Jury Still Out on Routine Dementia Screening for Seniors

By Steven Reinberg
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- There's not yet enough evidence to support screening all older adults for dementia or a less severe condition called "mild cognitive impairment," according to a statement released Monday by the influential U.S. Preventive Services Task Force.

Mild cognitive impairment is a type of mental decline that does not interfere with activities of daily life.

General screening tests for dementia typically involve health professionals asking patients to perform a series of tasks to assess memory, attention, language, and visual-spatial and executive function.

"We found there wasn't sufficient evidence to recommend for or against screening," said task force member Dr. Douglas Owens, a professor of medicine at Stanford University's Center for Health Policy.

"This recommendation applies to people who are completely free of symptoms," Owens said. "If someone has symptoms, they should be evaluated -- that's not screening in the sense we are talking about. We are talking about screening for people who have no symptoms whatsoever."

Screening all older adults for dementia or mild cognitive impairment would only be worthwhile if there were meaningful treatments, Owens said.

"There would need to be interventions that you can do where the benefits would outweigh the harms," he said.

Currently, the benefits of available treatments are "modest to small," Owens said, "and how important those are clinically is uncertain."

More research is needed on how early detection of mental decline could help older adults, their families and their doctors, Owens said.

The new statement, published online March 24 in the journal Annals of Internal Medicine, is the final recommendation, and updates the task force's draft recommendation released in November 2013.

One expert, however, suggested that the task force's recommendation is dodging a very important issue -- an epidemic of dementia.

"Apparently, the task force perceives a need to defend its statement that screening for cognitive impairment is not recommended," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City.

"Like Medicare's decision not to cover [a brain scan for Alzheimer's], the bottom line here is a cost-effectiveness analysis -- in other words, since we have no effective treatment, we should not spend money on proactive diagnosis of dementia," he said.

Many doctors avoid diagnosing dementia because, among other reasons, discussion of a dementia diagnosis with patients and family "is time consuming and the outlook is hopeless," Gandy said.

"The task force's advice that we look the other way can be interpreted as providing justification for this practice and misses an opportunity to elevate the conversation on dementia," he said.

Gandy said a recent report found that Alzheimer's may kill six times as many people as previously believed.

"This figure came as no surprise to dementia specialists," he said. "As long as primary-care physicians and other professionals fail to confront the epidemic status of dementia, the more time will be required before governments take seriously the economic threat of the dementia epidemic."

Heather Snyder, director of medical and scientific operations at the Alzheimer's Association, said there is value in detecting dementia early, despite the task force's stance.

"Their recommendation is that they can't make a recommendation," she said. "It's very important to separate insufficient evidence from no evidence."

The Alzheimer's Association supports early detection and diagnosis of Alzheimer's, Snyder said. "We know there is a better chance that an individual would be able to benefit from the current medications that are available," she said. "They would be able to take advantage of clinical trials and participate in conversations with their family about planning for their care and financial future."

According to the task force, dementia affects approximately 2.4 million to 5.5 million Americans. It results in trouble remembering, speaking, learning new things, concentrating and making decisions that affect daily life.

Alzheimer's disease is one type of dementia. Mental decline is not always as severe as Alzheimer's.

A recent study, published in the March/April edition of the journal Annals of Family Medicine, found that only about 20 percent of people who experience mild cognitive impairment will go on to develop serious brain-related disorders such as Alzheimer's.

Although some people will be stricken with Alzheimer's or other dementia, many will see their symptoms remain the same or disappear, the researchers said.

The U.S. Preventive Services Task Force is an independent, volunteer panel of experts in prevention- and evidence-based medicine. It makes recommendations about clinical preventive services such as screenings, counseling and medications.

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Douglas Owens, M.D., professor of medicine, Center for Health Policy, Stanford University, Palo Alto, Calif.; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; Heather Snyder, Ph.D., director, medical and scientific operations, Alzheimer's Association; March 24, 2014, Annals of Internal Medicine

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Health Tip: Understanding Eye Allergies

(HealthDay News) -- Red, itchy, teary or burning eyes can signal allergies, a condition that affects millions.

But what causes allergies? The American College of Allergy, Asthma, & Immunology mentions these possible triggers:

Pet danderDust mitesMoldPollen, with common sources such as weeds, trees and grass.While not allergens themselves, things like cigarette smoke, diesel exhaust or perfumes can worsen existing symptoms.

-- Diana Kohnle
Copyright © 2014 HealthDay. All rights reserved.

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Toddlers Who Sleep Less May Eat More

TUESDAY, March 25, 2014 (HealthDay News) -- Toddlers who get too little sleep tend to eat more and are at increased risk for obesity, a new study indicates.

The study included children in over 1,300 British families who had their sleep measured when they were 16 months old and their diet checked when they were 21 months old.

Those who slept less than 10 hours a day consumed about 10 percent more calories than those who slept more than 13 hours, according to the study in the International Journal of Obesity.

This is the first study to link amount of sleep to calorie consumption in children younger than 3 years, the University College London (UCL) researchers said. They suggested that shorter sleep may disrupt the regulation of appetite hormones.

"We know that shorter sleep in early life increases the risk of obesity, so we wanted to understand whether shorter sleeping children consume more calories," Dr. Abi Fisher, of the Health Behavior Research Centre at UCL, said in a university news release.

"Previous studies in adults and older children have shown that sleep loss causes people to eat more, but in early life parents make most of the decisions about when and how much their children eat, so young children cannot be assumed to show the same patterns," she added.

Although the study found an association between toddler's sleeping less and eating more, it did not prove a cause-and-effect relationship.

The main message from the study "is that shorter-sleeping children may [be] prone to consume too many calories. Although more research is needed to understand why this might be, it is something parents should be made aware of," Fisher concluded.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCE: University College London, news release, March 24, 2014

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Blindness Rates Dropping Worldwide, Study Finds

MONDAY, March 24, 2014 (HealthDay News) -- Global rates of blindness and poor vision have fallen sharply over the past two decades, especially in rich nations, a new study reveals.

And providing eyeglasses for common vision-loss problems could improve the situation even more, according to the researchers.

The investigators analyzed 243 studies conducted in 190 countries and found that rates of blindness and poor vision fell by 37 percent and 27 percent, respectively, from 1990 to 2010.

In wealthy nations, the prevalence rate of blindness dropped by half, from 3.3 million people (0.2 percent of the population) to 2.7 million people (0.1 percent of the population), the findings showed.

