it seems strange to force parents to their children undergo medical treatment. But vaccination is different from most medical treatments because it affects the other. If your child is sick with preventable by vaccination, they can infect others.

It's not just about you and your child. Vaccination has never been. It is all around you, not only in school, but everywhere, for the rest of his life. This concerns not only high school students who may be exposed to HPV during sex with their non-vaccinated; This is about the prevention of cancer in the life of every child.

Rhode Island allows some exceptions, and clearly some exemptions are necessary. Some children can not get the vaccine for medical reasons. And we do not want to create a situation where families are really terrified of vaccines feel that they can send their children to public schools; Not only could this be an ordeal for families without the means to pay for private school, but you could end up with complete underimmunized children private schools, creating a perfect breeding ground for diseases and epidemics preventable vaccination that cause. But derogations must be very difficult to achieve. Many states allow objections "philosophical", no questions asked, and must be changed.Because if you put other people at risk, you should have a very good reason.

When vaccines are required for school, we have more children vaccinated. When we get more children vaccinated, we prevent diseases, including cancer. When we have a vaccine that works and is safe, we should ensure that you give as many people as possible, and need a vaccine for the school is there for.

When the necessary vaccines, including HPV at school, not only to our children an education, give them the best chance of a healthy future.
By: Claire McCarthy, MD

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In addition to understanding how exercise keeps the brain young

Most of us have had first-hand experience with blackouts. We try nervous to remember a name during a conversation. We forget where we parked the car. We can not recall the items in the list of short purchases left at home.

Although memory lapses can occur at any age, most often occur as we age. Not that fear are the first signs of Alzheimer's disease or other dementia. But for most, the changes fleeting memory difficulties are normal age-related in the brain. Our recovery is slowing and is a little more difficult to learn new things quickly.

Many studies have shown that physical activity and exercise regularly in middle age and beyond can help slow and perhaps even prevent the deterioration of brain function. Since most of these studies were mostly observational, they can not show the associations and do not prove cause and effect.So there is no scientific evidence that exercise itself is the direct reason to stay mentally strong. At least not yet.

New studies suggest how exercise helps the brain
More recent studies show the positive brain changes associated with an increased amount of daily physical activity and higher levels of fitness.Last month, a small but interesting study examined changes in oxygen and related neural processing in the brain. These characteristics have been shown to correlate with better memory and brain function with age.

The researchers identified 100 men and women in relatively good health aged 60-80 with different levels of physical activity reported. For a week, the study participants wore an accelerometer to measure the amount of physical activity. Each had also measured their oxygen consumption during a maximal exercise test. The oxygen consumption during peak exercise is a standard way to assess cardiorespiratory fitness.

As expected, people with high levels of fitness were the same who were physically more active during the week. They were also the same people who have demonstrated more positive oxygen and related MRI compatible with faster processing in neuronal changes in the brain. The results of the study were published in the journal PLoS

Is it important that long and intensive exercise?
We do not have a prescription of specific exercises to guide the long and difficult that we should exercise. Based on the results of this study and others, including the activity of low intensity for an hour one day seems to be much better for brain health than sitting on the couch.

You should not participate in high-performance athletics to preserve and protect the brain. Just be more active during the day:

     *  Get up and move every hour during the day
     *  Walk more, use less the car
     *  Use the stairs instead of the elevator
     *  Gardening or work

More ways to help your brain stay young
Staying physically active with the intended daily exercise is devoted one-way road to improve brain function. This is the most you can do:

     *  Get enough sleep
     *  Find out if any of your medications cause memory problems
     *  no smoking
     *  Limit alcohol consumption
     *  Reduces stress
     *  Treating high blood pressure
By: Howard LeWine, M.D.

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What use "off-label" of a drug really is, and why you need to know about it

When your doctor prescribes a medication for you, you assume probably - and rightly - which is an FDA approved treatment for your condition.

This may or may not be the case.On average, one in five prescriptions are written for "off-label" use of a drug. This means that your doctor thinks that the drug will help you, even if it has not been specifically approved for illness or symptoms.

Prescription medications off label is legal and common, and can be beneficial for patients. For example, beta blockers (drugs approved for lowering blood pressure and treating heart disease) may also help some people with migraines or anxiety. Tricyclic antidepressants are not FDA approved to treat nerve pain, but many doctors do a good drug of choice for this disease in question.

When the off-label use is supported by strong evidence presented to the FDA, which can lead to FDA approval for that use. Most people know of botulinum toxin type A (Botox or) as a way to remove wrinkles, but originally won approval from the FDA for the treatment of a number of different conditions, sweating Excessive use of muscle spasms.

While some off-label uses for drugs are well studied and have been a part of medical practice routine for years, many off-label uses not. When a drug has not been tested for an individual or a group of people in particular state, it could have unexpected and dangerous effects. For example, doctors prescribe antipsychotic drugs such as haloperidol, off-label to manage behavior problems in people with dementia. Now we have evidence that the administration of these drugs to people with dementia is associated with a higher mortality rate.

