Dr. Lawrence Cohen, M.D., F.A.C.P., Gastrenterology, in his office at 311 East 79th Street.

An associate clinical professor of medicine at Mount Sinai School of Medicine, Lawrence Cohen is a gastroenterologist who specializes in endoscopy and cancer screening.

Who’s at risk

Gastrointestinal endoscopies are some of the most frequently performed medical procedures done today, with over 10 million colonoscopies performed every year in the U.S.

"Endoscopy is a general term for any examination performed using a tube that has a light on the end of it," says Cohen. "Gastrointestinal endoscopies examine the gastrointestinal, or GI tract, a long conduit that carries food from the mouth to the anus."

The most common GI endoscopy is a colonoscopy, which is often used to screen for colon cancer. GI endoscopies are divided into two major categories: upper and lower.

"The upper endoscopy examines three organs: the esophagus, the stomach and the first portion of the small bowel, called the duodenum," says Cohen. "The lower endoscopy, or colonoscopy, is an exam of the colon, also known as the large bowel."

Upper endoscopies are most often done for patients suffering from chronic acid reflux, unexplained abdominal pain or a swallowing disorder. Lower endoscopies are sometimes done for patients who have symptoms of colon cancer, but are most often done as part of a routine screening for all Americans over the age of 50.

Doctors have set guidelines calling for universal colon cancer screening, because 1 in 18 Americans will have the disease during their life. “We use colonoscopies for cancer prevention, because everyone is at risk of colon cancer,” says Cohen. "It’s a disease that affects men and women, regardless of family history, and it can be deadly."

In many cases, colon cancer can be prevented entirely if caught while still in a precancerous state.

Signs and symptoms

Although the goal of a colonoscopy is to catch polyps before they can develop into full-blown cancer, it’s a good idea to keep an eye out for the symptoms colon cancer can cause once it progresses.

"The warning signs most likely to trigger a doctor to call for a GI endoscopy are painless rectal bleeding, a persistent change in bowel pattern [persistence of symptoms is important] and unexplained abdominal pain or swelling," says Cohen.

Traditional treatment

It’s important for patients to know what to expect from gastrointestinal endoscopy. "First of all, the patient will be asked to come in fasting to prevent stomach contents from fluxing upward, and possibly getting into the lungs," says Cohen. "The bare minimum is ­nothing by mouth for two hours beforehand," he says.

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Dr. Lisa Satlin, Chair of the Department of Pediatrics at Mt. Sinai Hospital, in her office.

As the chair of pediatrics at the Mount Sinai School of Medicine, Dr. Lisa Satlin is a kidney specialist who sees patients from birth to age 21. Since starting her career as a pediatric nephrologist in 1982, she has treated children and their families for problems like hypertension.

Who’s at risk

Hypertension, or high blood pressure, is an extremely common health risk familiar to any American over the age of 50. But it can be present in childhood and adolescence as well.

Blood pressure measurements are reported as two numbers: systolic blood pressure (blood pressure when the heart contracts) over diastolic blood pressure (blood pressure when the heart is relaxed). "In a pediatric patient, hypertension is defined as at least three readings showing a blood pressure level above the 95% percentile" higher than 95 out of 100 children of the same age, gender, and height, says Satlin.

"Having a blood pressure below 90% is normal, and between 90% and 95% is considered prehypertension." According to national guidelines, blood pressure measurements should be a routine in office visits for children over age 3.

"For children, we almost never make a diagnosis of hypertension based on a single casual blood pressure measurement, unless it is extremely high. Instead, this diagnosis usually is made only if the blood pressure is above 95% on three separate occasions, because many situations can lead to a single or temporary elevated blood pressure," says Satlin.

"Children may be in pain from an illness or get anxious or frightened going into the doctor’s office, and the blood pressure might be normal at other times."

Checking the blood pressure at home when the child is more relaxed can help determine whether a child has true hypertension or whether it is only high when seeing a doctor — "White Coat Hypertension." Satlin’s team often has a child use a take-home, wearable, "mini"- blood pressure machine to check the pressure during an entire day.

There are two main types of hypertension. "Primary, or essential, hypertension has no identifiable cause and is most common in children beyond puberty," says Satlin. "Often these children have a family history of high blood pressure and are overweight or obese."

"Secondary hypertension is due to an underlying cause like kidney, hormonal or heart disease, or medication," says Satlin. "This is more common in younger children, under the age of 5-10 years."

Elevated blood pressure in secondary hypertension cases tends to be more severe and consistent than in primary hypertension and may require a variety of special diagnostic tests for identification.

Risk factors for pediatric hypertension include obesity and family history. Up to 80% of children with primary hypertension have a family history of the disease.

Gender and ethnicity also can be risk factors. "We have learned from studies of children in their second decade of life that boys are twice as likely to have prehypertension as girls," says Satlin. "Blood pressures tend to be higher in Hispanic and African-American children, compared to Caucasian children."

Signs and symptoms

One of the difficulties of treating childhood hypertension is that it is frequently a silent disease. "Hypertension typically does not present with any major symptoms in children, except perhaps headache," says Satlin. "This is a big problem, because hypertension that begins in childhood and goes untreated can persist into adulthood, increasing the risk of heart disease, stroke and kidney disease." Because pediatric hypertension is often asymptomatic, it’s usually diagnosed through routine screening.

If pediatric hypertension is severe, it can lead to a variety of symptoms and in rare cases cause seizures, kidney disease, eye disease or heart failure.

Traditional treatment

When a child is diagnosed with hypertension, it is important to determine if there is an underlying cause. "The evaluation usually includes a full history and physical exam, blood pressure measurements in both arms and legs, blood and urine tests, and frequently ultrasounds of the heart and kidneys," says Satlin.

In children, secondary hypertension is often the result of kidney, heart or
hormonal conditions. "Depending on what is found, besides a nephrologist, a child might see a pediatric cardiologist or endocrinologist," says Satlin.

For children with primary prehypertension or hypertension, lifestyle modification can be enough to reduce blood pressure. "The key steps are a healthy diet with low salt intake and more fruits and vegetables, avoiding obesity and getting regular exercise," says Satlin. "Children with more severe hypertension also need to do these things, but their doctor might also need to treat the blood pressure with medications until the blood pressure improves or if it does not improve enough."

Children with an identifiable cause may need a specific treatment. For instance, children with the kidney disease called nephrotic syndrome, which can cause hypertension, often respond well to temporary use of diuretics or oral corticosteroids. "If we can treat the underlying disease, the blood pressure will usually return to normal" says Satlin, "and since the long-term consequences of hypertension can be very significant, it’s important to identify and treat this early in life."

Research breakthroughs

Scientists have vastly enhanced our understanding of the causes of hypertension in children as well as adults by studying patients with extreme elevations of blood pressure or a family history.