In those countries, the rate of poor vision decreased 38 percent, from 25.4 million people (1.6 percent of the population) to 22.2 million people (1 percent of the population).

In high-income countries, women were more likely than men to be blind or to have poor vision throughout the study period.

The study was published online March 24 in the British Journal of Ophthalmology.

During the 20-year study timeframe, macular degeneration replaced cataracts as the most common cause of blindness, except in central and eastern European nations, according to a journal news release. The most common cause of poor vision remained uncorrected refractive errors such as long- and short-sightedness.

The findings show "that even for the highly developed countries one of the most effective, cheapest, and safest ways of improving vision loss by providing adequate spectacles for correcting refractive errors, is being overlooked," study author Rupert Bourne, a professor with the vision and eye research unit at Anglia Ruskin University, in Cambridge, England, and colleagues wrote.

They added that the growing number of people with diabetes will have a major effect on eye health worldwide, with as many as 100 million people expected to develop an eye disease called diabetic retinopathy. Of those, about one-third will be at risk of losing their vision.

"Strategies to screen for diabetic retinopathy and provide timely treatment access are critical to prevent this condition from having a greater impact on blindness prevalence in the future," the researchers concluded.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCE: British Journal of Ophthalmology, news release, March 24, 2014

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Health Tip: Enjoying Warm Weather Fitness

(HealthDay News) -- When the snow finally begins to melt and the weather starts turning warmer, the improving forecast offers great motivation to get moving.

The Weight Control Information Network offers these suggestions for warm weather exercise:

Jump in the pool and swim some laps.Stroll through the zoo, a museum or an aquarium.Talk a walk through the nearest farmer's market and pick up fresh fruits and vegetables.Start a neighborhood garden.At least twice weekly, lift weights and do some push-ups.On hot days, work out indoors to a DVD. Remember to drink plenty of water.

-- Diana Kohnle
Copyright © 2014 HealthDay. All rights reserved.

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E-Cigarettes Won't Help You Quit, Study Finds

By Steven Reinberg
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- Contrary to some advertising claims, electronic cigarettes don't help people quit or cut down on smoking, a new study says.

Users of e-cigarettes inhale vaporized nicotine but not tobacco smoke. The unregulated devices have been marketed as smoking-cessation tools, but studies to date have been inconclusive on that score, the study noted.

"When used by a broad sample of smokers under 'real world' conditions, e-cigarette use did not significantly increase the chances of successfully quitting cigarette smoking," said lead researcher Dr. Pamela Ling, an associate professor at the Center for Tobacco Control Research and Education at University of California, San Francisco.

These findings -- based on nearly 1,000 smokers -- are consistent with other studies and contradict the claims frequently found in e-cigarette advertising, she said.

"Advertising suggesting that e-cigarettes are effective for smoking cessation should be prohibited until such claims are supported by scientific evidence," Ling said.

For the study, Ling's team analyzed data reported by 949 smokers, 88 of whom used e-cigarettes at the start of the study.

One year later, 14 percent of the smokers had quit overall, with similar rates in both groups.

"We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not," Ling said.

There was no relationship between e-cigarette use and quitting, even after taking into account the number of cigarettes smoked per day, how early in the day a smoker had a first cigarette and intention to quit smoking, Ling added.

However, the researchers noted that the small number of e-cigarette users may have limited the ability to find an association between e-cigarette use and quitting.

The report, published online March 24 in JAMA Internal Medicine, also found that women, younger adults and people with less education were most likely to use e-cigarettes.

One expert said the study is flawed and shouldn't be taken seriously.

"It's an example of bogus or junk science," said Dr. Michael Siegel, a professor of community health sciences at Boston University School of Public Health.

"That's because the study does not examine the rate of successful smoking cessation among e-cigarette users who want to quit smoking or cut down substantially on the amount that they smoke, and who are using e-cigarettes in an attempt to accomplish this," Siegel said. "Instead, the study examines the percentage of quitting among all smokers who have ever tried e-cigarettes for any reason."

Many of the smokers who tried e-cigarettes may have done so out of curiosity, Siegel said.

"It is plausible, in fact, probable, that many of these 88 smokers were not actually interested in quitting or trying to quit with electronic cigarettes," he said. "These products have become very popular and have gained widespread media attention, and it is entirely possible that many of these smokers simply wanted to see what the big fuss is all about."

Calling that a "fatal flaw" in the research, Siegel said it "destroys the validity of the authors' conclusion."

It would be a tragedy, he said, if policy makers use the study to draw conclusions about the effectiveness of e-cigarettes for smoking cessation purposes.

Erika Ford, assistant vice president for national advocacy at the American Lung Association, said the study confirms what is already clear -- "e-cigarettes are not associated with quitting among smokers."

Ford noted that most e-cigarette companies no longer make claims that their products help smokers quit. "But there is a need for the FDA [U.S. Food and Drug Administration] to begin their oversight of these products. It's time for the FDA to find out which products are making no smoking claims and which ones might be in violation of current law," she said.

The FDA plans to introduce regulations for e-cigarettes, but hasn't yet. In the past, the agency has warned companies about making false claims and for poor manufacturing practices.

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Pamela Ling, M.D., M.P.H., associate professor, Center for Tobacco Control Research and Education, University of California, San Francisco; Michael Siegel, M.D., M.P.H., professor, Department of Community Health Sciences, Boston University School of Public Health; Erika Ford, assistant vice president for national advocacy, American Lung Association; March 24, 2014, JAMA Internal Medicine, online

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Spanking Triggers Vicious Cycle, Study Finds

By Dennis Thompson
HealthDay Reporter

TUESDAY, March 25, 2014 (HealthDay News) -- Parents who spank unruly children may not know it, but they are participating in a vicious cycle that will lead to both more spankings and more misbehavior in coming years, a new study suggests.

Researchers wanted to resolve the age-old "chicken-and-egg" question that surrounds the issue of physical discipline in childhood -- do spankings promote aggression in children, or do naturally aggressive children simply receive more spankings as parents try to control their behavior?

The answer is yes to both, said study author Michael MacKenzie, an associate professor at the Columbia University School of Social Work in New York City.

Across a child's first decade of life, current spankings will lead to future misbehavior -- but current misbehavior also will lead to future spankings, the investigators found.

