The lesser number of PSA tests for prostate cancer means less?

The lesser number of PSA tests for prostate cancer means less? - It used to be that the prostate was cancer detection routine for men over 50.

The positive results to the test antigen (PSA) prostate specific trigger a biopsy and the results would almost inevitably lead to treatment cancer. 

But recently, the detection rate of the APS in the United States has declined - and the number of new cases of prostate cancer has decreased, too. That's according to a pair of studies published together last November in the Journal of the American Medical Association.

The studies could not prove these two trends are causally related; However, the authors think they are. In other words, the decline in the number of new cases likely reflects the decreased detection, instead of a decrease in the number of men who have prostate cancer. 

Like other cancer screenings, such as mammography for breast cancer, the PSA test has been the subject of increasing attention. Experts say too many low-risk tumors flags that can only become harmful to the life of a man. Cancer treatment can expose people to unnecessary risk of impotence, incontinence and other side effects.

Why the numbers are declining 

In 2008, the Working Group Preventive Services Task Force of the United States (USPSTF), an influential group of volunteer medical experts, it ruled against PSA screening in men over 75 Then, in 2012, a recommendation was issued against updating exam for all men, regardless of age, race or family history.

These recommendations are controversial. Although many experts acknowledge the PSA test boundaries, who fear that the abandonment of the total PSA test drive tumor diagnosis at an advanced stage may not be curable. 

One of the recently published revised national PSA detection data collected between 2000 and 2013. The results showed that the detection rate began falling in the 2010 study, but only in men under 75 years and above in the 50-54 and 60-64 age groups. The overall detection rate (for all men alike) fell from 36% to 31%.

The second study found a similar decline in PSA screening rates - 37.8% to 30.8% - as well as a decrease of 22% of new prostate cancer diagnoses. The authors of this study examined data maintained by the National Cancer Institute and found the number of diagnoses per 100,000 men aged 50 and older cases fell from 540.8 in 2008 to 416.2 cases in 2012. largest declines came after the USPSTF recommendations published a screening project updates in October 2011.

"These data are the first national, showing what appears to be an effect on prostate screening and diagnosis of the Working Group recommendations based on the population," said Ahmedin Jemal, DVM, Ph.D., Vice president of research services and health surveillance at the American Cancer Society, and a key author of the first study.

Do not scratch the PSA test for now 

In an accompanying editorial, Dr. David F. Penson, President of urologic surgery at Vanderbilt University Medical Center, warned that the "pendulum" of popular opinion could turn too far from screening. But instead of stopping the complete projection, Penson asked the most intelligent, the most specific detection approaches aimed primarily at women considered at high risk of developing prostate cancer. 

"These new results are an expected consequence of the conclusion of the Working Group that the PSA test is probably more harm than good," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and of Beth Israel Deaconess Medical Center and editor of the Harvard Knowledge.org prostate.

However, Dr. Garnick also called for better screening, recognizing that the number of men with more advanced prostate cancer now likely to increase. "We also need studies focused on those that offer potentially high risk of more aggressive forms of detection of prostate cancer," he said. "The investigation must determine whether early treatment saves lives or lowers death rates from prostate cancer. Until we have this data, the true effect of lower detection rate remain unknown, and discussions about the PSA test will, without clear answers in sight ". 
By: Charlie Schmidt  

Read More

Only overwork dying young

Only overwork dying young - Billy Joel was on to something. As the singer suggested in "Movin 'Out" working too hard can really give you a "heart-DCA crisis ..." And, as a recent study has also shown, stroke can be an even bigger problem than to a heart attack in people who are overworked. 

For the study, researchers at University College London compile data on the relationship between working hours and the risk of heart attack by more than 600,000 workers, and similar data on the risk of stroke more than 500,000 workers.

They adjusted their data to compensate for differences due to health behaviors of individual workers, such as smoking, alcohol consumption and physical activity, and also adjusted for the presence of other cardiac risk factors, such as high blood pressure, diabetes and high cholesterol.