"It has become clear that high blood pressure is the end product of an interaction of genes and environment," says Satlin. "Thanks to major research breakthroughs, we’ve finally uncovered the genetic basis for a number of causes of hypertension."

Questions for your doctor

A good way for some parents to start a conversation with their child’s pediatrician is, "I have high blood pressure. Is my child at risk?"

Parents also may want to ask specifically about their child’s blood pressure percentile. If your child is at risk or already has higher-than-normal blood pressure, ask, "What can I do to lower my child’s blood pressure?" There is a lot that doctors and parents can do to prevent or treat childhood hypertension, so get prepared to ask the right questions.

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Pamela Anderson hot photos

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Ella, an emergency contraceptive that can be taken up to 5 days after unprotected sex, has been approved by the FDA. Plan B, above, can only be taken within 72 hours of unprotected sex.

A controversial emergency contraceptive that women could take up to five days after they had unprotected sex has won federal approval, the drug's manufacturer said.

The medication provides two more days than Plan B, the "morning-after" pill that's already available to women.

Known as "ella," the new drug will hit the markets later this year, according to its makers, Watson Pharmaceuticals.

Women will need a prescription from their doctor to obtain ella. Plan B is available over the counter.

The new drug blocks the female hormone progesterone, stopping ovaries from producing eggs.

The Food and Drug Administration gave the OK to ella two months ago. The manufacturer's announcement on Friday drew praise and criticism along the political spectrum.

Kirsten Moore, president of Reproductive Health Technologies Project, said ella gives "couples another safe and effective option for preventing unintended pregnancy after unprotected sex or contraceptive failure."

Critics said the new drug should not have been classified as emergency contraception because it can induce an abortion. Emergency contraceptives are eligible for federal funding.

"This decision flies in the face of the Obama administration's promise to transparency and a commitment to science," said Jeanne Monahan, a director at the Family Research Council. "The difference between preventing and destroying life is enormous, and women have the right to know how this drug will act on their bodies and on their babies."

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Oil floats in the Gulf of Mexico near Orange Beach, Alabama, U.S., on Friday, June 18, 2010.

Mental health claims should be paid out just as all other health claims related to the Gulf of Mexico oil spill, says the American Psychiatric Association.

And the group hopes Kenneth Feinberg, BP claims administrator, will make sure claimants get reimbursement for mental health visits, according to Medical News Today.

"Mental illnesses brought on by difficult situations surrounding the BP oil spill may be less visible than other injuries, but they are real," APA president Dr. Carol A. Bernstein said in a news release from the APA.

"An entire way of life has been destroyed and this is causing anxiety, depression, post-traumatic stress disorder, substance use disorders, thoughts of suicide and other problems."

The APA was one of the mental health organizations that objected to recent testimony from Feinberg before the House Judiciary Committee.

In his testimony, Feinberg said it was unlikely that money from the $20 billion relief fund would be used for claims in which the main complaint involved mental health issues.

The National Alliance on Mental Illness and Mental Health America also objected to Feinberg’s testimony.

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As sexual beings, it's important to remind ourselves that sexual abuse is never a normal, healthy part of human sexuality or expression. When it happens, there is always an offender, always a victim. Healthy sexuality does not create victims.

Sexual abuse involves power, control, rage and other intense, unresolved issues which are acted out in a sexual way. In any form, it entails an imbalance of personal power and disrespect for the boundaries of others--whether it's hands-off offending, like obscene phone calls and letters, or hands-on offending, like inappropriate touching, rape and other intense forms of sexual assault.

Disabilities create major changes in people's lives, and survivors often find they have less control--in an abundance of ways--than they once had. This can make them more vulnerable to those who might exploit their disability, sexual abusers included.

Sex offenders seek out the most vulnerable prospects as victims, and people with limited mobility are easy targets. Crucial to not becoming a victim is looking ahead and having a safety plan--how to feel, act and be as safe and strong as possible.

Don't Be a Victim

Attitude is paramount--if you feel confident, it shows. If you don't, that shows, too. Knowledge is equally important--where to get help if you need it, how to use self-defense tactics within your physical limitations, what your neighborhood and neighbors are like, where it's safe and where it's not. And you need to know these things both at home and away from home.

Some abusers are less obvious and more insidious than the chance attacker. They exploit vulnerability and create victims in more private ways. Some are personal health care providers, for example. By the nature of their work, they are in a position of providing--or withholding--your personal care needs. They have access to your most intimate spaces, psychological and physical, and may have the ability to set you up for abuse. This abuse, regrettably, is seldom reported to police.

If you depend on others for care, you need assertively protect yourself from abuse. Screen anyone who works for you. Unless you know them personally, always check references with diligence. If you can do so legally, run a criminal history check. And trust your hunches--if for some reason someone doesn't feel "right" to you, listen to that little voice and hire someone else. Or if that someone is already working for you, let him or her go.

Another form of subtle abuse is sexual exploitation in a relationship. The thing to watch out for here is skewed personal power. If both partners aren't on even ground with mutual respect and caring, equal control of the relationship and individual value--abuse can follow.

Do what you can to avoid becoming a victim. But if you or someone you know is abused, report it to the police and take steps to get counseling and emotional support.

Victims are never to blame for what has happened. Time and support can help them to be strong survivors. And it's never too late to spill the beans; a lady in her 80s once told me about being abused as a teen. I was the only person she'd ever mentioned it to, and being able to talk about it meant a lot to her.

The Bottom Line

You might be asking yourself, "Can people with disabilities be offenders as well as victims?" Of course, though they are a small minority. I do know of a paraplegic woman who sexually abused a boy for over a year, but he kept it to himself until he was an adult. Clearly she had her own unresolved problems and, in this case, acted them out through child sexual abuse.

The bottom line is this--respect and value yourself, and work through your personal issues (we all have them). Acknowledge and face the limitations imposed by your disability, and be assertive in relating to the world and the people in it. Be proactive about personal safety, and if you are ever sexually abused, despite your precautions, talk with someone you can trust who can give you caring support.

While sexuality is a wonderful part of being human, sexual abuse is a hurtful and quite different aspect of our human experience.

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Q: What’s the germiest at the gym or spa: the sauna, steam room, or whirlpool?

A: Picture that scene in old horror movies where a mad scientist holds up a bubbling beaker full of some strange toxic brew. Blow up the size of that beaker, and you have a whirlpool—a warm, bubbling cauldron of germs. It’s the worst of the three, by far.

Interestingly, most of the bacteria hang out in the pipes, not the water. But when we turn on the jets, the germs are sprayed into the water. (If you own a hot tub, get the pipes professionally cleaned, and use a bleach disinfectant once a week for the tub. Remember: The hotter the water, the less effective chlorine is at keeping it germ-free.)