"You can think of it as an escalating arms race, where the parent gets more coercive and the child gets more aggressive, and they get locked into this cycle," MacKenzie said. "These processes can get started really early, and when they do there's a lot of continuity over time."

The findings are based on almost 1,900 families from the Fragile Families and Child Wellbeing Study. That's a decade-old research project conducted by researchers at Columbia and Princeton universities involving children born in 20 large American cities between 1998 and 2000.

Families in the study took part in assessments shortly after giving birth and when the children were approximately 1, 3, 5 and 9 years old. These assessments included questions about whether the children received spankings and the extent to which the children behaved aggressively, broke rules or acted surly or antagonistic.

About 28 percent of mothers reported spanking their children during their first year of life, increasing to 57 percent at age 3 and then hovering around 53 percent at age 5 and 49 percent at age 9.

But researchers also found that at each age, children who exhibited more behavioral problems went on to experience more spanking at a later age, indicating that the more difficult children might prompt increasing levels of punishment from their parents.

"Some children are eliciting higher levels of physical discipline, and high levels of physical discipline are in turn associated with later higher levels of parental aggression," MacKenzie said.

Even though the study shows that spanking and misbehavior tend to feed each other, the investigators also found strong evidence that spanking a child within the first year of life likely is the catalyst that starts the cycle.

These findings put an end to the "chicken or the egg" debate over which comes first, the spanking or the childhood misbehavior, said Dr. Andrew Adesman, chief of developmental & behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York in New Hyde Park, N.Y.

"I see it starting with the egg, with the egg being the spanking, and then the spanking then leads to more aggressive behavior, and the aggressive behavior then leads to more spanking," Adesman said.

The findings are published in the March 25 online issue of the Journal of Youth and Adolescence.

If parents can stick to non-physical forms of punishment when a toddler acts out, they are more likely to have a well-behaved child at ages 3, 5 and 9, he said.

"During the early toddler years, parents probably need to get more counseling or advice on strategies for managing children's behavior without resorting to spanking," Adesman said.

Unfortunately, MacKenzie said, it can be tough to avoid the urge to spank, given how stressed and overwhelmed many young parents can become.

"Spanking gives very immediate feedback, because children will stop doing what they were doing, but it's not giving children the ability to regulate themselves over time," he noted.

"But parenting is not an easy thing, and challenging kids make the job even tougher," MacKenzie explained. "We need to give these parents the support they need to do as well as they'd like by their children."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Michael MacKenzie, associate professor, Columbia University School of Social Work, New York City; Andrew Adesman, M.D., chief, developmental & behavioral pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, N.Y.; March 25, 2014, Journal of Youth and Adolescence, online

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Tiny Wireless Pacemaker Shows Early Promise

By Dennis Thompson
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- A new wireless pacemaker appears safe and feasible for use, potentially advancing the technology that cardiologists use to maintain heart rhythm in patients, according to results from a new clinical trial.

Doctors successfully implanted the device in 32 out of 33 patients. Of these, two people who received the pacemaker developed side effects -- a complication-free rate of 94 percent. Complications for the patient with unsuccessful implantation, however, proved to be severe.

After three months, the new pacemakers continued to function well, the researchers reported in the April 8 issue of the journal Circulation. They expect to report longer-term outcomes later this year.

The concept of a self-contained wireless pacemaker has been around more than 40 years, and this first successful use of such a device to treat humans is considered a step forward for cardiology.

"This is an advance that will have a huge impact on the field," said Dr. Bradley Knight, a cardiologist at the Northwestern University Feinberg School of Medicine and a spokesman for the American Heart Association. "This opens up a whole bunch of new potential opportunities for pacing a patient's heart."

Today's pacemakers maintain the heart's rhythm by sending electrical signals through wires that run from the device into the heart through a person's veins, said the study's lead author, Dr. Vivek Reddy, director of the cardiac arrhythmia service at Mount Sinai Hospital in New York City.

"These leads are the weak link for the whole system," Reddy said of the wires. The leads tend to break over time, and when they do doctors must extract and replace them.

Unfortunately, the wires sometimes grow into the wall of the vein, and laser surgery could be required to cut them free.

This new wireless pacemaker contains its own pulse generator, and is affixed directly inside the right ventricle of the heart through a catheter run up a vein from a patient's leg or groin, Reddy said. The nonsurgical procedure is faster and easier than the surgery currently required to implant a pacemaker, the researchers said.

The unit itself is smaller than a triple-A battery -- 6 millimeters in diameter and about 42 millimeters long. "The total amount of space it displaces is about 1 cc of fluid, so it's very, very small," Reddy said.

The wireless pacemaker is expected to operate for eight to 14 years before it runs out of juice, Reddy said.

The pacemaker is manufactured by Nanostim Inc., of Sunnyvale, Calif. The study was funded by Nanostim, which, according to the study, employs two of the researchers and has provided several more with grant support. Reddy also has stock options in the company.

The clinical trial for the device involved 33 patients at two hospitals in Prague and one in Amsterdam. The average age of the patients was 77, and two-thirds were men.

One patient experienced complications during the implant procedure, and this case highlights one of the potential problems with the new pacemaker, Reddy and Knight said.

Since the device must be placed inside the heart, there is a risk that the heart muscle can be torn during the procedure. That's what happened to the 33rd patient, who underwent emergency surgery to repair the tear but later died after suffering a stroke.

Two patients who successfully received the implant later developed complications.

In one patient, the pacemaker drifted into another heart chamber through a hole in the person's heart wall left by a birth defect. Doctors discovered the problem, removed the device in about six minutes and replaced it with another wireless pacemaker, according to the study.

The second patient with complications experienced fainting and rapid heart beat, and doctors ended up replacing the pacemaker with an implantable cardioverter-defibrillator.

Also, the pacemaker initially would be of limited use in the United States because it can only provide pacing to one chamber of the heart. Between 75 percent and 80 percent of patients in the United States need pacemakers that help control the rhythm of both the upper and lower chambers of their heart, Reddy said.

This wireless pacemaker would at first be useful in treating people who have atrial fibrillation -- an irregular heartbeat -- since they need pacing only in their right ventricle, Knight said. It also could help people with less severe heart problems who need only intermittent pacing.

Knight said he believes problems related to heart tears and single-chamber pacing will be resolved as newer, smaller models of wireless pacemaker become available.