They found that those who worked more than 55 hours per week had an increased risk of suffering a heart attack by 13% and were 33% more likely to suffer a stroke compared to those who have worked 35-40 hours a week.

The high risk of heart attack with more hours of work was only seen among workers with low socio-economic status. The risk of heart attack in high-wage workers who worked long hours was similar to that of high-wage workers who had normal working hours. The risk of stroke was higher among those who worked long hours, regardless of their socioeconomic status.

Why overwork and cardiovascular risk are related is not entirely clear. Hormonal factors, such as high levels of hormones "stress" such as cortisol and adrenaline, may be involved. Overwork and stress at work are also associated with many cardiac risk factors.

Those who work long hours tend to have unhealthy lifestyles, with less exercise, the worst regimes, and increased consumption of alcohol and snuff. Type 2 diabetes is more common among workers with low socioeconomic status who work long hours, but not workers with a high socioeconomic level working similar hours.

Metabolic syndrome, a set of cardiovascular risk factors, including high blood pressure, high triglycerides, low levels of good cholesterol, high blood sugar and abdominal obesity "apple shape", is associated with a stressful job.

Death from overwork in Asia

In more developed countries, overdrive is not considered a public health problem. However, death from overwork is quite common in Japan there is a word for it: karoshi. Japanese, or employee, company workers have a tradition of job security for life. 

Unfortunately for them, the decline is expected to enter additional long hours without pay. The work addiction is so bad that the Japanese government has considered imposing a mandatory annual leave of five days. 

In China, death from overwork, known as guolaosi name, is also said to be widespread. A tobacco epidemic is probably a major contributing factor; 63% of middle-aged men in East Asia are regular smokers.

Staying healthy at work 

A number of strategies can help you avoid work habits that are bad for your health:

     *  Eat well and avoid "tension".
     *  Avoid sugary drinks and salty snacks in vending machines; bring a lot of nuts, fruits and vegetables of the house instead.

     *  Integrating physical activity into your workflow: hurry up the stairs instead of taking the elevator, or walking in an office colleagues for a while face rather than an email exchange.

     *  Prolonged sitting is associated with increased mortality from any cause; try to work whenever possible.

     * Joke; the mood is associated with better cardiovascular health and increased labor productivity.
     *  Make sure your major cardiac risk factors such as pressure and sugar levels in the blood and blood cholesterol are under good control. 

And if you're the boss, remember that a low stress, positive work environment is not only good for the health of employees, it is also good for business.
By: John Ross, MD,FIDSA

 

Read More

Awake, alert and alive: Is two hours enough sleep?

Awake, alert and alive: Is two hours enough sleep? - The sun's rays had not yet illuminating the sky at dawn on 10 August 2008, when two lives changed forever.

Lynn Baldwin new candy on the way home after being awake for much of the day and night. Bridge over the Chesapeake Bay, she fell asleep.

Here the car swerved over the median and hit a truck. He collapsed in the bay, killing its driver.Ms. Baldwin suffered non-fatal injuries, but will live with his guilt for the rest of his life. The pilot, John Short, became one of more than 6,000 people die each year due to drowsy driving.

He joins an unfortunate list that includes limousine driver comedian Tracy Morgan (hit by a truck whose driver had been without sleep for 24 hours) and Maggie McDonnell (killed in a head on collision with a truck driver who had been awake for 30 hours in a row).

The death of Ms. McDonnell has inspired as "Maggie's Law," which makes it illegal in New Jersey to drive knowing with problems of lack of sleep.

How can you (technically) go? 

Chances are that everyone drove a car drowsy at least once. But how much sleep do you really need before it is definitely dangerous to drive? Recently, the National Sleep Foundation, in consultation with experts in the field of sleep medicine and the transportation industry, to convene a panel to answer this question.

