Experts say that no amount of alcohol is safe during pregnancy

Let's face it: pregnancy is difficult. Yes, it is ultimately a wonderful thing to bring a baby into the world. But the process does not always feel so wonderful; accompanied by nausea, fatigue, stomach fat and uncomfortable varicose veins are not the things that are asked pregnant women to stop smoking. As the sushi; Swordfish; eggnog; Some soft cheeses; this extra cup of coffee; for smokers, cigarettes; and alcohol.

For some women, it is difficult to stop drinking completely. It can be tempting, especially on special occasions or in restaurants where everyone is drinking, to have a teensy-tiny glass of wine. After all, how much damage can a glass of wine?

But here's the problem: we do not know the answer to that. This means that to be safe, pregnant women should not drink alcohol at all. This is the conclusion of a clinical report just published by the American Academy of Pediatrics.

This is what we know: the alcohol is dangerous to the developing fetus. It can cause problems with the baby's growth. It can affect the kidneys, heart, muscles, eyes and ears. But what is more worrying is that it can affect the brain in a variety of ways - causing smaller and actually physically different, for a learning pattern and behavior.

The most serious form of damage is called fetal alcohol syndrome, or FAS. Babies born with this condition are smaller than other babies have distinctive facial features (small eyes, a thin upper lip, flat to the skin between the nose and the mouth instead of the usual chants), and effects on the brain. Occasional consumption at a party is unlikely to cause FAS; often occur when mothers drink at least a moderate amount of alcohol during pregnancy.

But what researchers have been finding is that there may be softer, more subtle effects of small amounts of alcohol. A study of 31,000 pregnancies found a risk for developmental problems when women had one alcoholic drink per day. And because some of the learning and behavior problems will not become clear until years after his birth, it is likely that even small amounts of alcohol have an effect. In fact, some experts believe the Disorder Fetal Alcohol Spectrum (a broad term that encompasses all the possible negative effects of fetal alcohol syndrome) affects up to 5% of all children.

About half of all women of childbearing age drink alcohol drink from sporadic to heavy drinking. Some of the damage caused by alcohol passes before women realize they are pregnant. Although most women cut or stop once they know they expect, over 7.6% of alcohol consumption continued - and 1.4% report binge drinking.

There is no time during pregnancy when it is "safe" to drink either. Yes, most organs are formed in the first quarter. But the baby grows and changes, and the brain develops during pregnancy. Alcohol can still hurt.

So do not risk it. Give your baby the best chance for the best life possible. If you are pregnant or could become pregnant, choose sparkling water instead. Nine months can seem like an eternity, but it is not.

If you do not think you can stop drinking for nine months, talk to your doctor. We can help you.
By: Claire McCarthy, MD
 

Read More

Stress busting medicine mind body reduces the need for health care

This week, Harvard researchers reported a powerful way to keep the doctor away. And it is not an apple a day or a new drug - is a life skill called resilience. It is the adult equivalent of hitting a hedge on his first bike trip without training wheels, shaking the leaves and dirt from your hair, and think, "Well, it was not too bad I will try again. ".

People tend to think that resilience is something the lucky and unlucky people are missing, but it's not true. It is a skill that can be learned. Anyone can build resilience to practice the relaxation response - a deep relaxation physiological state induced by practices such as rhythmic breathing, mindfulness meditation, yoga, tai chi, qi gong, or prayer. The relaxation response was described over 40 years ago by Dr. Herbert Benson, founder and director emeritus of the Benson-Henry Institute for Mind Body Medicine at Harvard-affiliated Massachusetts General Hospital (MGH).

The power of resilience is central to a study published this week in PLoS One by Benson and his colleagues at MGH. Those who graduated from a resistance program increase developed by the Benson-Henry Institute use health services significantly less in the year after the course compared to the previous year.

The resilience of the impact of training 
Benson-Henry has developed an eight-week course, called resilience Intervention Program (3RP) Relaxation for Endurance. To measure the effect of this program on the use of health services, the PLoS One study mined a rich database of information compiled by Partners HealthCare patient, a system that includes MGH Hospital Brigham and women and other health centers in the Boston area. The study compared the use of health care for more than 4,400 graduates 3RP Partners 13,150 patients who were not taking the 3RP courses. Within one year of training, the use of health services by 3RP graduates fell by 43%.

"We have shown in the past that worked in the laboratory and at the individual physiology, and now we can see that when you do good to people, they do not want to use both health care," says study leader Dr. James E. Stahl, formerly affiliated with the Benson-Henry Institute but now based at Dartmouth-Hitchcock Medical Center in New Hampshire.