"This is just the beginning," he said. "These things will get smaller and be able to be placed in multiple locations in the heart."

For example, dual-chamber pacemaking could be achieved using a pair of the wireless devices -- one in the upper atrial chamber and another in the lower ventricular chamber -- if communication is established between them to sync their pulses.

Clinical trials for the device already have begun in the United States, Reddy said. The first American received a wireless pacemaker about a month ago at Mount Sinai Hospital.

Researchers hope the device can receive approval from the U.S. Food and Drug Administration by 2016. The wireless pacemaker currently is available to patients outside the United States, Reddy said.

The medical device firm Medtronic has developed a competing wireless pacemaker, Reddy said, and clinical trials for that device started in late 2013.

Because of the competition, Reddy expects that the new pacemakers will be more expensive than current devices but not exorbitantly so.

"I'm sure they'll charge a premium in the beginning, but if there's any competition they can't charge too much more," he said.

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Vivek Reddy, M.D., director, cardiac arrhythmia service, Mount Sinai Hospital, New York City; Bradley Knight, M.D., cardiologist, Northwestern University Feinberg School of Medicine, Chicago, and spokesman, American Heart Association; April 8, 2014, Circulation

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Medical Marijuana Pills May Ease Some MS Symptoms: Review

By Maureen Salamon
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- Medical marijuana pills and sprays might ease the symptoms of multiple sclerosis, but most other alternative therapies do little to lessen the pain and muscle rigidity that often accompanies the disease, according to new guidelines.

To reach that conclusion, an expert panel from the American Academy of Neurology reviewed more than 40 years of research on alternative medicine treatments for multiple sclerosis (MS).

In addition to the recommendations about medical marijuana use, the nine experts also found that ginkgo biloba might help with the fatigue of MS and reflexology may ease MS symptoms such as tingling, numbness and other unusual skin sensations. Bee sting therapy and omega-3 fatty acids, however, offer weak evidence supporting their use.

"It's a very common practice in the MS patient population to try alternative therapies," said the author of the guidelines, Dr. Vijayshree Yadav, clinical director of Oregon Health & Science University's MS Center, in Portland.

"The problem is there was never an evidence-based recommendation for MS patients or those taking care of patients," Yadav said. "This is a first step to educate each audience."

The guidelines are published in the March 25 issue of the journal Neurology.

Affecting more than 2.3 million people worldwide, MS causes a variety of symptoms such as loss of balance, vision loss, bowel problems, slurred speech and numbness, which can come and go. The disease of the central nervous system is thought to be caused by an inflammatory response of the immune system, which attacks nerve tissue in the brain and spinal cord.

According to the academy, two types of conventional drugs are available for the incurable disorder: disease-modifying therapies, which can slow progression and reduce the number of relapses, and symptomatic therapies, which relieve some symptoms but don't affect the course of the disease.

Of all the alternative therapies reviewed, the experts' strongest support was for medical marijuana pills and spray, which moderate evidence indicated could ease MS patients' pain, frequent urination and muscle rigidity known as spasticity. Not enough evidence showed whether smoking marijuana is helpful in treating MS symptoms, Yadav added.

The researchers said there can be serious side effects with medical marijuana, such as seizures, dizziness, thinking and memory problems, and depression. Since some people with MS face a higher risk for depression and suicide, patients should discuss the safety of medical marijuana with their doctor.

Between 33 percent and 80 percent of MS patients use various alternative therapies to treat their symptoms, especially women, those with higher education levels and those reporting poorer health, according to the academy. But the safety of most of these therapies is unknown, and most are not regulated by the U.S. Food and Drug Administration.

Timothy Coetzee, chief advocacy, services and research officer for the National MS Society, was not involved in crafting the guidelines, but said the potential of marijuana and its derivatives as a treatment for MS symptoms is important. "I think it really emphasizes our approach to support the rights of people with MS to work with their doctors, recognizing that they need to do this in the context of the legal regulations of the state they're in," he said.

Marijuana-based spray isn't legally available in the United States, Yadav said, but is sometimes obtained by U.S. patients from Canada, where the spray is legally available.

Man-made marijuana pills, known as dronabinol and nabilone, are FDA-approved for nausea and vomiting associated with chemotherapy. Yadav said MS patients can be prescribed the pills as an "off-label" use, at their doctors' discretion.

Yadav said she was surprised to find benefits from the use of an alternative treatment known as magnetic therapy, in which magnets are placed on the skin to produce a magnetic force that is thought to improve body function. Moderate evidence showed magnetic therapy reduced tiredness in MS patients, but it did not help with symptoms of depression.

Coetzee said the guidelines are important because they will help inform conversations between people with MS and their doctors about strategies they can employ to reduce symptoms, which are often a combination of conventional and alternative therapies.

"We're at a place where we need to continue to understand and better appreciate the benefits of what we know and don't know about [alternative medicine]," he said. "I view it as integrated care. It's important we continue to keep our options open so people with MS can live their best lives."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Vijayshree Yadav, M.D., clinical director, Oregon Health & Science University MS Center, Portland; Timothy Coetzee, Ph.D., chief advocacy, services and research officer, National Multiple Sclerosis Society; March 25, 2014, Neurology

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Many Don't Understand Obamacare or Health Insurance, Survey Finds

By Amy Norton
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- As the deadline looms for Americans to enroll in "Obamacare" this year, a new study finds that many people -- especially the uninsured and those with lower incomes -- know little about the new health care law, known as the Affordable Care Act.

Most significantly, researchers found, Americans show little understanding of the cornerstone of the reform -- the online marketplaces, or "exchanges," that have been set up to help people shop for an insurance plan, and find out if they're eligible for Medicaid or subsidies to help pay for their health insurance.

Overall, half of the 6,000 U.S. adults surveyed did not even know what an exchange was, and among the uninsured, a full 64 percent didn't know. In addition, over 40 percent of survey respondents did not know what an insurance deductible was, including nearly 60 percent of the uninsured.

Experts were concerned by the findings, reported in the March 24 online edition of the Proceedings of the National Academy of Sciences. But they were not shocked.

"No, this doesn't surprise me at all," said Dr. Kavita Patel, a fellow at the Washington, D.C.-based Brookings Institution.

Low "health literacy" -- people's understanding of health information and ability to use it -- is a well-known problem, and not limited to health care reform, noted Patel, who was not involved in the study.