It is complex because there are several other factors that sleep duration to determine the level of sleepiness. For example, a large amount of "sleep debt" preexisting magnify the impact of acute sleep deprivation. In addition, the time of the day makes a difference.

At night, the natural body clock (circadian rhythm) is set to "sleep," and thus reduce the vigilance of acute sleep loss will be worse than during the day. This is why accidents occur drowsy driving especially at night. And, of course, the quality of your sleep is essential - which is why, for example, is not advisable to try to repay your sleep debt with a motel room beside the tracks!

After considering all these issues and available evidence, the Committee concluded that the driver is definitely compromised if he or she has had less than two hours of sleep in the previous 24 hours.

Put in perspective drowsy driving 

Does this mean that it is safe to drive if you sleep for only two hours mean? The answer to this question is a resounding no. Most people still affected by a lack of sleep even if they sleep for more than twice that amount.

As chairman of the committee, Dr. Charles Czeisler, chief of the division of sleep and circadian disorders Harvard-affiliated Brigham and Women's Hospital and professor Baldino of Sleep Medicine, Harvard Medical School, "the two-hour limit should be a warning red flag for individuals as a guide to those responsible for public policy. 

" In other words, in the development of future legal status as "Maggie's Law," should be the absolute lower limit used to define drowsy driving, similar to the way of driving under the influence is defined as a content alcohol blood of 0.08%.

Are there ways to reduce the impact of sleep deprivation on driving performance? Stimulants like caffeine can certainly reduce sleepiness during a short period of time, but not indefinitely. 

Other commonly used methods have been ineffective. For example, increasing the volume of the radio and opening the car window are both useless. 

Moreover, even if you do not feel sleep, it can still be affected because there is a weak correlation between sleepiness and performance. Only sleep can reverse the impact of sleep deprivation! 

Drowsy driving is a danger to public health in the United States. According to an estimate from the Institute of Medicine, up to 20% of all car accidents, they are related to drowsy driving. This means that drowsy driving causes more than 1 million accidents per year. And the actual number could be much higher due to drowsy driving is often under-reported.

The only remedy is for people who do not drive without enough sleep. Two hours can be the lower limit, but should not be fooled into thinking that it is safe, even if you have slept longer. The end result: "Private-Sleep not drive." 
By: Stuart Quan, MD.  

 

Read More

Gout: Sleep apnea can increase the risk

Gout: Sleep apnea can increase the risk - Gout is the most common type of inflammatory arthritis and affects more than 8 million adults. Men have a higher risk than women.  

And according to a new study, the risk of gout also increases if you suffer from sleep apnea, a condition in which breathing stops the repeatedly during sleep.

What exactly is gout?

The reduction was triggered by the crystallization of uric acid in the joints. It goes like this: Your body produces uric acid breaks down purines, natural waste product of living cells. Normally, uric acid dissolves in blood and passes through the kidneys into the urine.

However, sometimes the body produces too much uric acid or secreted very little. This causes uric acid to accumulate and form urate crystals in the needle form a joint or surrounding tissue. The result flare-ups that cause severe pain, inflammation, swelling and redness.

While the large joint of the big toe is the most affected area, gout can occur in any joint, including their ankles, knees, hands and wrists. The episodes can last from days to weeks.

The relationship between sleep apnea and gout 

For the study, published in Arthritis & Rheumatology, the researchers spent combing through the records in a health database of British comparing people with and without sleep apnea. A total of 9.865 persons were screened with sleep apnea (average 54 years) and are entitled to a "control" group of 43.958 persons without trouble. After one year, people with sleep apnea were 50% more likely to have had an attack of gout compared with the control group.

The exact nature of the relationship between gout and sleep apnea is unknown, but there are two possible explanations, the researchers said. First, the two conditions share common risk factor: overweight. "Although it is not clear how being overweight is associated with gout, many people who suffer from the condition tend to be overweight," says Dr. Robert Shmerling clinical chief of rheumatology at Harvard University affiliate Beth Israel Deaconess Medical Center.