The 3RP training was ultimately responsible for the decline in demand for medical care? This study can not prove beyond doubt, as only found statistical links. The researchers were careful to consider factors other than 3RP training that could affect the amount of health care people seek - including age, sex, race, education and income level. "Can you ever really delete it? I do not think anyone can be sure," says Dr. Stahl.

For policymakers, the study offers the possibility of safe and inexpensive way to help control the costs of health care are rising. But in fact, this study does not provide evidence to prove otherwise. For example, if a group 3RP failed tests and other services that otherwise would have improved your health? more research is needed before anyone can drop resilience training as a way to reduce costs. "As for the use is the first step towards measuring the costs," says Dr. Stahl.

You can strengthen the resilience without formal training 
For those of us who do not live in Boston and can not be part of the 3RP training, it is still possible to increase our resilience in a variety of ways. Resilience is partly to make meaningful connections with others, such as through volunteering, caring for aging parents and other service jobs.

In addition, the positive psychology research shows that having an optimistic outlook and a sense of connection, meaning and purpose in life contributes to resilience. This includes learning to identify and combat negative attitudes of daily life that can harm health.

"As fluoridation of its water or vaccinate yourself, they are ways to keep it healthy with, from a public health perspective, the minimum investment," says Dr. Stahl. "My opinion is that we should probably teach these skills in elementary school."
By: Daniel Pendick
 

Read More

Heads Up Parents: A new study important information about life in adolescents Online

Let's face it: most parents do not know what their teenagers are doing online. According to a new study, even parents who think they know what is going missing more.

For the study, in partnership with CNN two researchers - Marion Underwood, University of Texas and Robert Faris, University of California, Davis - to study the life of social media 216 eighth graders in eight secondary schools of Georgia, Indiana, New Jersey, New York, Texas and Virginia.  

The researchers installed software that monitored what teens have been queuing for six months (with their permission) and had completed questionnaires adolescents and their parents at the beginning and end. Some highlights of the large study that all parents of teenagers should know:

13 are "intensely engaged with social media." It is not a surprise to anyone who has hung a 13 year old recently. About 63% of young people in the study were in Instagram, 34% were on Twitter, and 20% were on Facebook. On average, they publish four times a week. They also spend more time online than in the media; most of the time spent watching and reading what others do online.

FOMO (afraid to lose) is a great reason to get online. Teenagers see social networks as a way to connect with their peers and see what they do, and frequently check social media. One in five teens if anyone said anything to each other, which is sad - and one in three checks to see if your friends do not do anything without them. Although the most common reason for social media monitoring is boredom (80%), many adolescents see social media as the main way to know what your friends are doing.

There is a dark side to form: the study found that teens who spend a lot of "lurking" time online were more likely to experience anxiety - feel excluded, feel enough is not popular, upset by things that read or online dispute. Because ...

Online conflict is common. In the study, 42% of students reported a conflict - usually with a friend - at least once a month. There are also conflicts that arise when young people feel they have been excluded from society, and conflict often develops with friends online.

Adolescents view social networks as a barometer of popularity. For teenagers, especially teenagers, popularity is very important - and the supporters, "love", "tags", and comments may seem a quantifiable way to measure popularity.

Interestingly, two groups of teenagers were more likely to experience distress were those using social media to try and increase its popularity and adolescents who feel attractive they do not get enough recognition through the media.

Parents do not really know what their children are doing. The document was signed a few examples of the disconnect between what parents have said and thought about the online behavior of their children and what is actually happening. The authors wrote: "Parents systematically underestimate the amount of emotion and their children experiencing negative behavior problems, and overestimated the amount of happiness and fun in their teens were in the process".

This does not mean that the online experience is mostly negative for youth. However, most young people said made them feel good, and that allowed them to connect and make new friends and find support.

In reality, teen life online is simply an extension of their offline life. The subjects are all the same. They simply are played in a different space, which can be both good - and dangerous. That is why it is so important that parents are involved. In fact, the study found that when parents were aware of what their children were doing online, their children were less likely to experience distress. 