To be fair, the new report is based on a survey done in August and September of last year -- before the state and federal exchanges were up and running, and before the troubled federal website was grabbing headlines everywhere.

By now, Americans may know more, according to Silvia Barcellos, an economist at the University of Southern California who led the study.

She said she and her colleagues are planning a follow-up survey in April to see if there has been a change.

Regardless, Barcellos said, the current findings are worrisome, especially the lack of awareness among the uninsured.

"These are the people everyone is counting on to enroll," she noted.

And the problems go beyond awareness of the exchanges. "Many people lack a basic understanding of how health insurance works," Barcellos said.

March 31 is the deadline for enrolling for insurance coverage for 2014 under the Affordable Care Act.

Of all survey respondents, 42 percent did not know what an insurance deductible was -- including 58 percent of the uninsured.

The same was true for 30 percent to 45 percent of those living between 100 percent and 400 percent of the federal poverty level. Many of those Americans are eligible for tax credits to help pay for insurance bought through the exchanges. They are another group that stands to benefit the most from the Affordable Care Act.

But if uninsured and lower-income people don't understand how health insurance works, Barcellos said, "how can you expect them to make informed decisions when they choose a plan?"

Sharon Long, of the Urban Institute's Health Policy Center in Washington, D.C., agreed.

"Health insurance is complicated, and we're talking about people who may never have had it in the past," said Long, who was not involved in the study. "It's ironic that we're asking people without that experience to make good choices."

Brookings' Patel pointed out that this problem was anticipated. Federal and state governments have so-called navigator programs to help applicants get through the enrollment process. Those navigators include individuals and groups -- from nonprofits to hospitals to church groups -- who are trained and certified (and paid) by the government.

"The role of the navigators is important," study author Barcellos said. But, she added, people also need to know the programs exist.

There are other potential ways to make the exchanges more user-friendly, according to Barcellos. One step, she said, could be to redesign the exchange websites to "nudge" people to the best plans -- by highlighting certain economical and better-quality plans on the first page of the site.

Barcellos said research has shown that when people have too many choices -- especially complex ones -- their tendency is to opt for whatever seems easiest.

"Or," she said, "they may make no choice at all."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Silvia Helena Barcellos, Ph.D., research scientist, University of Southern California Center for Economic and Social Research, Playa Vista, Calif.; Kavita Patel, M.D., managing director, clinical transformation and delivery, Brookings Institution, Washington, D.C.; Sharon Long, Ph.D., senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; March 24, 2014, Proceedings of the National Academy of Sciences, online

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Violent Video Games Tied to Combative Thinking in Study

By Alan Mozes
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- Frequent exposure to violent video games increases the likelihood that children and teens will engage in aggressive behavior themselves, new research indicates.

The study of more than 3,000 children found that habitually playing games such as "Call of Duty" and "God of War" might alter their view of their real-world environment and peers, the researchers said.

"[Violent gaming] basically changes a child's or adolescent's personality in some sense, so that they start to see their world in a more aggressive way," said study co-author Craig Anderson, director of the Center for the Study of Violence at Iowa State University.

"They start to expect people to behave more aggressively toward them, and they tend to see aggressive solutions as being more appropriate for solving problems," Anderson said.

More than 90 percent of American kids play video games, many of which portray violence in a fun framework free of negative consequences, the researchers said. Because of these large numbers, research such as this has significant implications, they said.

Still, parents shouldn't panic, Anderson said.

"Playing a violent video game isn't going to take a healthy kid who has few other risk factors and turn him into a school shooter," he said. "But it is a risk factor that does drive the odds for aggression up significantly."

Anderson said there are many other known risk factors for aggression, such as growing up with parents who are visibly aggressive or living in a violent neighborhood.

The children enrolled in the study, which was published online March 24 in the journal JAMA Pediatrics, came from six primary and six secondary schools in Singapore. All were between 8 and 17 years old, and nearly three-quarters were boys.

For three years, the students were surveyed annually about the time they spent playing video games and about the nature of their favorite games.

In addition, the children discussed their feelings of empathy and aggression, and were asked about any past aggressive behaviors. For example, children were asked if they felt it was OK to respond to certain provocative situations by hitting someone, whether they ever thought about hurting a peer and whether seeing someone else who was upset bothered them.

By stacking violent video game habits up against aggressive thought patterns and behavior, the investigators determined that during the three-year study period kids with a lot of exposure to violent video games were more likely to engage in aggressive behavior.

This link seemed to result from a lasting increase in aggressive thinking, the researchers said. That included a rise in aggressive fantasies, and a growing tendency to attribute hostile motives to others.

The shifts in thinking associated with heavy use of violent games occurred for both girls and boys, even when parents monitored their child's gaming habits. The changes were also found to be independent of a child's initial aggressiveness, the study found.

The researchers also said having feelings of empathy didn't seem to dampen the link between violent gaming and aggression, and the link was seen more or less across all age groups.

The authors said more research is needed to better understand the effects of playing video games that glorify brutality. "[But] at least one major reason aggressive behavior went up in children is because violent video games seemed to increase a child's violent thought patterns," Anderson said.

Richard Gallagher, director of the Parenting Institute at the New York University Child Study Center, said he wasn't surprised by the findings.

"Research data with persons of all ages has consistently indicated that playing violent video games does change attitudes and does possibly alter behavioral tendencies," he said. "And it's looking like it shifts kids to what's considered to be a kind of disturbed and biased thinking."

This is important for people to know in terms of public policy and parenting, Gallagher said.

"These kinds of games are not benign," he said. "They might not cause all kids to get involved with negative and aggressive behavior, but they do push them more in that direction."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Craig Anderson, Ph.D., distinguished professor, psychology, and director, Center for the Study of Violence, Iowa State University, Ames, Iowa, and past president, International Society for Research on Aggression; Richard Gallagher, Ph.D., director, Parenting Institute, and associate professor, New York University Child Study Center, New York City; March 24, 2014, JAMA Pediatrics, online

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New Guidelines Might Limit Need for Lymph Node Removal for Breast Cancer

MONDAY, March 24, 2014 (HealthDay News) -- Biopsies of so-called "sentinel" lymph nodes under the arms should become more widespread among breast cancer patients, according to updated guidelines from the American Society of Clinical Oncology (ASCO).

The group, which represents cancer specialists, said the new recommendations should also restrict the number of women who will require further removal of multiple nodes after biopsy, cutting down on painful side effects.

