A new study shows a laugh signifies more than humor and ridicule, at least when used in therapy. Researchers from Massachusetts General Hospital in Boston have found the first physiological evidence of the role of laughter during psychotherapy.

Carl Marci, M.D., lead author of the study, says many therapists are caught up in the old notion that using laughter in therapy is inappropriate. But, he says, current research shows laughter is more about communicating emotion than about humor. Even more, when patients and therapists laugh together, it magnifies the emotional intensity and creates rapport between them.

Researchers videotaped therapeutic sessions and took physiological measurements of both members of 10 patient-therapist pairs where patients were being treated for outpatient mood and anxiety disorders.

There were 145 episodes of laughter during the sessions. On average, patients laughed more than twice as often as therapists. However, patients' physiological response when therapists did laugh showed they felt validation of the emotions they were expressing.

Overall, laughter showed to produce physiological responses in patients and therapists, with arousal strongest when both laughed together.

Dr. Marci says he was surprised to find how common laughter was in therapy. He says: "Taken together with the current understanding of laughter outside of psychotherapy, our findings suggest that the patient who is laughing is trying to say more than has been expressed verbally to the therapist. Laughter is an indication that the subject is emotionally charged."

This study, the researchers say, supports the need for therapists to pay closer attention to when patients laugh during therapy and for them to explore the meaning of what is said immediately before the laughter.

If you don't tell your physician the whole truth and nothing but the truth, you're not alone. A recent study from the University of Minnesota in Minneapolis shows a surprising number of people take herbal supplements in addition to their prescription medications but do not tell their doctors they are doing so. The study revealed patients often think their physicians will chastise them if they admit to using herbals.

Researchers conducted a three-stage interview process with rural West Virginian women following a gynecological appointment. First, a researcher asked patients open-ended questions about what medications they were using, specifically mentioning over-the-counter drugs and herbal supplements. Next, the researcher asked patients what they used to treat specific ailments. Finally, the researcher and patient reviewed a specific list of drugs, including 20 to 30 herbal medications, to determine which ones the patient was using.

Researchers say patients disclosed a little more information in each stage. Researchers found 92 percent of patients were taking prescription medications, nearly 97 percent were taking over-the-counter drugs, and nearly 60 percent were taking herbal supplements. Researchers say physicians were shocked when shown the data, commenting, "I had no idea my patients were taking this medication or this one."

Researchers say communicating to doctors about medications is critical because of potential interactions herbals could have with their over-the-counter drugs or prescribed medications. Several women in the study, for example, were taking St. John's Wort, which can potentially reduce the effectiveness of birth control pills or adversely interact with prescription antidepressants.

Researchers advise physicians, "We need to be more specific in our questioning about herbals. And we need to create an environment where the patient feels comfortable sharing the information with you."

There are many self-help approaches to treating disease and illness and getting well. Authors have written about the healing powers of everything from positive thinking to visualization and imagery. In this collaboration, authors Ina Albert and Zoe Keithley introduce us to a fresh approach as they offer insight into a technique that has proven to be statistically valid, yet is virtually unexplored.

Journaling.

Clinical studies show that the simple act of writing can speed healing, improve one’s ability to handle pain and generally enhance a person’s outlook. In this book, the authors carefully document those studies and then artfully tackle the barriers that arise for most people when asked to begin actually putting pen to paper.

"Write Your Self Well ... Journal Your Self to Health"  is based upon the premise that illness and disease require the body to expend energy to heal and recover. Dealing with fears, relationship problems and unresolved issues from the past also requires energy. Since the latter usually occurs at a subconscious level, individuals are often unaware that they are dealing with issues. When we find ourselves ill, if we are also subconsciously dealing with other matters, our bodies may not have the energy reserves needed for healing.

Bringing unresolved issues from a subconscious to a conscious level frees our bodies of the need to expend energy on those issues and, instead, our bodies can concentrate on getting well. Albert and Keithley explain that writing 20 minutes a day, every day, enables us to uncover issues we may be ignoring. Writing about them allows us to disclose them -- even though no one may ever read our written words. While it is written disclosure which demonstrates the most dramatic results in clinical trials, the authors emphasize that there are documented benefits to the daily practice of writing about any subject.