Number two on the ick list: steam rooms. Warmth and extreme moisture are ideal for breeding germs. And a sauna is number three on the list because the heat is dry, but any lingering sweat in the room is a moist habitat for germs.

To be safe, don’t park your bare butt on the bench in a steam room or sauna; sit on a towel that’s folded enough times to keep your skin away from the moisture. (Wooden benches are worse than tile ones, by the way, because the cracks in the wood provide a place for germs to settle in and set up shop.) Always wear underwear or a bathing suit, too. And if you have any cuts or open sores, avoid these spa amenities until you’ve healed.

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The Pill works as well for full-figured women as it does for waifs - if taken consistently.

That's the findings of a study by New York-Presbyterian Hospital/Columbia University Medical Center researchers that appears to refute a long-held belief by many doctors that birth control pills aren't as reliable for overweight women.

"Weight does not seem to have an impact on suppression of ovulation, but consistency of pill-taking does," chief investigator Dr. Carolyn Westhoff said. Nearly 65% of U.S. women are overweight or obese, according to U.S. government.

And for those women, pregnancy poses extra risks. Previous studies on the pills' effectiveness relied on womens' recollections of how much they weighed when the pill failed. This time, groups of normal and overweight women were randomly assigned to take either a lower- or higher-dose version of the pill.

Then after three or four months, the women were given multiple ultrasounds and blood tests to determine if ovulation was being suppressed.

Of the 150 women who used the pill consistently, just three of the 96 women with normal weight ovulated. Of the 54 obese women, just one did.

Researchers also reported that when women failed to take the pill regularly, they ovulated with greater frequency.

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Aarthi Chabriya Hot Photos

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The myth that humans are the only tool-wielding animals was laid to rest long ago: chimps, otters and even birds use sticks and stones to leverage their innate abilities. But like so many other attributes we share with other creatures — including communication, thought, emotion and social behavior — we take tool use to an entirely different level.

Starting millions of years ago, the evolutionary ancestors of humans figured out how to use primitive stone tools in a systematic way. For example, they learned how to butcher large animals, which gave them access to a source of food their primate cousins couldn't touch. That's what may have fueled the growth in their brain size, which eventually led to modern humans. (See TIME's video "Animal Intelligence: Birds That Use Tools.")

Exactly when that leap took place has never been pinpointed, but the oldest evidence of stone tools has dated back to about 2.5 million years ago — at least until now. In a new paper, released on Wednesday by the journal Nature, Zeresenay Alemseged, an anthropologist at the California Academy of Sciences, and several colleagues say they have pushed that milestone back 800,000 years. Two animal bones, excavated in Dikika, Ethiopia, bear what the authors call "unambiguous stone-tool cut marks for flesh removal and percussion [i.e., smashing] for marrow access."

In other words, some species of human ancestor — likely Australopithecus afarensis, whose best known representative is 3.2 million-year-old Lucy, the authors say — not only had a hankering for meat, which scientists had not expected, but used tools to get it. That demonstrates cleverness, says Alemseged. It also shows that the butchers were capable of complex social behavior. "They're sharing the landscape with dangerous scavengers such as hyenas," he says, "and so some would have had to serve as lookouts." And because that landscape bore only pebbles, not rocks, they would have had to carry the stone tools several miles before using them. (See pictures of smart animals.)

The marks were evident as soon as the bones came out of the ground — one from a large, hoofed mammal about the size of a cow, the other from a goat-size antelope. "The [marks] were clearly V-shaped, which potentially indicated that they were made by tools," says Alemseged. (Comment on this story.)

He and his fellow excavators used a scanning electron microscope to take a closer look. Sure enough, the grooves in the fossilized bones bore fine striations running in the same direction as the cuts themselves — the hallmark of deliberate cutting. The scientists even found a tiny fragment of the tool itself embedded in one of the cuts. Chemical analysis shows that "it was clearly embedded before deposition," says Alemseged, which rules out a random piece of grit having worked its way into the groove later on. (See TIME's video "How Animals Learn Language.")

Fortunately for the researchers, the bones were buried in sediments whose age was easily determined; based on a relatively straightforward analysis, the fossils can be dated to between 3.24 and 3.42 million years old, and probably closer to the latter. Because the only hominin known to have lived in that area back then was A. afarensis, the anthropologists believe that's the species that used the tools.

Whether A. afarensis actually fabricated their scrapers or simply used sharp rocks they found lying around is much less clear, since the tools themselves haven't been found. That's not surprising, Alemseged says. "The earliest stages of tool use will probably be less widespread, more erratic," he says.

Alemseged argues that anthropologists should be doing more systematic surveys for animal fossils of this vintage, to uncover further evidence of butchery. Typically, anthropologists look for animal bones only to determine what species of creatures co-existed with human ancestors. But since the two bones Alemseged's team found would not have been useful for that purpose, "you probably wouldn't collect them," he says. "But we made an effort to collect all the bones we found. We need to replicate that strategy, and urge others to do the same."

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You may assume that if your weight is in the healthy range, you have a low risk of heart disease, diabetes, and other conditions linked to obesity. But new research suggests that waist size could play as important a role as body weight in determining how long you live. After examining a database of more than 100,000 men and women ages 50 and older participating in a cancer prevention study, researchers found that those with the largest waistlines had about twice the risk of dying over a nine-year period as those with the smallest waistlines. (Nearly 20 percent of the men and 10 percent of the women died over the duration of the study, mainly from heart disease, cancer, and respiratory conditions.)
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What's especially troubling, though, is that even big-waisted folks who had a healthy body mass index—a measurement of weight to height—had a higher risk of dying. Every 4-inch increase in waist size was associated with a 25 percent greater risk of death, says Eric Jacobs, an epidemiologist at the American Cancer Society who led the study, published in the Archives of Internal Medicine . What is an ideal waist size? Less than 35 inches for men and 30 inches for women, according to the study. These measurements are considerably smaller than what the American Heart Association defines as optimal: below 35 inches for women and 40 inches for men.

[Here's how to measure your waist size.]

Why is a big waist so dangerous? Previous research indicates that those who carry more fat around their abdomen also have higher amounts of fat around vital organs like the kidneys, liver, and pancreas; this so-called visceral fat is more "metabolically active" than fat that lies just below the skin and is thought to promote chronic inflammation, which has been linked to heart disease, diabetes, and certain cancers. Jacobs believes that action should be taken the moment you notice your pants getting too tight. "The take-home message is that it's important to watch your waist, not just your weight," he says, "and to start eating better and exercising more if you see your waist size starting to increase."

While eating fewer calories or burning off more through exercise can help reduce abdominal fat, a spate of recent studies also suggest that reducing stress and getting enough sleep—seven to eight hours a night for most people—can lower levels of stress hormones; that's a good thing since some of these hormones trigger the body to produce visceral fat. Researchers are also studying mindful eating, where you eat slowly and pay attention to the taste, smell, and texture of your food, to see whether the practice helps redistribute body fat from the waist to the hips.