The authors said that they agreed with the researcher Danah Boyd, who wrote in his 2014 book is not so easy: the social life of teenagers in the network:

    "What makes the secure digital street is when adolescents and adults collectively agree to open their eyes and listen, communicate and collaborate negotiate difficult situations. Adolescents need the freedom to move in the digital street, but also to know that caring adults are behind them and support them wherever they go The first step is to disable the tracking software then ask your children that they are doing when they are online - ... And why it is so important to them " That is very good advice.
By: Claire McCarthy,MD,

Read More

The harmful effects of supplements that can be sent to the emergency room

For many people, a healthy lifestyle means more than eating a good diet and exercise - vitamins, nutritional supplements and complementary products are also part of the plan. But although there is much publicity about its potential benefits, there is less awareness of their potential adverse effects.

In fact, the use of these products can land in the emergency department.

A study published today in the New England Journal of Medicine found that the adverse effects of the supplements were responsible for an average of about 23,000 emergency department (ED) visits per year. That's a lot of something that is supposed to be good for you.

In this 10-year study, researchers analyzed data from 63 monitoring of hospital emergency departments to estimate the annual number of visits to emergency rooms related to the adverse effects of dietary supplements. The authors define 'food supplements' as herbal products or amino acids and micronutrients complementary or vitamin.  

Patients who visit the ED for symptoms related to supplement use were on average 32 years, and women account for over half of all visits. Just over 10% of these visits resulted in hospital admission, especially in adults over 65 years.

Weight loss products accounted for one quarter of all visits for a single product and women disproportionately affected, while men were more likely to suffer the adverse effects of products advertised for sexual enhancement and bodybuilding. Energy products increased up to another 10% of these visits.

Young adults are not the only ones affected. Many children under 4 years old have suffered allergic reactions or digestive symptoms (nausea, vomiting, abdominal pain) of unsupervised ingestion, accidental vitamins. Patients over 65 were more likely to have difficulty swallowing after taking vitamins or trace large pill.

Although study results are based on visits to emergency rooms annually estimated at a relatively small number of hospitals, reflecting the increased use of food supplements and micronutrients. These products are widely available without a prescription and are advertised as alternatives or supplements to pharmaceutical drugs prescribed in therapeutics. Consequently, dietary supplements or herbal are widely perceived as natural and safe. The latest figures indicate that more than 55,000 of these products available in the United States.

What you need to know before taking a supplement 
Although the Food and Drug Administration (FDA) is responsible for the supervision of food supplements, no safety testing or FDA approval required before a new supplement hits the market. In addition, it is not only the potential effects of the requirements of the list of undesirable packing dietary supplements nor are there rules for the maximum size of the pill (a clear risk to the elderly). 

Health care providers may also neglect to ask patients about using over-the-counter or herbal dietary supplements. Without this information, they can not recognize all the signs and symptoms of their patients may experience may be related to these products.

No doubt some dietary supplements can be beneficial. This is because these products contain active ingredients - interacting molecules on receptors in the body and cause physiological changes. However, because they contain active ingredients, they can also cause side effects such as high blood pressure, racing or irregular heartbeat, headache, dizziness, or gastrointestinal symptoms.

What is the safest approach to the use of these supplements? Staying healthy requires a multidimensional approach to self-care. You become aware and informed all supplements, if they are advertised as natural, herbal or no drugs - is part of that care.

If you take vitamins, supplements or herbal products, always read the safety labels included with the package. Ask a pharmacist, your doctor or nurse to check everything you need to make sure that the supplements will not cause damage, either alone or in combination with regularly prescribed or over-the-counter medicines. If you develop symptoms after taking a food supplement, stop and call your doctor.

By: Susan Farrell, MD.

Read More

Depression can worsen the symptoms of rheumatoid arthritis or have a less effective treatment?

About one in six suffering from rheumatoid arthritis (RA) suffer from depression. Common symptoms of depression, such as fatigue, muscle pain and difficulty to complete activities of daily living (eg, dressing, cooking, cleaning), can mimic the symptoms of an epidemic of arthritis. It is also possible that depression can contribute to a relapse.

So unravel the relationship between depression and RA flare is a challenge.

Recently, a team of researchers set out to do just that. They studied 379 people with RA who are already enrolled in a trial comparing different drugs for the treatment of arthritis. Participants were asked to describe their feelings using one of the following sentences: "I am not anxious or depressed", "I am moderately anxious or depressed" or "I am very anxious or depressed" This evaluation was administered using standard scales used. to measure whether RA symptoms are getting better or worse or remaining stable (doctors call the disease activity).

The researchers found that participants who reported more anxiety and depression scores had higher disease activity. They also reported more tender joints and, when asked about your symptoms, they rated their disease as superior activity. At the same time, depression and anxiety seem to have no effect on the number of swollen joints found during physical examinations or the level of inflammation in the body, as measured by a blood test called ESR (also known as the speed sedimentation).