The other theory may be related to hypoxia, a sleep apnea causes complication levels of a person of oxygen to fall during sleep. "This can cause tissue damage and decomposition of the cell, which can cause uric acid levels increase," says Dr. Shmerling.

Even if you have sleep apnea, the risk of a gout attack gets up at night - gout attacks are twice as likely to strike during the night or early morning. It is believed that the main reasons for this drop in body temperature and dehydration that occur during sleep. "The crystals are more likely to crystallize at lower temperatures, and dehydration can prevent excess uric acid is flushed from the body," explains Dr. Shmerling.

The treatment of gout

Gout can be confirmed by analysis of the liquid in a joint by their level of urate crystals. Their level of uric acid in the blood may also be useful for the diagnosis of gout - the higher the level, the greater your risk.

In sudden acute crises, the first line of treatment is a drug, says Dr. Shmerling. These include anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) and prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex). Colchicine and corticosteroids can also help relieve pain and reduce inflammation. 

Changes in diet and lifestyle can reduce the risk of another attack. Avoid eating seafood and red meat (which can increase levels of uric acid) and limit alcohol and drinks with high fructose corn syrup. Stay well hydrated and adopt an exercise program to help lose excess weight. 

Try to include foods rich in lowering uric acid in your diet, including coffee (caffeinated or decaffeinated) and cherry juice. It also helps to increase your intake of vitamin C through supplements or foods such as peppers, broccoli, strawberries and oranges.

What to do

The investigation has not yet been confirmed whether treating sleep apnea will reduce the risk of gout, but worth discussing with your doctor that sleep apnea is associated with other serious problems health, such as heart disease, hypertension and stroke. There are several ways to treat sleep apnea - and many health benefits to be gained by doing so. 

By: Matthew Solan 
 

Read More

Active surveillance is safe for prostate cancer at low risk

Active surveillance is safe for prostate cancer at low risk - Active surveillance is becoming a widely adopted alternative for some men with prostate cancer.  

Instead of immediate treatment, men on active surveillance are monitored with periodic biopsies, physical examination and specific tests for prostate antigen (PSA) prostate. Treatment begins only when the cancer shows signs of progression.

But it is safe to wait until then? A new study adds to the growing evidence that the answer is yes, but only for men whose cancers are divided into favorable risk categories.

The study is based on data collected at Johns Hopkins Hospital in Baltimore, Maryland, the site of an active long-term monitoring program. The authors studied nearly 1,300 men who were enrolled in active surveillance between 1995 and 2014.  

Most of the men had "very low-risk cancer," which means their PSA levels were too high at diagnosis and only small amounts of low-grade cancer was found in a maximum of 2 nuclei in a standard 12-core biopsy. The rest was a category of "low risk", which means that the low-grade cancer was detected in no more than 5 cores.

The men averaged 66 years old at diagnosis. At the time of analysis, 49 men were dead was complete, but only two of them for prostate cancer. The rates of specific cancers in the categories of both low-risk and low-risk combined survival exceeded 99% in both 10 and 15 years of follow up, and the predominant cause of death was by far heart disease.

"These results confirm that men with a favorable risk of cancer should be encouraged to consider active surveillance instead of treatment given the low probability of damage diagnosis," said Dr. Jonathan I. Epstein, professor of pathology, Urology and Oncology, Johns Hopkins Hospital, who led the study.

It is important to note that prostate cancer may worsen active surveillance. During this study, 22% of very low risk men and 31% of low-risk people may need treatment within 15 years. But the processing time began, men were under active surveillance for an average of 8.5 years.

"The very low risk men clearly are the best candidates for active surveillance," said Epstein. "But in the case of cancer, and even low-intermediate risk, health problems and other seniors can increase eligibility."

Epstein added that some men may feel strongly that they do not want to live with cancer, which can lead to opt for active surveillance in favor of treatment. "We try to think of strategies to help these men stay on track," he said.