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Is food really akin to a deity? Actually, it may be our replacement for one says Geneen Roth, author of the best-selling book, Women, Food and God. She says many of us use food to avoid the emptiness that comes from feeling a lack of love, comfort, or passion for life. It's only when we acknowledge and examine our emotional hardships, she says, that we can truly develop a healthful relationship with food. She recommends trying these five things to overcome emotional eating:
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1. Pay attention to when you eat. Yes, you should tune in to those occasions when you eat but aren't really hungry. Are you stressed, bored, or sad? But also pay attention to how you spend your time and your money—and what you value most in the world. Often, Roth explains, people turn to food to express core beliefs. Those who feel the need to be in control in order for things to go smoothly often go on extreme diets only to find themselves bingeing uncontrollably after a period of deprivation. Those who can't sit quietly with their loneliness or solitude may seek out pleasure from a bowl of ice cream or a bag of chips. "Ask yourself what's going on in those moments when you turn to food," Roth advises.

2. Take action to avoid eating when you're not hungry. Consider what would happen if you didn't eat when you're, say, feeling sad. You may, even on a subconscious level, believe that you'd fall apart if you let the sadness in or never stop crying, says Roth. Or you may think you just can't deal with your boredom. But give it a try once and see. "Allow yourself to feel the boredom, sadness, or anxiety," she says, "without using food to change the channel on what's happening in your life."

3. When you are hungry, stick to the following rules. Eat sitting down in a calm environment—not in your car. Avoid any distractions, like TV, newspapers, books, or anxiety-producing conversations. Eat what your body wants and just enough to feel satisfied but not stuffed. Have your meals with the intention of being in full view of others and do so with enjoyment, gusto, and pleasure.

4. End dieting once and for all. "Until I was 30, I was convinced that if only I could become thin, I'd be happy—that all my suffering would be gone," says Roth, who gained and lost more than 1,000 pounds before dealing with her own emotional eating issues. She spent two years as an anorexic weighing 80 pounds before she finally realized that she was just as miserable thin as fat. It was only after she stopped dieting that she reached a healthy weight, which has remained stable for 30 years. "I've never met a diet that didn't have a binge attached to it," Roth adds.

5. Embrace curiosity. "Most of us aren't curious about why we do what we do," says Roth. That may be because we don't want to be our own worst critics. Roth recommends a Buddhist practice called inquiry where you examine your thoughts and actions with kindness and curiosity. Sit quietly for 20 minutes and feel the sensations around you: the smell of the air, the feel of your clothes, the sounds your body is making and then begin associating those sensations with a memory or a particular feeling, like tension or loneliness. Sit with those sensations, those thoughts, and be curious about them without trying to direct the inquiry or distract yourself. In fact, allow yourself to be astonished by what you're discovering. This sense of being astonished will help you also pay attention to the goodness in your life, she explains. "I think it's important for us to see how much we already have, to feel gratitude instead of using food to make us feel good."

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Doctors and parents were stunned when research published more than a decade ago found American girls were beginning puberty at much younger ages, some as early as 7. A new study released Sunday suggests the average age at which puberty begins may still be falling for white and Latina girls.

According to the paper, which appears in the journal Pediatrics, almost 25% of African American girls have reached a stage of breast development marking the onset of puberty by age 7, as had almost 15% of Latina girls and more than 10% of white girls.

Those percentages are significantly higher than in 1997, when a landmark study first reported that girls were beginning puberty much younger than they had in the mid-20th century. In that study, the rate of girls who had begun puberty at age 7 was, on average, 5% for whites, compared with 10.4% in the new study.

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In other words, the average age of puberty onset still appears to be in flux.

"In 1997, people said, 'That can't be right; there must be something wrong with the study,' " said Dr. Frank M. Biro, director of adolescent medicine at Cincinnati Children's Hospital Medical Center and the lead author of the new study. "But the average age is going down even further."

Biro's study included 1,238 girls ages 6 to 8 who lived in one of three regions: Cincinnati, East Harlem, N.Y., or San Francisco. Puberty was determined by two examiners who worked independently to assess the girls' breast development. By age 8, 27% of the girls had begun puberty: 18.3% of whites, 42.9% of blacks and 30.9% of Latinas.

Compared with data from the 1997 study, the age at which puberty begins did not fall for African American girls, although they still mature at younger ages than white or Latina girls. It's not clear why there was no change for black girls. "Perhaps black girls have approached a biologic minimum," Biro said.

Even for white and Latina girls, it is too early to declare that puberty age is still falling, said Dr. Joyce Lee, assistant professor of pediatric endocrinology at C.S. Mott Children's Hospital at the University of Michigan, who was not involved in the study. The methodology used in the new study differs somewhat from the one in 1997, making direct comparisons difficult, she said.

But, she added, "it's incredible the difference you see between the two studies."

There are numerous potential explanations for why puberty is starting earlier. Chief among them is the increase in average body weight among children over the last three decades, Lee said. Excess body weight, especially body fat, is thought to increase the blood levels of estrogens that promote breast development. Earlier studies, including one by Lee, have linked early puberty to higher body mass index as far back as the toddler years.

But other studies suggest that body fat may not be the only cause. A Danish study released last year in the journal Pediatrics found puberty occurring earlier in children regardless of body mass index at age 7. Factors may include a diet that is increasingly high in sugar and fat, declining physical activity and exposure to endocrine disrupters, chemicals in the environment that act on hormones.

"Kids today are exposed to plastic much more than they were 10 or 20 years ago," Lee said.

Biro said that his study would continue to follow the girls' development, and that blood and urine samples were being collected to look at biomarkers that reflect potential environmental exposures.

Early development in girls is not inconsequential. Studies have linked it to various health risks including a poor body image, reduced self-esteem, higher rates of eating problems, depression and earlier onset of sexual activity. Early maturation in a large population of girls may also affect future breast cancer rates. Studies have linked a younger age at the first menstrual period to a higher risk of breast cancer after menopause.

Parents may be able to influence the timing of puberty, Biro said, through such lifestyle decisions as encouraging a healthful diet and physical activity, and avoiding lotions, shampoos and other products for children and babies that contain phthalates, which are known endocrine disrupters.

"For younger children and the tweens, they should probably live a little bit greener," Biro said. "People could eat together as families — not avoiding fast food, but minimizing it to once a week — and families could engage in regular physical activity."

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Fewer young New Yorkers are drinking sugary beverages each day, according to a new Health Department survey.

Young New Yorkers are going on a diet.

Fewer than half of city residents between 18 and 24 drink a soda, sweet tea or other sugar-filled beverage each day - down 10 points in two years, to 48%.