For many people, writing is something they do infrequently if at all. For those, committing to write for 20 minutes a day is tantamount to a couch potato committing to exercise rigorously for that same amount of time every day. So, instead of writing at length about the benefits of journaling, Albert and Keithley offer practical advice and examples that instruct us how to go about keeping a journal. In fact, much of the book is a workbook that guides readers step-by-easy-step through the process. Follow their directions and it would be virtually impossible to fall short.

Both authors bring background and experiences to the book that complement each other. Albert has spent more than 30 years in health care marketing and communications. She has facilitated seminars and training in interpersonal communications and leads workshops in aging and managing life transitions. Keithley taught fiction for 15 years at Columbia College and is a teacher and director in their Story Workshop® method. A writing specialist for Northeastern Illinois University and Chicago Public Schools, she also provides private coaching to fiction and non-fiction writers.

An easy read, "Write Your Self Well… Journal Your Self to Health" is a creative guide to a self-help approach that promises to be beneficial for those who try it.

There is good news for those with arthritis of the knee. A study reported in this month’s Archives of Internal Medicine shows a topical, non-steroidal anti-inflammatory drug can relieve pain.

Doctors have long known that NSAIDs can relieve joint pain in patients with osteoarthritis, but oral medications can have negative side effects such as gastrointestinal problems. Now, researchers say topical medications may be a better alternative.

Researchers from Arizona Research and Education in Phoenix treated 326 men and women with topical diclofenac sodium, an NSAID also known as Pennsaid, or a placebo. They found after 12 weeks of treatment, those on the active medication reported a 45.7-percent reduction in knee pain. Additionally, they reported improvement in physical function and stiffness as well as the ability to walk without pain.

The most commonly reported side effect of the treatment was a minor skin reaction at the application site, which was reported by 41 percent of the participants.

Lead author of the study, Sanford H. Roth, M.D., writes, “This study demonstrates that topical diclofenac solution ... effectively treats symptoms of primary OA of the knee.” Since the treatment is delivered topically, it eliminates side effects brought on by oral NSAID treatment.

A growing body of research points to the dangerous impact of sedentary behavior in children. Now, doctors have another health concern to add to the list -- chronic fatigue syndrome.

A study reported in the British Medical Journal explains that children who have sedentary behaviors are at increased risk for developing chronic fatigue later in life. Chronic fatigue syndrome is an often disabling condition that affects primarily women. The condition is characterized by deep-seated fatigue that cannot be overcome with rest and often worsens with physical activity. The cause of the condition is unknown, and there are no diagnostic tests or cures.

Researchers from London monitored more than 16,500 children over 30 years for the study. Participants were followed up with at ages 5, 10, 16 and 29 or 30. Parents and teachers filled out questionnaires about the child’s activity level.

After examining the data, the researchers determined that being female, being in a high social class during childhood, and having a long-standing medical condition in childhood were all factors that increased a person’s risk of developing chronic fatigue. High levels of exercise in childhood were attributed with a lower risk of the condition.

Unlike previous studies, this study found no association between the development of chronic fatigue later in life and maternal behaviors, parental illness, or childhood distress.

Lead author Russell Viner says, “Contrary to previous suggestions that high levels of exercise increase risk, we found that the most sedentary children were at greatest risk, adding further weight to current public health efforts to promote healthy exercise and reduce sedentary behavior among children.”

The five-year-old anti-inflammatory arthritis drug Vioxx, generically called rofecoxib, is off the market, as a study shows it raises the risk of heart attack and stroke.

More than 2 million people use Vioxx in more than 80 countries, putting last year's sales at $2.5 billion. Since its launch in 1999, 91 million prescriptions have been written in the United States alone. Vioxx is in a class with other newer anti-inflammatory arthritis drugs like Pfizer's Celebrex (celecoxib) and Bextra (valdecoxib). They are designed to block inflammation and pain as effectively as drugs like aspirin and ibuprofen, but with fewer side effects such as ulcers and gastrointestinal problems. These arthritis drugs block a protein called Cox-2 that has been linked to inflammation.