"The study adds important information about the growing practice of active monitoring of certain populations of men," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center and Editor Chief of the Harvard Knowledge.org prostate. "

But we must also keep in mind that we have no evidence of survival benefit with treatment pro men at risk, or when they are diagnosed or when cancers progress through active surveillance. The benefits of treatment are difficult to not prove the risk of prostate cancer is generally favorable life threatening over the expected life of a man. "
By: Charlie Schmidt 

Read More

Complementary therapies for neck pain

Complementary therapies for neck pain - May have escaped, but the neck is an amazing thing. At the top, which has a cage-hard rock - the cervical vertebrae, which contains and protects the top of the spinal cord, which connects the brain to the rest of your body.  

Nevertheless, the neck is completely mobile, allowing you to turn the corner and nods. Then there are the blood vessels, the esophagus, trachea, thyroid, and (among other structures). And, of course, day after day, neck worn around the equivalent of a bowling ball - 11 pounds skull and its contents. It is no wonder, then, that sometimes the neck becomes painful.

Business Neck Pain  

For many people with neck pain, it is much more than a "pain in the neck." It is the leading cause of doctor visits and disability. The improvement may be slow. In many cases, there is no single treatment uniformly successful. (Long term) Chronic neck pain is a painful condition for millions of people worldwide.

Many causes pain

Neck pain is not a disease. It is a symptom, and a number of conditions that can cause. Some of the most common causes are:

       *  muscle strain or spasms
       *  discopatía
       *  arthritis
       *  a wound

In many cases, however, the precise reason for neck pain can not be identified. Add to this the fact that the treatments do not always work well, and work fast, and can be a very frustrating problem.

That is why the results of a new study are so encouraging - and potentially important.

Complementary therapies for neck pain 
Research published in the latest issue of the Annals of Internal Medicine compared two alternative approaches to the treatment of chronic neck pain with the results of standard care. The researchers randomly divided the patients with neck pain into three treatment groups:

    *  "The usual treatment." This includes treatments commonly recommended by doctors in primary care, such as medication and referral to a physiotherapist.

    *  Acupuncture. These patients received usual care, more than 12 acupuncture sessions over five months.

    *  Alexander Technique. The usual care group received 20 training sessions over one by one toward the Alexander technique, a self-care approach that emphasizes "self-observation and subtle behavior change" of to monitor response to pain and improve how daily activities are performed life.

Of course, there are warnings 
Before declaring victory over neck pain, it is worth mentioning some important limitations of this research. They understand:

     *  More than half of patients with neck pain originally considered for the study were excluded. The most common reasons for exclusion were the presence of only a slight pain, neck pain causes "serious" (such as rheumatoid arthritis), or previous surgery

     *  Differences in the degree of improvement between the three groups was rather modest. For example, with respect to symptoms initially, there was a 32% improvement in pain score with acupuncture, 31% with the Alexander technique, and 23% for usual care.

     *  These study subjects were highly motivated to enroll in a clinical trial that requires a good amount of time and commitment.

     *  These treatments require not only a large time commitment, but outside of clinical trials can be expensive.

     *  We do not know whether the benefits go beyond a year.

What the results for people suffering from neck pain mean? 
Even with the encouraging results of this study, we need better treatments for neck pain and why they work. For example, observed improvements in acupuncture and Alexander Technique groups could be due to the placebo effect. Many chronic pain significantly improve with lots of personal contact between patients and professionals and an expectation of improvement, which are both key acupuncture and Alexander technique throughout. 

If only these two features - unlike the actual interventions - could explain the findings of this study, which means that we must find ways to exploit this effect so that more people can benefit. Finally, future research may yet prove better results with a combination of acupuncture, Alexander Technique lessons, and other non-pharmacological approaches.

Given the amount of stress we put on our necks is neck pain may never be completely eliminated. Therefore, we must be open to any new approach is safer and better than what we already have.
By: Robert Shmerling, M.D. 
 

Read More