That's part of a broad decline in the number of people who told a city Health Department survey they have a nondiet drink every day.

"Soda has fueled the obesity epidemic," said Health Commissioner Thomas Farley. "We still have a long way to go to reduce the consumption of sugar-sweetened drinks, but it's encouraging to see that New Yorkers are starting to move away from these products."

In all age groups, men are more likely than women to drink a nondiet beverage every day, the survey shows, and people who live in poor neighborhoods do it more than in wealthier ones.

The survey shows differences among the boroughs and races. While 40% of all Bronx residents have a sugary drink each day, only 24% of Manhattan residents do, and 45% of blacks do compared with 22% for whites.

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Fibromyalgia patients have more “connectivity” between brain networks and regions of the brain involved in pain processing, which may help explain why sufferers feel pain even when there is no obvious cause, a new study suggests.

Researchers had 18 women with fibromyalgia undergo six-minute fMRI brain scans, and compared their results to women without the condition.

Participants were asked to rate the intensity of the pain they were feeling at the time of the test. Some people reported feeling little pain, while others reported feeling more intense pain.

Brain scans showed the connectivity, or neural activity, between certain brain networks and the insular cortex, a region of the brain involved in pain processing, was heightened in women with fibromyalgia compared to those without the condition.

The connectivity to the insular cortex was even stronger in participants who reported feeling more intense pain compared to milder pain, said study author Vitaly Napadow, a neuroscientist at Massachusetts General Hospital.

“We took advantage of the fact that there is a large discrepancy in the amount of pain patients happen to be in at the time they come in. Unfortunately some patients come in, and they are in a lot of pain. Other patients come in and they are not in pain,” Napadow said.

The study, by researchers from Massachusetts General Hospital and the University of Michigan, is published in the August issue of Arthritis & Rheumatism.

Fibromyalgia is a chronic pain syndrome that’s characterized by widespread pain, fatigue, insomnia, and the presence of multiple tender points. The syndrome can also cause psychological issues, including anxiety, depression and memory and concentration problems, sometimes called the “fibromyalgia fog.”

Prior research has shown that people with fibromyalgia feel a given amount of pain more intensely than others, Napadow explained. In other words, studies have shown a typical person might rate a painful stimuli a “one” on a scale or one to 10, while a person with fibromyalgia might rate the pain a 5 or higher.

The new study is different in that fibromyalgia patients’ pain responses were measured while they were at rest and not being exposed to anything painful, Napadow said.

The brain networks involved were the default mode network (DMN) and the right executive attention network (EAN). The DMN is involved in “self-referential thinking,” when you think about yourself or what’s happening to you, Napadow explained.

The EAN is involved in working memory and attention. When that brain network is occupied, or distracted, by pain, it may explain some of the cognitive issues that fibromyalgia patients experience, Napadow said.

Dr. Philip Mease, director of rheumatology research at Swedish Medical Center in Seattle and a member of the National Fibromyalgia Association medical advisory board, said the study provides insight into what may be going on in the brains of people with fibromyalgia.

“This work shows there is increased connectivity between different brain centers that connect the purely sensory pain processing centers of the brain with some of the emotional and evaluative parts of the brain, or areas of the brain that take a sensory stimulus and say, “How do I interpret this? How do I feel about this’?” Mease said.

For years, fibromyalgia has been a highly misunderstood syndrome, with some doctors doubting it even existed, and others attributing the pain to depression or other psychological issues.

That began to change early this decade, when brain scans showed pain-processing abnormalities in fibromyalgia patients, Mease said.

“That first neuroimaging study really demonstrated fibromyalgia patients were different than normal individuals, and at a neurobiological level, were truly experiencing more pain at lower intensities,” Mease said.

The new research moves understanding of the condition a step further, by exploring what’s happening in the brain during a resting state.

“Regardless of poking or prodding them, this study is trying to get at an understanding of what is crackling in the brain, intrinsically, such that they have this higher sensitivity,” Mease said.

About 10 million Americans are believed to have fibromyalgia, almost 90 percent of whom are women, according to the National Fibromyalgia Association. Sufferers report a history of widespread pain in all four quadrants of the body for at least three months, and pain in at least 11 of 18 “tender points.”

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My husband sustained a spinal cord injury just a year after we married. He said that he pretty much is not interested in sex anymore. I try to be understanding and assure him that to be even cuddled or for him to hold my hand and talk a bit would be wonderful...but he refuses to even do that. He does not touch me at all. When I go up to even hug him goodbye he pushes me away as soon as he can. I have begged him to go to marriage counseling with me to get help but he refuses. This has gone on for years and to be honest I feel like I am going to go insane. His refusal to even try to work on our problems has made me resentful and I have stopped even trying. I live in one part of the house and he lives in the other and we don't spend time together at all without fighting. Part of me thinks, "Leave and get a life" and part of me still loves him, feels sorry for him, and feels that marriage is a sacred thing and when I said for better or worse it was a vow that I should live with. I just don't know what to do anymore. All I know is that I am miserable.


It sounds like you are both miserable! Obviously that's not a great way to live your life together. Unfortunately it often gets to this point before one partner gets fed-up or worn-out and, through desperation, reaches out for help. Since you’re the one reaching out, I'll direct my comments to you. While the cuddling, holding hands, and talking combo is a great prescription, one that I would definitely include somewhere down the line if I were a therapist, it is a prescription based on understanding from your point of view as a woman. I'll give you some over generalized insights about men that may help you to have a better understanding from your husband's perspective. I'll also offer a few general words of advice.

Avoidance seems to be a common reaction for men when faced with inability to live up to an expected role. We are trained to be goal oriented and to finish what we start. We are also trained not to show our fears and not to reveal our weaknesses. Cuddling and holding hands translates into an initiation of intimacy, which for many men means the start of sex. Talking means sharing our feelings. Your husband is likely feeling incapable of being the husband he imagined when he said I do, and incapable of being the lover he was before his injury. He probably also senses that you feel sorry for him which is likely to compound his feelings of being a burden instead of a provider. Cuddling, holding hands, and talking may all be painful reminders of his inability to fulfill his role as husband and hence may be interpreted as direct threats to his manhood. Sometimes fighting and displaying anger are the only other actions that we are well versed in when the first line of defense, avoidance, isn't working.

What does this mean for you and your relationship? Begging, pleading, and trying to get your husband to change have not been successful. The other option is changing you. If he will not go with you to counseling, go on your own. Work through your conflicted feelings then make a plan for how you will relate to your husband with the support of a therapist. You can let your husband know that you still love him and are committed to the ideal of marriage, but from now on you will not be trying to change him as his lack of willingness only feeds your resentment. You will be doing whatever you need to do to gain a sense of sanity for yourself. Then he will have to choose to make his own changes in order to maintain and improve the relationship or to continue on in misery on his own. Choice can be empowering and give us a sense of control we need to act in ways that we know are good for the heart.