A newly released colon cancer trial designed to test how effectively Vioxx prevents recurrence of colorectal polyps shows the drug did so insufficiently. The study did confirm concerns that the drug poses cardiovascular health risks. A recent study by the Food and Drug Administration showed patients taking the typical starting dose of Vioxx face a 50-percent greater risk of heart attacks and sudden cardiac death than those taking any dose of Celebrex. The FDA says people taking a high dosage for longer than the approved five days puts them at an especially high risk.  Patients with a prescribed daily dosage of 50 milligrams, as opposed to the average 12.5 milligrams, sometimes continue to take the drug for several months.

Representatives from the drug's manufacturer, Merck & Co., say, "[In the cancer trial,] there was an increased relative risk for confirmed cardiovascular events, such as heart attack and stroke, beginning after 18 months of treatment in the patients taking Vioxx compared to those taking the placebo." They believe pulling the drug is the most responsible course of action. Raymond V. Gilmertin, chairman, president and CEO of Merck, says, "We are taking this action because we believe it best serves the interest of patients."

An alternative method used to screen women for breast cancer isn’t living up to expectations, report researchers from Northwestern Memorial Hospital in Chicago.

They found ductal lavage -- a process by which doctors take fluid from the milk ducts in the nipple and analyze it for the presence of abnormal cells -- fails to identify cancer in many women.

The research was spurred by recent reports suggesting ductal lavage might be a good way to detect breast cancer because milk ducts that yield fluid are considered more likely to contain cancerous cells. An earlier study, for example, showed the procedure correctly identifies breast cancer in four out of 11 women with no previous evidence of the disease.

The current study evaluated the procedure in 32 women with known breast cancer who were scheduled to undergo a mastectomy and seven women without breast cancer who were having preventative mastectomies. Results show the test revealed cancer in only about half of the breasts with known cancer. Also, in women with cancer, the milk ducts that yielded fluid were not necessarily the milk ducts where cancer cells were found.

The authors write, “Although further studies are warranted in women with early lesions, our results and those of others indicate that ductal lavage should not be recommended to high-risk women as a technique to detect cancer earlier than imaging modalities.” They emphasize mammograms and physician examinations should remain the breast cancer detection methods of choice.

Patients with chronic sinus infections, known as chronic rhinosinusitis, do not appear to develop resistance to antibiotics taken over long periods of time, shows new research. This finding comes after years of warning that resistance can develop from long-term use of antibiotics.

The study authors say guidelines recommend four to six weeks of antibiotics as a first-line treatment for chronic sinus infections before surgery is considered. However, they say little data exist on the appropriateness of this prescription.

Researchers from Brigham and Women's Hospital in Boston tracked 90 adult patients over seven years. They took about 2.5 microbiological sinus cultures from each person every 157 days to measure the effectiveness of the drugs over time.

The results show no increase in severity of antimicrobial resistance, and in fact, many patients showed a less degree of antimicrobial resistance over time.

The authors attribute the lack of developing resistance to the very specific use of antibiotics that was guided by culture results. The culture results were used to confirm the type of bacteria and need for antibiotics.

A cocktail using popyseed oil is being used to target cancer cells in the liver. That's a first in the United States.

Nearly 19,000 cases of liver cancer are diagnosed each year in the United States.

"It is one of the more common tumors in the world ... in the United States it's a little less common," says oncologist Howard Ozer, M.D., of University of Oklahoma Health Sciences Center in Oklahoma City

With traditional chemotherapy, only 13 percent of people survive. In his search for something better, Dr. Ozer uncovered a treatment pioneered in Hong Kong and Paris that has significantly better results. He says, "It's been demonstrated that 60 percent to 70 percent of the patients that have been treated are alive at five years."

The treatment uses a combination of popyseed oil and a radioactive isotope called i-131.

"You have to be able to deliver therapy directly into the liver," Dr. Ozer says. "A catheter is inserted and threaded up and the radioactive isotope is infused. It's localized there and as a result the radioactivity is released locally to the tumor. "

He says all the red tape was worth it to open doors for liver cancer patients. Clinical trials are expected to begin in the United States later this year. "It's extremely exciting to be the first in the country to try something that's that unique." Unique and hopefully life-saving.

Dr. Ozer will be starting clinical trials by the end of the year.

Babies who weigh more at birth are at an increased risk of developing leukemia in childhood, report investigators publishing in this month’s Journal of the National Cancer Institute.