In sentinel lymph node biopsy, a few lymph nodes are removed and checked for signs of cancer -- hence the name "sentinel." Usually, if these lymph nodes have no cancer, it means the remaining, unchecked lymph nodes should also be cancer-free.

The new ASCO recommendations expand eligibility for sentinel node biopsy and will reduce the number of patients who undergo a more invasive procedure called axillary -- underarm -- lymph node dissection, which carries a higher risk of complications, the group said.

In axillary lymph node dissection, most lymph nodes under the arm on the same side as the breast tumor are removed and examined for cancer. This procedure can cause long-term side effects such as pain and numbness in the arm and swelling due to a build-up of lymph fluid.

The new guidelines state that for women whose sentinel lymph nodes show no signs of cancer, removal of more underarm lymph nodes is not recommended.

The guidelines also addressed the case of women who undergo lumpectomy instead of full mastectomy and are also scheduled for whole-breast radiation therapy to help "mop up" residual cancer. If these patients have signs of cancer in only one or two sentinel lymph nodes upon biopsy, they too may opt to avoid further node removal, the ASCO experts said.

Women who have undergone mastectomy but show signs of cancer's spread in sentinel lymph nodes should be offered further node removal, the guidelines reaffirmed.

The ASCO also said women who are diagnosed with certain breast cancers while pregnant can skip sentinel node biopsy.

The ASCO issued initial guidelines on sentinel node biopsy in 2005. The new guidelines, published March 24 in the Journal of Clinical Oncology, are based on the findings of a panel of experts who reviewed studies published between 2004 and 2013.

"The updated guideline incorporates new evidence from more recent studies -- nine randomized controlled trials and 13 cohort studies since 2005," panel co-chairman Dr. Armando Giuliano said in an ASCO news release.

"Based on these studies, we're saying more patients can safely get sentinel node biopsy without axillary lymph node [removal]," he said. "These guidelines help determine for whom sentinel node biopsy is appropriate."

Panel co-chairman Dr. Gary Lyman said, "We strongly encourage patients to talk with their surgeon and other members of their multidisciplinary team to understand their options and make sure everybody is on the same page."

"The most critical determinant of breast cancer prognosis is still the presence and extent of lymph node involvement," he said. "Therefore, the lymph nodes need to be evaluated so we can understand the extent of the disease."

Two breast cancer specialists welcomed the new guidelines.

"Over the past few years, there has been a movement to limit the amount of axillary [lymph node] surgery in patients undergoing breast conservation," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

Bernik said the new guidelines are important because some doctors have been reluctant to move away from further underarm node removal when a patient has even one affected sentinel node. "This update will give surgeons the confidence to tell patients that a sentinel lymph node biopsy may be enough, even if there is evidence of spread, in patients undergoing [lumpectomy]," Bernik said.

"However, it is still important for surgeons to discuss the pros and cons with a patient, as not all [real-world] patients fit the study criteria," she said. "Furthermore, it needs to be stressed that the more limited surgery does not apply to women undergoing mastectomies."

Dr. Debra Patt is the medical director of an expert panel that assesses cancer care guidelines for the US Oncology Network. She said she was "thrilled" at the new ASCO guidelines because they seem to echo the results of recent studies.

"In 2010, a study presented at the ASCO annual meeting showed that women undergoing breast-conservation surgery with clinically node-negative small breast cancers could safely avoid removing all the lymph nodes from under the arm in most cases," Patt said. "There has been greater variance in treatment patterns in my community practice, and I believe these updated guidelines will direct practitioners to evidence-based patient care."

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCES: Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Debra Patt, M.D., medical director, Pathways Task Force and Healthcare Informatics, US Oncology Network; American Society of Clinical Oncology, news release, March 24, 2014

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New Therapy May Shrink Enlarged Prostate With Fewer Side Effects: Study

MONDAY, March 24, 2014 (HealthDay News) -- A new noninvasive procedure may bring long-term relief from symptoms caused by an enlarged prostate, a new study suggests.

As men age, the prostate gland grows larger and may begin to press on the urethra. Enlarged prostate affects more than half of men by age 60 and causes symptoms such as frequent urination, weak urine stream and a persistent feeling of having to urinate.

Surgery is the standard treatment for the condition, but can cause complications such as sexual dysfunction and impotence, experts note.

The new treatment is called prostate artery embolization. "Prostate artery embolization is a promising therapy that has been performed outside the United States to improve men's symptoms," explained Dr. Man Hon, chief of interventional radiology at Winthrop University Hospital in Mineola, N.Y.

"This procedure works by closing the blood supply to the prostate," said Hon, who was not involved in the new study. "As a result, the prostate shrinks in size, causes less blockage, and the symptoms improve."

The study was conducted in Portugal and included nearly 500 men, aged 45 to 89, with enlarged prostate -- formally called benign prostatic hyperplasia -- who underwent prostate artery embolization.

Improvements in symptoms were reported by 87 percent of men three months after the procedure, 80 percent after 18 months, and 72 percent after three years. The procedure did not cause sexual dysfunction or impotence, according to the findings, which were slated for presentation on Monday at the annual meeting of the Society of Interventional Radiology (SIR), in San Diego.

"The results of prostate artery embolization (PAE) are similar to surgery but with fewer complications," study author Dr. Martins Pisco, director of radiology at Saint Louis Hospital in Lisbon, said in a meeting news release. "Patients are discharged three to six hours after the treatment with most of the individuals we've treated noting almost immediate symptom relief."

"I believe PAE could eventually become standard treatment for enlarged prostate," he added.

However, Dr. James Spies, president elect of SIR, stressed that further studies are needed before the procedure could become widely available. Also, studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Another expert agreed that more study is needed. Dr. Manish Vira is director of the Fellowship Program in Urologic Oncology at The Arthur Smith Insitute for Urology in New Hyde Park, NY. He pointed out that the Portuguese study was not designed to compare the success rate of embolization to that of other treatments.