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The camper only wanted to use the bathroom in the middle of the night. But it was dark at Olympic National Park in Washington and the man did not realize he was near a cliff."He fell off a cliff over 60 feet into a pile of rocks," said ranger Dan Pontbriand, now the chief ranger at Isle Royale National Park in Michigan.The camper screamed for his wife to help. She climbed to the bottom of the pit and found he had two broken legs, ankles and feet. She stabilized his condition and hiked to the nearest ranger's station for help.

Along the way, the woman left notes on the trail asking others to call for help. A passer-by found the note and called 911 before she reached the ranger's station. "She did everything right to save her husband," Pontbriand said. "She was in good shape, got him in stable condition, hiked out and left a bunch of clues around."

Other outdoor adventurers aren't always so sure how to respond during an emergency. Pontbriand said too many hikers assume a cell phone or location device will save the day (not always the case). Others wander in search of help and become lost.

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So how should you respond if there's an emergency outdoors? The answer depends on where you are, your surroundings and whether you're alone. Here are ways to handle several outdoor emergencies.

Head injury in a remote location

Sit in an open area and remain still to avoid raising your blood pressure. Send a partner for help. Partners should leave behind extra clothing and supplies, Pontbriand said.

If alone, hug a tree and wait for rescuers to find you. Solo exercisers are advised to tell friends or family about their plans so they can call for help if a return deadline is missed.

"Don't keep it a secret," said Alan Russell with the National Academy of Sports Medicine. "If you're going to run or walk in the park, hike in the mountains, let someone know. Say, 'I'm going to hike from 10 to noon, I expect to be back around 1, I'll check in at that time.'"

Heavy bleeding in an urban area or populated recreational trail

Enlist the help of passers-by to contact emergency authorities, Russell said.

Wearing an emergency bracelet is advised as first responders can collect basic information such as name, address, blood type and next of kin.

"Those are pretty common with cyclists," Russell said. "I've heard stories of several cyclists who were treated by ID bracelet. They get caught in loose gravel, get knocked off and a car that comes upon them knows what to do with them."

Heavy bleeding in a remote location

An injured person can try to stop the bleeding by applying direct pressure above the wound. If this does not work, the next step is to apply pressure to the artery.

A tourniquet is a last resort as it cuts off blood supply to the rest of the limb. "Everything down limb begins to die," Russell said.

Broken arm or wrist in an urban area or populated recreational trail

Do not try to realign a broken or dislocated bone. Head toward help, Russell said.

"You're going to be uncomfortable but you're going to be fine," Russell said. "It's not comfortable, it's painful, miserable. You're bordering on the edge of shock. It's a little freaky."

Sprained ankle in an urban area or populated recreational trail

Walk on your ankle and get help. Sprained ankles tend to stiffen and swell. "What the swelling does is provide external rigidity and stiffness to the joint," Russell said. "That provides you enough stability in that joint to get away."

The stiffness will be painful but can help exercisers leave the situation and get help.

If necessary, Russell said, a large stick can be used as a cane to minimize the weight placed on the ankle.

Broken bone, unable to walk for help in a remote location

Injured hikers who need to wait for rescuers are advised to secure shelter.

"You can deal without water for a couple of days, food for a couple of weeks but you cannot live without shelter," Pontbriand said. "Lying out there in the elements is not a good idea."

Shelter can mean setting up a tent or finding a covered area away from the wind or rain. If possible, shelters should be constructed in open areas so helicopter rescue teams can easily spot the missing person.

A fire can also be built to keep the injured warm and attract attention. Pontbriand said that many national parks ban fires, but this rule can be broken in the event of an emergency such as a serious injury.

While cell phones can help injured people in urban or suburban areas connect with emergency authorities, Pontbriand said many electronic devices do not function in remote areas.

He also warns adventurers not to assume that an electronic device is a type of insurance. For example, hikers should not approach a stream and try to "risk it," assuming help is a mere call away if crossing the stream becomes dangerous.

"An emergency device is not to alleviate risk; you still have to make good, clean decisions," Pontbriand said.
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Having a miscarriage is a difficult challenge for couples to overcome, both physically and mentally, but most are eager to try to conceive again as soon as possible after the loss. It is not clear, however, how long a couple should wait before attempting to become pregnant after miscarriage to maximize their chances of a healthy pregnancy.

A new report by researchers at University of Aberdeen in Scotland suggests that sooner may be better. The scientists found that women conceiving within six months of a miscarriage have better chances of a successful and complication-free second pregnancy than women who conceive later. But the conclusion is contrary to an earlier report from Latin America that found higher pregnancy rates among women who waited at least six months to conceive; that report formed the basis the World Health Organization's 2005 recommendation that women delay pregnancy for six months after miscarrying. (See the most common hospital mishaps.)

Since then, however, the World Health Organization (WHO) has called for more studies on conception after miscarriage, and the new Scottish study is the first attempt to provide better data on optimal timing for women. Dr. Sohinee Bhattacharya, an obstetrician at University of Aberdeen, led an analysis of more than 30,000 Scottish women in the national health registry who had lost their first pregnancy but were able to conceive a second time. In line with the WHO's advice, she found that a larger proportion of women (59%) conceived six months or more after miscarriage, compared with 41% who became pregnant within six months.

But the latter group, it turns out, was also least likely to miscarry again, and more likely to have a live birth. Women who conceived within six months of their miscarriage were 34% less likely to miscarry again, compared with those who became pregnant six months to a year after the initial miscarriage. (See pictures from an X-ray studio.)

While the study did not address the causes of miscarriage, Bhattacharya speculates that age may be a dominant factor. For many women who decide to start a family at an older age, waiting six months to attempt another pregnancy may work against them, since age is itself a primary contributor to miscarriage. "If a woman is over 30, then waiting another six months will reduce her chances of getting pregnant at all and increase her chances of having another miscarriage, simply because of the age difference," Bhattacharya says. "Our research shows that there is no justification in terms of health reasons for delaying." (See the top 10 medical breakthroughs of 2009.)

Dr. David Keefe, chair of obstetrics and gynecology at New York University Langone Medical Center, notes that in developed countries, the biggest predictor of a woman's likelihood of pregnancy is her age, not when her last pregnancy occurred.

That is not true, however, in developing nations, where it is more important that women have access to health care to ensure that any infection or other consequence of miscarriage are fully addressed before they try again. Studies conducted in these areas have recommended a longer interval following a miscarriage, says Keefe, noting that such guidelines were based not only on the toll of miscarrying, but also on the impact of carrying a baby to term. Health officials assumed that it takes a woman the same amount of time to recover physically after a miscarriage as after a full-term pregnancy — about six months. But that is not necessarily the case, since a successful pregnancy may deplete a woman's body more, in terms of nutrients, than a miscarriage.