Overall, the risk of developing leukemia increased by 26 percent for about every additional two-pound increase in birth weight. However, the finding held true for only one type of leukemia -- acute lymphoblastic leukemia (ALL). The study found no link between acute myeloid leukemia (AML) and birth weight. The study also linked birth order with one form of ALL known as B-precursor ALL, with children born later more affected than those born earlier. Children who developed ALL, however, did not differ significantly in birth weight from their siblings.

The investigators believe these findings help shed light on the link between gestational development and childhood leukemia, which has long been recognized by doctors. They write, “Our results are compatible with the hypothesis that high birth weight modified the risk of ALL, either through proliferative stress and/or by increasing the number of cells at risk of leukemia-associated genetic aberrations.”

The study involved more than 2,000 children with the two types of leukemia who were identified by a patient database in Denmark, Iceland, Norway and Sweden. These children were compared to their siblings and to more than 10,000 children without leukemia.

Nurse care management -- a widely used system of phone-based health follow-up and instruction aimed to help patients manage their illnesses -- does not decrease rehospitalization rates in low-risk heart failure patients, according to a new study.

Researchers from Stanford University School of Medicine in California studied 462 patients receiving treatment for heart failure. Half of the participants received nurse care management, and all received the usual follow-up care with their doctor.

Results show half of patients were rehospitalized, regardless of whether they received nurse care management. The majority was treated for coronary heart disease compared to only one-third of patients who were treated for heart failure.

The study contradicts previous research that has shown substantial benefits of specialized care management. However, past investigations evaluated groups of patients with more advanced levels of heart failure.

According to lead study author Robert F. DeBusk, M.D., differences in patient baseline risk and differences in overall health care received may explain the study results. He notes those enrolled in his study were already receiving good overall care.

DeBusk concludes, "Nurse care management holds tremendous promise for patients at higher risk or those not receiving comprehensive care, but that doesn't mean it's universally effective."

Heart failure, a chronic ailment in which the heart loses some of its pumping capacity, is the leading cause of hospitalization for people ages 65 or older.

A new study out of Finland shows young adults who have poor functioning of a key heart measure may be more likely to develop deadly blockages in their arteries.

The researchers looked specifically at how the functioning of the inner layer of blood vessels in the arteries, called endothelial functioning, affects the development of artery blockage, or atherosclerosis.

The investigation involved more than 2,000 people who were followed from childhood. Over the 21 years of the study, researchers kept track of traditional risk factors for heart disease among the group including being overweight or smoking cigarettes. At the end of the study, when the participants ranged in age from 24 to 39, researchers used standard tests to measure the level of blockage and endothelial functioning in each individual.

Results show people with enhanced functioning were significantly less likely to have blockages when compared to those with impaired functioning. Childhood risk factors for heart disease, however, were only associated with impaired functioning, not with enhanced functioning.

The authors believe assessing the inner layer of blood vessels could serve as an early way to identify people at risk for heart disease. They write, “In addition to the evaluation of conventional cardiovascular risk factors, noninvasive evaluation of endothelial dysfunction might be helpful to discriminate individuals at risk for atherosclerosis.”

Newer medications used to treat serious psychiatric disorders in children may also be increasing their risk of developing type 2 diabetes and heart disease in adulthood.

Researchers who studied 11 children taking antipsychotic drugs found nine developed evidence of insulin resistance, a condition in which the body is unable to properly use insulin. When insulin is not used properly, sugar builds in the bloodstream. That leads to diabetes, which increases the likelihood of developing heart problems and stroke.

Most of the children in the study gained significant weight while taking the drugs and were considered overweight or obese. Being overweight or obese increases the risk of insulin resistance. However, the researchers note the insulin resistance seen in the children was greater than would have been expected from excess weight alone, suggesting the drugs themselves may be causing some of the problem directly.

The investigators do not believe children should necessarily be taken off these medications. They say newer antipsychotic drugs like olanzapine (Zyprexa or Zydis), quetiapine (Seroquel), and risperidone (Risperdal) are effective in treating conditions like bipolar disorder and schizophrenia without causing as many unwanted side effects as older drugs. Instead, they call for doctors to find the lowest possible effective dose for these children to minimize the risk of developing insulin resistance. They also say doctors should carefully monitor children taking these drugs for insulin problems.