Advertising off-label and courtsThe application can not become particularly difficult when it comes to drug advertising. Historically, the FDA has prevented most pharmaceutical companies advertise proactive off-label uses for their products. But that could soon change, thanks to two recent judgments that federal courts have cleared the way for the promotion of unapproved uses for prescription drugs. These decisions and their implications are discussed in New England Journal of Medicine.

The first case occurred in 2012 and involved the drug Xyrem (FDA approved to treat a rare disorder called narcolepsy sleep). In this case, a representative of drug sales, Alfred Caronia, facing a lawsuit after suggesting to physicians who use the drug as a treatment for other conditions such as insomnia, fibromyalgia and Parkinson's disease, despite lack of evidence that the drug worked with these health problems.

As Dr. Ameet Sarpatwari, a lawyer and an epidemiologist at Brigham and Women's Hospital and Harvard Medical School, explains that "the government has not indicated that the off-label promotion of Caronia was false or misleading. Rather He argued that the restriction on off-label promotional moved directly its real interest in protecting patients from unsafe and ineffective drugs, and therefore the constitutional requirement to intervene in the protected commercial speech met. "A federal court It divided appeals disagreed, however, noting that the Government has failed to demonstrate that less restrictive measures of speech, that the exemptions would not have achieved the same goal.

A more recent case is that of a fish oil pill called Vascepa ordinance approved by the FDA to reduce high triglyceride levels. The manufacturer, Amarin, sought approval from the FDA to promote its use in patients with moderately elevated triglyceride levels - use of the indications that the FDA considered, but not adopted.  

When the FDA said no, Amarin sued, alleging that - as in the case Caronia - off-label promotion Vascepa was protected by the First Amendment. The court ruled in his favor. Dr. Aaron Kesselheim, director of the Division of Law Programme and the therapeutic Pharmacoepidemiology and Pharmacoeconomics settlement at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School professor, said the impact of the case could Amarin be substantial: "The decision on the case Amarin is a new setback for the FDA to try to maintain their level of off-label marketing If these cases become the law of the land, there would be no motivation for companies submit. its evidence to the FDA for approval of additional indications. "

The courts have decided that pharmaceutical companies have the right to provide, and consumers have the right to receive accurate and not misleading drugs about which can help them to information. However, Dr. Sarpatwari advises that patients should also be aware that the quality and objectivity of the information is at risk. "Off-label claims do not have full and impartial review of the promoted FDA has determined safe and effective use," he said. "However, companies that make these claims have financial incentives to encourage more prescription drugs."

What this means for you
You will need to work ever more closely with your doctor to assess the risks and benefits of any medication recommended for you to off-label use. When your doctor prescribes a new medication, ask if it is approved by the FDA for your condition. If not, ask what is already known (and unknown) to use for your health, and if there are drugs that are just as good for what approved. 
By: Gregory Curfman, MD,

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"Stress" cardiomyopathy: Another type of heart attack

Most heart attacks are caused by the coronary arteries are blocked by blood clots that form when the cholesterol plaque rupture. The lack of blood flow through blocked arteries cause death of heart muscle - hence the name "heart attack".

But in recent years, doctors have come to recognize and understand other form of heart attack. This rare type of heart attack has no plaques or rupture of blood vessels clogged. He called Takotsubo cardiomyopathy or stress cardiomyopathy. 

Japanese doctors, who were the first to describe this condition, she was named "Takotsubo" because during this disorder, the heart takes on a distinctive shape that resembles a Japanese pot used to trap octopus. The disorder is generally believed to be caused by the sudden emotional stress, such as the death of a child, and be much less harmful than the typical heart attack. For this reason, some have also marked this condition "broken heart syndrome."

A study in the September issue of 3 New England Journal of Medicine reports on the work of an international collaboration of US and European doctors who studied 1,750 patients with Takotsubo cardiomyopathy. Interestingly, 90% of these cases were women, and women in this study were on average 67 years. The most common triggers of stress cardiomyopathy were physical (such as lung problems, infections), and the next most common cause was a "shock" emotional. But a substantial proportion of patients, no trigger which could be identified.

Compared to people who had suffered a "typical" of heart attack, patients with Takotsubo cardiomyopathy were almost twice as likely to have a neurological or psychiatric disorder. And contrary to common belief among doctors that Takotsubo cardiomyopathy is less severe than other forms of heart attack, death rates in hospital again Takotsubo attacks 'traditional' cardiomyopathy were similar.

As awareness of this disease increases between doctors and patients, I think we will be even more cases of Takotsubo cardiomyopathy grateful to the future. The condition certainly does not seem as rare as suspected, not as harmless as previously believed. Further research is needed to determine the best care for patients with Takotsubo cardiomyopathy and reduce your risk of future problems.  

At this time, we often use the same drugs to treat heart muscle weakened Takotsubo cardiomyopathy as we do with other forms of heart attack, but really are not many good studies yet on optimal treatment options for people who they have experienced Takotsubo cardiomyopathy.  

The link with neurological or psychiatric disorders is intriguing and suggests that an important mind-heart connection is relevant to certain manifestations of Takotsubo cardiomyopathy, and perhaps also other heart conditions. This article in the New England Journal of Medicine sure to generate more interest in the study of this fascinating disease.
By: Deepak Bhatt, MD, MPH

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