This is not to the first study to observe an association between depression and anxiety and activity of RA. In another recent study of 275 people with RA, the researchers measured the activity of disease and the symptoms of depression in the same visit. Here, as in the previous study, depression was associated with increased disease activity and the inability to achieve clinical remission, even with treatment. In another study involving 31 RA patients, depression and mood, they were assessed several times a day for a period of one week. Patients who reported more depressive symptoms also reported more pain and articulate during the sensitivity of the study period.

These studies suggest that depression may aggravate RA disease activity and even reduce drug benefits with rheumatoid arthritis. But the results are not conclusive and more studies need to understand the complex relationship between RA and depression. For example, another explanation for these results is that patients with RA more tender joints and less able to carry out regular activities are more depressed because your illness is worse.  

Another problem is that we normally use scales to measure disease activity in RA may not be as accurate when used with depressed patients. Despite the uncertainties, these studies make the important point that people with RA need to be educated about and planned for signs of depression and the appropriate resources data and processing needed. In addition, physicians should consider the depressive symptoms in the assessment of disease activity.

More importantly, if you have rheumatoid arthritis and begins to experience symptoms of depression - fatigue, feeling blue, loss of interest in usual activities, tasks difficult to perform, sleep disorders - or you feel that RA drugs do not work as well as general, be sure to tell your doctor.
By: Bonnie Bermas,MD.

Read More

First, do no harm

As an important step to becoming a doctor, medical students must take the oath of Hippocrates. And one of the promises in this oath is "first, do no harm" (or "First do no harm", the Latin translation of the original Greek).

Right?

Wrong.

While some medical schools require their graduates to meet the Hippocratic Oath, others use a different garment - or not at all. And in fact, although "First, do no harm" is attributed to the ancient Greek physician Hippocrates is not part of the Hippocratic oath at all. In reality, it is another of his works called epidemics.

So why the confusion? 
It is true that there are similar language found in two places. For example, here is a line of a translation of the Hippocratic Oath:

"I will follow this treatment system, according to my ability and my judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."

Yes, the applicant must be avoided damage, but nothing that is a top priority. Meanwhile, epidemics says

"The doctor should be able to tell the story, meet present and predict the future - must reconcile these things, and they have two special view of illness, that is, to do good or evil purposes".

Again, there is no clear priority to the prevention of damage to the objective of providing assistance.

It is "First, do no harm" possible? 
The idea that doctors should, as a starting point, will not harm his patients is an attraction. But that does not mean that since the bar low? Of course, any doctor should be set to do something that comes only predictable and preventable damage. We do not need an old ancestor, so respected, or an oath to convince us that!

But if doctors took "First, do no harm" literally nobody would have the surgery, even if it was rescue. We could stop ordering mammograms because they could lead to a biopsy of a non-cancerous tumor. In fact, we could not even require blood tests - pain, bruising or bleeding required to draw blood are clearly avoidable damage.

But doctors do not recommend these things within ethical practice, as the modern interpretation of the "first, do no harm 'is closer to this: physicians should help patients as much as possible by recommending tests or treatments that the potential benefits outweigh the risks of damage yet, in reality, the principle of "first, do no harm" may be less useful -. and less convenient - than you think. 

How convenient is "First, do no harm"? 
Imagine the following situations:

   * Their diagnosis is clear - for example, strep throat - and there is no effective treatment available that carries less risk. Here, "First, do no harm" is not particularly relevant or useful.

   * Its diagnosis is difficult and the optimal conduct of the test or treatment is uncertain - for example, you have back pain or suffer from headaches. It may be impossible to accurately compare risks and benefits concessions from a particular course of action against another. So you can not know in advance whether a test or treatment is "do no harm".

   * His diagnosis is severe - for example, an inoperable cancer - and treatment can cause damage. In this case, the term "First, do no harm" is relevant again. The only reasonable solution is to provide comfort care, support and relief from suffering. This is already a guiding principle of palliative care and is widely accepted.

The bottom line 
The fact is that when you have to make tough decisions in real time, is difficult to apply the "first, do no harm" dictum because estimates of risks and benefits are so uncertain and subject to errors.

But it is a reminder that we need high quality research to help better understand the balance of risks and benefits for tests and treatments we recommend. Ultimately, it is also a reminder that doctors should not overestimate their ability to heal, or underestimate their capacity to cause damage.
By: Robert Shmerling, MD,

Read More