The American College of Obstetricians and Gynecologists currently has no recommendations for when to conceive after miscarriage, but many obstetricians say they allow women to dictate when they feel ready to start trying again — which in most cases is sooner rather than later. "The guidelines have told us to wait six months, and sometimes even two years. So our heads told us to wait," says Keefe. "But our hearts always told us to get right back in the game."

The new data support that instinct, he says, and may help more doctors and hopeful parents feel comfortable about following up a failed pregnancy with another one as soon as possible.

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Watch what you swallow! A Consumer Reports investigation shows over-the-counter drugs can be dangerous.

You'd better think twice before taking over-the-counter supplements - it could be a matter of life and death.

Fighting the battle of the bulge? A new Consumer Reports investigation warns that taking bitter orange or country mallow to help the process can have fatal results.

Looking for an aphrodisiac? The magazine says it can be a killer at high doses.

Also on the Dirty Dozen list of legal, nonprescription remedies that can sicken or kill: aconite, chaparral, colloidal silver, coltsfoot, comfrey, germanium, greater celandine, kava and lobelia.

"Just because it's natural doesn't mean it's safe," supplement user Trieva Jordan, 33, said Monday at a midtown Manhattan Vitamin Shoppe.

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As temperatures creep into the 90s and beyond, dehydration and heat exhaustion while exercising become a very real—and potentially dangerous—threat. Exhibit A: Each year seems to generate a fresh crop of headlines about football players of all ages collapsing during preseason practice.

Competitive athletes aren’t the only ones who can experience problems when the mercury and humidity start to peak. Even if they’re in excellent shape, weekend warriors may find themselves suffering heat-related symptoms after a long run or even a day of lawn mowing and yard work.

“People get out there and…do a really hard workout,” says Scott Anderson, a certified athletic trainer in Clearwater, Fla. “The sensible thing is to go slow, and work up progressively. …A lot of people even go indoors and cross-train if it’s too hot.”

Not everyone has access to a climate-controlled gym, however. If your only option is to exercise outdoors despite the torrid weather, you can take some steps to avoid problems such as dehydration, cramping, heat exhaustion, and—because air quality gets worse on hot, muggy days—breathing trouble.

How heat and humidity take a toll

When your body gets overheated, its natural response is to sweat. And when that sweat evaporates off your skin, it lowers your body temperature.

But if the temperature or humidity is sky-high, this built-in cooling system can break down. Sweat doesn’t evaporate properly because of all the moisture in the air, and your skin doesn’t release body heat as effectively.

“You’re still sweating, but it’s not doing as much for your body temperature,” says Michael F. Bergeron, PhD, director of the National Institute for Athletic Health & Performance at the Sanford University of South Dakota Medical Center, in Sioux Falls.

As your body temperature climbs, lightheadedness, dizziness, nausea, fatigue, and muscle cramps can result. All of these are signs of heat exhaustion. And if you don’t cool off quickly—by going into an air-conditioned building or drinking cold water, say—heat exhaustion can sometimes turn into heat stroke.

Heat stroke occurs when your body temperature hits 105°. The condition can cause problems in the muscles, kidneys, liver, brain, and heart, and people with heat stroke often start to breathe quickly and behave erratically, Bergeron notes. If they don’t get medical help and bring their body temperature down, they may even have a seizure or slip into a coma.

In extreme cases heat stroke can be deadly. If you or someone you’re with start to experience the symptoms of heat stroke, seek medical attention immediately or call 911.

When is it safe to exercise outdoors?

It’s important to watch the temperature, but the most relevant number you need to know before heading outdoors is the heat index, which takes humidity into account and represents how hot it feels.

The risk of muscle cramping and heat exhaustion rises as the heat index climbs above 90. Although less serious than heat exhaustion, cramping is dangerous, especially when you’re dehydrated. “When you start cramping and don’t have enough fuel in the tank, that can lead to something more serious, like pulling a muscle,” Anderson says. When the index is higher than 100, heat stroke also becomes more likely.

In the Tampa Bay area, where Anderson conditions and trains high school football players, the index is almost always in the danger zone, and it’s not uncommon for it to reach 105. It’s really important to modify your exercise routine when the index is that high, Anderson says.

Anderson recommends scaling back the duration or intensity of your workouts once the hot weather hits. It takes about two weeks to get acclimated to exercising in the heat (especially if you’re not in top shape to begin with), he says. After that period, you’re free to gradually ramp back up.

When it’s really hot out, Bergen advises, it’s a good idea to take breaks more frequently, exercise in the shade whenever possible, and wear breathable and light-colored clothing.

Exercising in the heat is safe if you use common sense and follow some basic rules, Bergeron says. “As long as they’re not working [out] too hard, someone who is well rested, hydrated, and nourished can tolerate pretty tough conditions,” he says.

Stay hydrated

The most important thing to do while working out in the heat is to stay hydrated. That may seem obvious, but hydrating properly is more complicated than you may think.

For starters, you should drink plenty of fluids before and after your workout, not just during. Anderson tells his football players to hydrate throughout the day to prepare for their 4 p.m. practices, and to drink 16 to 20 ounces of water or a sports drink (like Gatorade) one hour before practice.

During your workout, you should consume 4 to 16 ounces of fluids every 15 to 20 minutes, according to the American College of Sports Medicine. Sports drinks—which contain lots of sugar and additives in addition to the electrolytes that help keep you hydrated—are most beneficial during prolonged exercise, Bergeron says, and it’s sometimes wise to alternate them with water.

Don’t rely on your thirst to tell you when to drink. “People let thirst drive them to drink, but it isn’t enough to match what they are losing [by sweating],” Bergeron says, adding that if you start feeling thirsty, you’re already dehydrated.

Food is also important for staying hydrated. Eating regular meals and snacks throughout the day—especially foods such as bananas that contain potassium and other vital nutrients (in addition to water)—will help prep your body for a workout in the heat.

“Maintaining good hydration is key to safety in the heat, but it is not all protective,” Bergeron says. Research that Bergeron took part in has shown that even if kids are well hydrated, they can overheat and even experience heat stroke if they exercise too intensely and get hot too quickly. “You can still overheat and have serious problems when you are well hydrated,” he explains.

Protect your lungs

Dehydration and heat exhaustion aren’t the only hazards of exercising on hot days. The stagnant air caused by heat and humidity tends to trap airborne pollutants, such as car exhaust, which react in the presence of sunlight to form ozone, a main ingredient in smog.

Working out in smoggy air can cause lung trouble in people with respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). But even in people without lung conditions, hard exercise on days with lots of smog can reduce lung function and create a reaction akin to an asthma attack, says Norman Edelman, MD, chief medical officer of the American Lung Association.