“Treatments are always a matter of risk and benefit balance,” says study author Mark A. Riddle, M.D., from Johns Hopkins Children’s Center. “Clearly these drugs are an important treatment option.”

Diabetics have three- to four-times the risk of developing liver cancer and more than twice the risk of developing pancreatic cancer, according to new research presented at the Third Annual Frontiers in Cancer Prevention Research Meeting in Seattle.

Researchers compared 3,288 men diagnosed with 12 different types of cancer to 509 healthy people to determine whether those reporting a prior diagnosis of diabetes were more likely to be diagnosed with cancer. Their findings are independent of other factors like participants' body mass index.

Researchers say, "Among those who reported being diabetic, there was a three-fold increased risk for liver cancer. When we looked at the individuals who reported taking medication for their diabetes, the risk for liver cancer increased to almost four-fold compared to individuals who were not diabetic."

However, diabetics were not found to be at an increased risk for other cancers, including melanoma, non-Hodgkin's lymphoma, and cancers of the esophagus, stomach, colon, rectum, lung, prostate, bladder, and kidney.

A review of 136 studies shows the majority of morbidly obese patients who underwent bariatric surgery between 1990 and 2003 lost weight effectively and improved obesity-related disorders including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.

According to the article in this week's issue of The Journal of the American Medical Association, morbid obesity is defined as having a body mass index of 40 or higher. The loss of life expectancy due to morbid obesity is significant, the article says. In comparison with a normal-weight individual, a 25-year-old morbidly obese man lives about 12 years less.

Henry Buchwald, M.D., Ph.D., of the University of Minnesota in Minneapolis, and colleagues set out to examine the impact of bariatric surgery on weight loss, operative mortality outcome, and obesity-related disorders. They reviewed 22,094 patients who underwent bariatric surgery, including gastric banding or bypass, gastroplasty, biliopancreatic diversion or duodenal switch. The average age of patients was 39.

Researchers found the average percentage of excess weight loss was 61.2 percent for all patients. Diabetes was resolved in 76.8 percent and resolved and improved in 86 percent of patients. Hyperlipidemia improved in 70 percent of patients. Hypertension was resolved in 61.7 percent and resolved or improved in 78.5 percent of patients. Obstructive sleep apnea was resolved or improved in almost 84 percent of patients.

They also found death due to surgery within 30 days ranged from .1 percent to 1.1 percent depending on the procedure.

The authors conclude, "Even after accounting for the pain and anxiety of surgery, the inconveniences of dietary restrictions, and possible complications including reoperation, quality of life should improve for the majority of bariatric surgery patients."

Giving adolescent girls estrogen treatments to keep them from getting too tall leads to fertility problems later on.

That’s the key finding from a new study out of Australia that compared tall girls who received the treatments with tall girls who were assessed for the therapy but never received it.

Overall, women who had been given estrogen as girls were 80-percent more likely to have been unsuccessful in achieving pregnancy after a year of trying, 80-percent more likely to have consulted with a doctor about fertility problems, and twice as likely to have taken fertility drugs. While most of these women did manage to finally become pregnant, they were 40-percent less likely to conceive in any given menstrual cycle when they were trying to become pregnant than women who didn’t take estrogen.

The study involved 780 women who had been assessed for estrogen therapy as girls and completed a fertility survey later in life. About half had actually been treated with estrogen, and the other half was not treated. Estrogen is thought to limit height by altering long bone development.

The researchers say these results confirm earlier findings suggesting adverse reproductive effects from estrogen given to limit height in girls. “Our findings indicate that exposure to high-dose estrogens in adolescence is associated with impaired fertility in later life,” says study author Alison Venn. “The availability of infertility treatments is likely to have contributed to the finding that women who were treated for tall stature had only a small decrease in the probability of eventually conceiving and having a live birth compared with untreated women.”

The good news is, report the investigators, fewer girls today are receiving this treatment, most likely because tall stature in women has gained greater social acceptance.

New research shows not only is breast feeding your newborn beneficial, but making sure the milk is fresh is also crucial.

According to a new study from the Robert Wood Johnson Medical School in New Jersey, breast milk that has been refrigerated or frozen for more than 48 hours begins to lose significant levels of antioxidants.