However, Vira added that "the results are especially significant given the very low complication rate and no incontinence. If these results are replicated in the ongoing U.S. trials, then prostate artery embolization will become an attractive treatment option" for men with enlarged prostate who have not responded well to other treatments.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCES: Manish A. Vira, M.D, director, Fellowship Program in Urologic Oncology, The Arthur Smith Institute for Urology, New Hyde Park, NY; Man Hon, M.D, chief, interventional radiology, Winthrop University Hospital, Mineola, NY; Society of Interventional Radiology, annual meeting news release, March 24, 2014

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Targeted Radiation Might Help Fight Advanced Breast Cancer: Study

MONDAY, March 24, 2014 (HealthDay News) -- A minimally invasive treatment that delivers radiation directly to tumors may slow progression of breast cancer that has spread to the liver, a new study suggests.

The treatment is called yttrium 90 (Y-90) radioembolization. Doctors insert a catheter through a tiny cut in the groin and guide it into the artery that supplies the liver. Radiation-emitting micro beads are then sent through the catheter and float out to kill small blood vessels that feed the tumor.

Researchers led by Dr. Robert Lewandowski, an associate professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, looked at the outcomes of 75 patients. The women ranged in age from 26 to 82, and had chemotherapy-resistant breast cancer that had spread to the liver ("metastatic" disease). Their liver tumors were too large or too numerous to be treated with other methods, the authors noted.

Y-90 radioembolization therapy stabilized 98.5 percent of the treated liver tumors, according to the study, which was to be presented Monday in San Diego at the annual meeting of the Society of Interventional Radiology.

In addition, 24 of the women experienced a more than 30 percent shrinkage in tumor size after treatment, which caused few side effects.

"Although this is not a cure, Y-90 radioembolization can shrink liver tumors, relieve painful symptoms, improve the quality of life and potentially extend survival," Lewandowski said in a society news release.

"While patient selection is important, the therapy is not limited by tumor size, shape, location or number, and it can ease the severity of disease in patients who cannot be treated effectively with other approaches," he added.

Two breast cancer experts were cautiously optimistic about the findings.

According to Dr. Neelima Denduluri, "while these results appear promising, this is a very small retrospective study," meaning that it fell short of the "gold standard" type of prospective trial that tracks patients going forward over time. "Randomized controlled prospective studies addressing this issue are necessary before radioembolization can be incorporated routinely," she believes.

For now, "in women that cannot receive systemic therapy due to toxicities [side effects], are not eligible for clinical trials that utilize new agents, or have exhausted conventional chemotherapy options, radioembolization may be a choice," said Denduluri, a medical oncologist with Virginia Cancer Specialists in Arlington, Va., a US Oncology Network affiliate.

Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She said that while this type of therapy has been used to fight liver tumors, "the ability to use this therapy in treatment of metastatic breast cancer to the liver offers some hope to patients with the disease."

Bernik stressed that, right now, the treatment can only extend survival for women with advanced breast cancer, it is not a cure. However, "as the technique is modified and perfected, it is hoped the [treatment] can help achieve remission in women with advanced disease."

Each year in the United States, about 117,000 patients are diagnosed with breast cancer that has spread to the liver. Chemotherapy is the standard treatment in such cases, but is not effective in, or suitable for, all patients.

Experts note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCES: Neelima Denduluri, M.D., medical oncologist, Virginia Cancer Specialists, Arlington, Va., a US Oncology Network affiliate; Stephanie Bernik, M.D., chief of surgical oncology, Lenox Hill Hospital, New York City; Society of Interventional Radiology, news release, March 24, 2014

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Anti-Seizure Drug May Guard Against Some Cancers

MONDAY, March 24, 2014 (HealthDay News) -- A drug used to treat seizures may reduce the risk of head and neck cancers, a new study suggests.

Valproic acid (Depakote) is prescribed to prevent seizures and also to control mood, but it is also being investigated for cancer prevention because it inhibits genetic changes that can lead to cancer.

The new study included nearly 440,000 U.S. veterans, including about 27,000 who were taking valproic acid for bipolar disorder, post-traumatic stress disorder (PTSD), migraines and seizures. Overall, veterans who took the drug for at least one year were 34 percent less likely to develop head and neck cancers than those who didn't take the drug, the investigators found.

The risk appeared to be even lower in those who took it in higher doses or for longer periods of time, according to the study published online March 24 in the journal Cancer.

Veterans who took valproic acid did not have a reduced risk for lung, bladder, colon or prostate cancers, said team leader Dr. Johann Christoph Brandes, of the Atlanta Veterans Affairs Medical Center and Emory University in Atlanta, and colleagues.

"A 34 percent risk reduction for the development of head and neck cancer with [valproic acid] use could result in the prevention of up to approximately 16,000 new cases and 3,000 to 4,000 annual deaths in the U.S. alone," Brandes said in a journal news release.

"Head and neck cancer is an important global health crisis, and low cost and low toxicity prevention strategies like [valproic acid] use have a high potential impact on pain, suffering, costs, and [death] associated with this disease," he added.

Although the study found an association between valproic acid use and reduced risk of certain cancers, it did not prove cause-and-effect.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCE: Cancer, news release, March 24, 2014

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10 Tips for Reading Body Language

Attention is the basis for effective interpretation of non-verbal communication. Constantly watch the gestures, facial expressions, postures of the person. It is the only way to be able to consolidate and improve this skill.

You need to remember that the signs of cheating as such do not exist: there is no single gesture, facial expression or involuntary muscle contractions which by itself would mean that the person is lying. Gestures, posture, facial expressions, voice, expressing the fear and anxiety of an innocent person can be observed in a liar. It is the observation in the context that helps distinguish the fear of groundless accusations from the fear of being exposed.

Some movements are almost impossible to control. Such as pulling down the corners of the mouth, which is very difficult to portray without experiencing negative emotions.

These are individual non-verbal signals peculiar to a particular person. To determine these signals, you need to know the person well enough. For example, if your friend bites his lips or strokes his hand before the interview or examination, it is a sign of excitement which reveals lack of confidence. In any future stressful situation the same signs will show up again.

The basic behavior pattern includes one’s body movements, posture, facial expressions peculiar to a person in the state of comfort or everyday life. We cannot see the deviations if we do not know what it looks like in the normal state.

In other words, consider the characteristic movements in the complex, draw conclusions on the basis of a number of credible and expressive gestures.

These may be gestures of uncertainty, and vice versa gestures of openness (or gestures of confidence) if the situation changes and the person feels comfortable and confident. If he is not sure of his words or actions, it will be expressed in the body language.

The skill of recognition of false or deceptive nonverbal signals comes with experience. We can meet people who know and confidently use non-verbal means of communication, using the necessary gestures to convince us of their honesty. Try to notice the contradictions in the body language and behavior of such people. You need to understand what kind of person is before you.