“Ground-level ozone is an irritant. If you breathe in too much, it irritates the nose, throat, and lungs,” Dr. Edelman says. “It’s like you’re getting a sunburn in your airways. Ozone promotes inflammation of the airways, and they get red and swollen.”

A partnership of government agencies publishes daily air-quality forecasts for every zip code in the U.S. at AirNow.gov, ranking air quality on a six-point, color-coded scale ranging from green (“good”) to dark red (“hazardous”).

The green and yellow (“moderate”) levels are normal for most of the country during the summer, Dr. Edelman says. The orange level can cause problems in people who are sensitive to ozone (like asthmatics), however, and on red days he recommends that everyone stay indoors to exercise.

“It’s important not to macho it,” he says. “Lots of people say, ‘I’m feeling tight in the chest, but I can run through it.’ But the more you run, the more bad air you take in, and if you have [sensitive] airways it can be very irritating.”

If you have to exercise outdoors, the best time to do it is early in the morning, Dr. Edelman says. He also suggests avoiding heavily trafficked roads to reduce the pollutants you inhale. And if you have asthma or other chronic lung disease, talk with your doctor about your exercise routine and make sure you have a plan in case you experience breathing problems.

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More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices, and contact lenses are the leading culprit.

More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices, and contact lenses are the leading culprit, the first detailed national estimate suggests.

About one-fourth of the problems were things like infections and eye abrasions in contact lens wearers. These are sometimes preventable and can result from wearing contact lenses too long without cleaning them.

Other common problems found by researchers at the U.S. Food and Drug Administration include puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls.

Malfunction and misuse are among possible reasons; the researchers are working to determine how and why the injuries occurred and also are examining the prevalence in adults. Those efforts might result in FDA device warnings, depending on what they find, said study co-author Dr. Brock Hefflin.

The most serious problems involved implanted devices such as brain shunts for kids with hydrocephalus (water on the brain); chest catheters for cancer patients receiving chemotherapy at home; and insulin pumps for diabetics. Infections and overdoses are among problems associated with these devices. Only 6 percent of patients overall had to be hospitalized.

Dr. Steven Krug, head of emergency medicine at Chicago's Children's Memorial Hospital, said the study highlights a trade-off linked with medical advances that have enabled chronically ill children to be treated at home and live more normal lives.

Home care can be challenging for families; Krug says he has seen children brought in because catheters were damaged or became infected.

"Health care providers need to be aware of these kids and their devices and how to recognize or diagnose" related problems, Krug said. He was not involved in the study.

The study appears in Pediatrics, published online Monday.

Hefflin and lead author Dr. Cunlin Wang work in the FDA's Center for Devices and Radiological Health. They note there has been recent concern about medical device safety in children, particularly since many devices intended for adults are used in children.

The researchers analyzed medical records from ER visits reported in a national injury surveillance system. Based on data from about 100 nationally representative hospitals, they estimated that 144,799 medical device-related complications occurred during 2004 and 2005, or more than 70,000 yearly.

Almost 34,000 problems were linked with contact lenses in the two-year period. The rest were scattered among 12 other categories including general medical devices such as needles and catheters, gynecology devices and heart devices.

Hefflin said the study is the first to evaluate device-related injuries in children only. It did not include device problems in already hospitalized children.

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The millions of people who take calcium supplements to strengthen aging bones and ward off osteoporosis may be putting themselves at increased risk of a heart attack, a new study has found.

Older people who take at least 500 milligrams of calcium daily—less than the amount in a typical one-a-day calcium pill—are 30% more likely to have a heart attack than those who take no calcium at all, the study estimates.

But people taking calcium supplements should not stop without consulting their doctor, says John Baron, MD, a professor of medicine at Dartmouth Medical School, in Lebanon, N.H., and a co-author of the study. More research is needed to confirm and clarify the results, he says.

The modest benefit that calcium supplements have on building bone density and reducing bone fractures may not justify the heart risks for most patients, Dr. Baron and his colleagues suggest. Bone loss and fractures are a major health concern among older people.

The findings, published in the journal BMJ, have some experts questioning whether calcium supplements should be used as widely as they are now, especially by elderly women, who suffer disproportionately from both heart disease and osteoporosis.

Sharonne Hayes, MD, the director of the Women’s Heart Clinic at the Mayo Clinic, in Rochester, Minn., says that in the past she did not discourage any of her patients from taking calcium supplements. Now, she says, she will try to determine if her patients have a calcium deficiency before making a recommendation either way.

“Up until this point, there was no evidence of harm,” says Dr. Hayes, who was not involved in the new research. “Now there needs to be a good reason to use [supplements].”

In the study, researchers combined data from 11 clinical trials in which patients were randomly assigned to receive calcium supplements or placebo pills. In all, the trials included nearly 12,000 people who were followed for an average of about four years. Most were women, and the average age was 72.

About 2.7% of the participants taking calcium had heart attacks during the trials, compared with 2.2% of those taking a placebo. This translated into an increased risk of between 27% and 31%, depending on how the researchers analyzed the data.

Although the increase in risk associated with calcium supplements was small, it could represent a large number of additional heart attacks in the general population because of how many people take the supplements, the authors note.

Dr. Baron was surprised by the findings. “Calcium supplements have been widely used for quite a while,” he says. “Other studies have suggested, if anything, that [calcium] might have a protective effect.”

The findings do not imply that people should reduce the amount of calcium in their diet, Dr. Hayes stresses. Calcium is found in vegetables, fortified cereal, and dairy products such as milk and yogurt, which are an important source of vitamin D in addition to calcium.

“Calcium isn’t bad,” she says.

John Cleland, MD, a cardiologist at Hull York Medical School, in the U.K., says that calcium supplements are helpful for “very few” patients.

They may be beneficial for some children, some pregnant women, and people with proven calcium deficiency (a relatively rare condition), says Dr. Cleland, who co-authored an editorial accompanying the study. But, he adds, “there’s no evidence for use in older people” who do not have calcium deficiencies.

Doctors should not recommend calcium supplements for patients with osteoporosis unless the patients are also taking an effective osteoporosis treatment, Dr. Cleland and his co-author conclude.

It’s unclear how calcium supplements might increase heart attack risk. They may contribute to the hardening of arteries (atherosclerosis) by increasing calcium levels in the blood, or they may cause changes to blood flow. Hormone responses caused by calcium may also be involved, the study notes.

The study leaves several unanswered questions for future research. The researchers only included patients who were taking calcium supplements but not vitamin D supplements, for instance. That combination—often found in a single pill—is common and may have a different effect than calcium alone on heart risk, as vitamin D is believed to promote heart health.

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After the World Cup, American fans of Paraguay sexy magazines are constantly invited to take pictures in south America. She did not hesitate to model highway curves which attracted not a gentleman can lethargy.
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