Researchers sampled milk from mothers who had delivered to full term or who had delivered premature babies, as well as formula milk.

Results show fresh human milk had a significantly higher value of antioxidants than formula. Although formula retained the same levels of antioxidants when frozen or refrigerated, antioxidant levels fell in breast milk the longer it was stored and the colder the temperature at which it was stored.

This study is of special importance to premature newborns, since they are born with lowered antioxidant capacity and are susceptible to high levels of oxygen free radical activity.

Babies born by Cesarean section may have greater sensitivity to certain foods and are at a greater risk for diarrhea, according to the German Infant Nutritional Intervention Program study.

Researchers studied 865 babies who had been exclusively breast-fed until they were 4 months old. None was born prematurely, and they were all born into families with a history of allergies.

The babies were monitored on four separate occasions until they turned 1. Blood samples were then taken to check for antibodies to food allergens including eggs, cows’ milk, and soy protein. Mothers also completed food diaries on their babies’ health and eating habits.

Babies born by C-section were significantly more likely to have diarrhea during their first year of life compared to babies born vaginally. They were also twice as likely to be sensitive to cows’ milk and any of the other five food allergens. However, delivery type had no bearing on problems like colicky pain or atopic dermatitis.

Study authors say their findings confirm the importance of gut bacteria in the development of the immune system response, and that C-section alters or delays “normal” bacterial colonization of the baby’s gut. They suggest vaginally delivered babies acquire those bacteria from the mother, whereas C-section babies acquire bacteria from the hospital environment.

Obesity in middle-aged men can have a significant impact on stroke risk, doubling its likelihood later in life, according to a new study.

Researchers in Sweden followed 7,402 healthy men between ages 47 and 55 for 28 years. Fatal and non-fatal incidences of stroke were recorded by using the Swedish National Register on Cause of Death and the Swedish Hospital Discharge Registry.

According to the study, 873 first strokes were recorded. Men who started the study with a body mass index of between 20 and 22.49 were significantly less likely to suffer a stroke than those who started with a BMI of more than 30. No significant association was found between BMI and risk for hemmorhagic stroke.

Researchers note the extended follow-up period of the study made it possible to show a link between obesity at middle age and an increased stroke risk later in life.

Lead study author Katarina Jood, M.D., concludes, "It is not enough to treat hypertension and diabetes to prevent stroke. Obesity should also be considered a risk factor."

Stroke is one of the leading causes of disability and death in Western countries. Because few efficient therapies exist, prevention remains the best approach.

Investigators from the Department of Preventive Medicine and Public Health in Spain followed 132 patients with lung cancer and 187 patients requiring routine surgery between 1999 and 2000. The majority of the patients were men in their early 60s.

Patients were asked about their diet, smoking habits, occupation, and the type and quantity of alcohol they drank each day. They were asked to specify if they drank red, white or rose wine.

Results show one-third of all of the patients studied were former smokers. Of the group with lung cancer, 60 percent were current smokers compared to 25 percent of the other patients. Those with lung cancer were also more likely to have worked in jobs that put them at an increased for the disease.

One in five of the routine-surgery group didn't drink compared to one in four in the lung cancer group. Researchers say no other type of alcohol seemed to have the same effect as red wine.

Doctors publishing in this week's Circulation offer a recipe for weight loss they believe could help many overweight and obese people shed pounds and reduce their risk of heart disease.

The common sense plan calls for people with a body mass index between 25 and 29.9 to watch their diets, exercise regularly, and make some behavioral changes. Those changes include setting weight loss goals, getting help with stress, and finding social support. People in this weight range are generally considered overweight but not obese.

Researchers say people with BMIs that top 30 should also consider drug therapy along with diet, exercise, and behavioral changes. Those with BMIs of 35 or higher who have been unable to lose weight using these more conventional strategies should be evaluated for gastric bypass surgery or other weight loss operations.

The authors note losing even a small amount of weight -- about 5 percent to 10 percent of body weight -- can significantly improve measures of metabolic syndrome, which is known to lead to heart problems. Risk factors for metabolic syndrome include high cholesterol, high blood pressure, higher-than-normal blood sugar, and being overweight.

What’s the best way to reach your weight loss goals? The authors suggest a slow and steady approach. “Making lifelong dietary and physical activity changes is key for successful weight management,” says author Robert H. Eckel, M.D. “So, it’s important that people select a healthy diet that they can follow for the rest of their lives,” he says. For most people, that means reducing calories to the point where they can lose a pound or two a week.

The authors also call for doctors to work more closely with their overweight and obese patients to achieve these goals.

Poor people living in Great Britain are significantly less likely to receive knee replacement surgery than their more affluent counterparts, report researchers publishing in this month’s Annals of Rheumatic Diseases.

Results of their study suggest the problem is particularly prevalent among older people and women. Overall, poorer people in the study were twice as likely to need the surgery but less likely to receive it. Women were twice as likely as men to require the operation but twice as likely not to have it. Those over age 75 were also less likely to get the necessary surgery.

Overall, surgical rates were low. Only 6.4 percent of people who needed the surgery received it within 18 months. This translates to about a 5-percent unmet need, the researchers explain.

The study involved a survey of 15,000 people age 65 and over living in England. About 11,200 responded. The findings are based on a severity score of 14, which indicates extremely severe knee problems. Researchers note if they had based the results on a lower score that measured only severe knee problems, even more people would have been classified as needing the surgery, which would be about 13 percent of the entire group.

The authors point out orthopedic waiting lists in England are currently among the longest in the country -- a fact they believe illustrates the urgent need to expand orthopedic services and the training of orthopedic surgeons in their nation.

Researchers are exploring whether fewer days in medical rehabilitation affects the well-being of patients staying in a hospital.

Between 1994 and 2001, there was a shift in length of stay (LOS) for inpatient rehabilitation from 20 days to 12 days. Researchers from the University of Texas Medical Branch in Galveston studied the impact of fewer days of this type of medical rehabilitation on functional status, living setting, and mortality.

Researchers studied the records of more than 148,000 patients who had brain dysfunction, spinal cord dysfunction, an orthopedic condition, or suffered a stroke.

Results show functional status and rates of discharge to home remained stable with fewer days in medical rehabilitation. However, the decrease in length of stay led to an increase in mortality.

Authors of the study say, "Determining the causes of the increase in rehabilitation efficiency and mortality requires further study. Our goal was to document the recent change in LOS and examine its association with function status, living setting, and mortality."

Researchers hope to use their findings to access the efficacy of future length of stay in medical rehabilitation programs and determine how this change can impact a patients care and outcome.

An alternative method used to screen women for breast cancer isn’t living up to expectations, report researchers from Northwestern Memorial Hospital in Chicago.

They found ductal lavage -- a process by which doctors take fluid from the milk ducts in the nipple and analyze it for the presence of abnormal cells -- fails to identify cancer in many women.

The research was spurred by recent reports suggesting ductal lavage might be a good way to detect breast cancer because milk ducts that yield fluid are considered more likely to contain cancerous cells. An earlier study, for example, showed the procedure correctly identifies breast cancer in four out of 11 women with no previous evidence of the disease.

The current study evaluated the procedure in 32 women with known breast cancer who were scheduled to undergo a mastectomy and seven women without breast cancer who were having preventative mastectomies. Results show the test revealed cancer in only about half of the breasts with known cancer. Also, in women with cancer, the milk ducts that yielded fluid were not necessarily the milk ducts where cancer cells were found.

The authors write, “Although further studies are warranted in women with early lesions, our results and those of others indicate that ductal lavage should not be recommended to high-risk women as a technique to detect cancer earlier than imaging modalities.” They emphasize mammograms and physician examinations should remain the breast cancer detection methods of choice.

In 1991, I underwent a hysterectomy and ovary removal procedure, and although I was only 38 years old at the time, I was immediately catapulted into surgical menopause. 

In other words, I had become a much older woman going through natural menopause, but with symptoms of greater intensity.

When a woman's ovaries are removed at the same time as her uterus, some of the nastier symptoms she may experience include severe hot flashes, night sweats, mood swings, vaginal dryness, depression, anxiety, and loss of libido, just to mention a few. 

In most cases, doctors prescribe hormone replacement therapy (HRT) for relief of these symptoms, but it doesn't always work.  At least not according to my personal experience, and that of the many women I interviewed for my book, "Misinformed Consent -- Women's Stories about Unnecessary Hysterectomy" (Next Decade, Inc., 2003; http://www.nextdecade.com). All commented on how difficult it was to find an effective and safe therapy

Studies on HRT are coming at us from all sides, but are they really presenting new information?

In the introduction to her book, "The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth" (Hyperion Press, 2003), Barbara Seaman writes that the  risks   associated with estrogens have been known for a long time. According  to Seaman's research, when the British biochemist first  published his formula   for oral estrogens in 1938, he claimed that drugs containing estrogens showed promise, but he also spent years warning his colleagues that estrogens could also put women at risk of endometrial and breast  cancer.

Women have reason to be concerned. I know I am. That's because, until a few months ago, I had been on the highest dose of a combined form of HRT since June of 1999. I decided to call Dr. Stanley West of New York, author of "The Hysterectomy Hoax" (Next Decade, Inc., 2002), to ask him about my chances of surviving without HRT.

"You can survive  quite   well without HRT (your grandmother did). Because of the problems  associated with, and the lack of benefit in HRT, we advise women to wean themselves off it, whether or not they have ovaries."

So, with the help of my GP and my gynecologist, I began weaning myself off HRT last December. My prescription was gradually decreased from the highest dose to the lowest. Then I began alternating days, before I attempted to decrease to twice weekly. By June 2004, I had decreased to just once weekly, and then to bi-weekly before I stopped completely about eight weeks ago.

Controlling Hot Flashes

When I reached the once-per-week stage in my weaning off process, the flushes were back, and I became more anxious and frustrated about their effect on my quality of life. My irritability and the abrupt shifts in my mood were indicators that I was in the withdrawal phase, which lasted about 2 weeks.

I began to experience a minimum of 15 violent flushes daily, but instead of giving in, and reaching for my jar of hrt cream, I decided to take control. Out came the fans for instant relief, and then I started thinking about other coping strategies on which I could rely when in need. I came up with several, all of which seem to be working quite well.

• Avoiding stress is crucial to decreasing the frequency and the intensity of hot flashes. I realize that it's hard to achieve a stress-free existence at all times, but once I identified the triggers that brought on stress and strong emotions, I was on my way. I revisit this strategy on a daily basis, reminding myself of the hot result if I don't remain calm.
• Rather than resist the flush, I ride it out. I tell myself that it will be over in a few minutes, and that my accelerated heart rate will be back to normal just as quickly.   
• Deep abdominal breathing works wonders at diminishing the intensity of the flush. 
• I've been wearing light clothing all year round since I underwent the hysterectomy, but cotton material helps me stay the coolest.
• I avoid spicy foods, alcohol and caffeine as much as I can.
• I exercise daily, but never within three hours of my bedtime.

What to do about Night Sweats

• My evenings at home are all about rest and relaxation. Candles and listening to classical or jazz music create the perfectly peaceful atmosphere.
• An extra long soak in the tub is equally relaxing.     
• Before I go to bed, I lower the thermostat or open my bedroom window if it's cool.
• A large fan on the floor by the side of my bed serves me well. 
• I don't drink hot drinks like tea or coffee in the evening. If you can't avoid these completely, try doing without after dinner or at least 3 hours before you go to bed.
• I don't smoke, but those who do can reduce the frequency and intensity of night sweats by avoiding smoking 3 hours before bedtime. Quitting altogether would be more beneficial, but I know that this is easier said than done.

Since I've implemented these strategies, I have managed to decrease my hot flash and night sweat frequency and intensity by 50 percent and things can only get better from this point on.

I knew that for women like me, who may no longer have any ovaries, stopping HRT would take a long time. But I also knew that it was doable, and in my view, much better than exposure to the risk of invasive breast cancer, heart attack, stroke and blood clot

Many of my research contacts pointed out that a woman's body eventually adjusts to functioning without the ovaries and the  hormones they produced. Last year, I was surprised when a pharmaceutical chemist, David Garshowitz at York Downs Pharmacy in Toronto, said the same thing. Given my painless and practically symptom free experience at decreasing and stopping my HRT, they were right.

My final outcome may not be perfect, but I happen to be in agreement with a woman from British Columbia who told me in a recent letter: "I'd rather flush than die."

She makes a good point, don't you think?