For example a person who wants to convince others of his sincerity will use gesture of open hands, but if at the same time his legs are closed it is likely that he is lying.

It will help you focus on the elements of behavior that can play the most important role in decoding nonverbal messages.

Conventionally, the human condition can be divided into comfort (satisfaction, happiness, relaxation) and discomfort (displeasure, stress, anxiety). The ability to distinguish between these two categories will give you an opportunity to understand the true feelings of a person and the ability to draw conclusions on what are the reasons of this condition.

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How to Get Luck on Your Side: 4 Habits of Lucky People

 

We tend to think that luck is an undefined power of kindness that comes from the universe. Sometimes it is indeed so, but many things we call “fatal” are not always associated with the fate. Instead, these things are the direct result of our actions. Even in order to win the lottery, you first need to buy a lottery ticket.

Psychological studies show that people who consider themselves lucky behave differently from those who believe they are not. Luck is a way of life, which can be changed. See how lucky people think and learn from them!

Seize the day, because time is relentless. Lucky people make time their ally and do not let the opportunities go lost because of fear of failure.

Lucky people believe that they are lucky so they face life openly and with optimism. Thus, they are always in an advantageous position and see before them only challenges, not obstacles.

Life is full of unexpected events but it does not determine the destiny of every person. Coincidences are everywhere around us, but luck is a personal matter. An unpleasant outcome that is influenced by external factors does not determine if a person is lucky or not.

Lucky people are not ruled by stress and thus keep their temper in all circumstances. This makes them properly use their strengths and always remain focused and effective.

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5 Habits That Will Boost Your Willpower

We all struggle with ourselves at times. Many times it is hard for us to make decisions, and finally we get stuck in life situations unable to find the way out.

In her new book, the author Katie Morton analyzes the habits that strengthen willpower. Here they are:

How can you know if you should “give in” or “resist” if you do not first know what the desired result of what you seek is? Clear goals leave no room for negotiations.

We cannot control everything, but we can control ourbehavior. The truth comes from within, and our choices reflect our beliefs. If you believe that something is too difficult to accomplish, then you will probably do likewise and will not to see any results.

Changes make us feel uncomfortable, and when faced with an obstacle we usually give up. In fact, we see it as an excuse to avoid any change.

We get trapped in bad habits when we blame circumstances and those around us for things we actually can control. People who have strong willpower take responsibility for their actions and habits in their lives.

When fear overwhelms us, we remain trapped in the safety of our thoughts and habits. But we have to take risks to get what we want.

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Your Subconscious Mind Can Do Anything: How to Use Its Power

The most important thing about the subconscious mind you need to know is that it is always “on”. That is, it is active day and night, regardless of whether you are doing. The subconscious mind controls your body. You cannot hear this silent inner process with your conscious effort. You need to start taking care of your subconscious mind. It is vital to maintain your mind in a state of expectation of only good events and make the usual mode of your thinking based solely on loyalty, justice and love.

Faith and belief are the foundation of the subconscious. Do not forget that “you will be rewarded according to your faith”.

A Protestant minister who suffered from lung cancer wrote about his methods of transferring thoughts of perfect health into his subconscious mind: “Two or three times a day, I put my body and soul in a relaxed state, repeating these words: “My feet are completely relaxed, my legs are relaxed. Right now my stomach muscles are relaxing. My heart is beating quietly, my breathing is calm and relaxed. My head is completely relaxed, my whole body is completely relaxed and calm.” After about five minutes, when I got into a drowsy, sleepy state, I repeated: “The perfection of the God’s plan finds its expression in me. My subconscious mind is filled with thoughts of that I have perfect health. My image is spotless before God.” This priest managed to heal himself.

Here are some brief recommendations to help you use your subconscious power for your best:

1. Your subconscious mind not only controls all the processes of the body, but also knows the answers to the various questions and can solve many problems.

2. Before going to bed, refer to your subconscious mind with any specific request and soon you will see its miraculous power in action.

3. Anything that is captured in your subconscious will directly affect you in the form of emotions, circumstances and events. Therefore, you need to watch closely what thoughts and ideas govern your mind.

4. All experiences arise from unfulfilled desires. If you are “fixated” on various issues and problems, thus will be the reaction of your subconscious mind.

5. When you have a specific goal or dream, consciously repeat this statement: “I believe that the power of the subconscious, which gave me this desire, will embody it in me now.”

6. Stress, anxiety and fear can disrupt the natural rhythm of breathing, heart rate and work of any other part of the body. Cultivate in your subconscious mind thoughts of health, peace and harmony, and all the functions of the body will return to normal.

7. Fill your subconscious with expectations of the best experiences and emotions, and your thoughts will become a reality.

8. Imagine a positive outcome of your problems, fully feel the enthusiasm from what has happened. All your fantasies and feelings are clearly accepted by your subconscious and then implemented in life.

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10 Real Reasons That Lie Behind Your Negative Emotions

When you do not get what you want, you can unconsciously cause a sense of anger in you in order to force another person to submit to you. So, anger helps you take control of the situation. Anger helps take the upper hand in the dispute, or take revenge for your failures. Anger can also be used to protect your rights. Anger helps us give the enemy to understand that he must retreat. Anger with yourself can be a way to force yourself to do something, get down to a task.

This is our way of expressing dissatisfaction with ourselves, our achievements. It can also be a form of manifestation of compassion. For example, when you sympathize with what happened to someone and use sadness to express your attitude and reaction.

This is a weak form of anger. It occurs when someone’s behavior provokes you and makes you nervous. It helps us stop the stagnation and encourage ourselves to action. Behind all cases of irritation, lies the desire to bring the situation under control. That is, we get irritated when everything goes wrong and not as we said.

It is a form of self-punishment. Sometimes it helps us avoid responsibility for our mistakes. Sometimes guilt is a form of manifestation of superiority: “I’m so highly developed that I even suffer about my mistakes.”

Feeling of guilt is a very destructive emotion, which signals the need to change something about ourselves. You need to figure out where it came from: forced upon you by your values or indeed you have done something icky. Then you need to analyze the cause of your action, sincerely forgive yourself and promise that this will not happen again. It will be good if you compensate the damage or apologize to those you offended.

Disappointment is a manifestation of discontent in those situations when you do not get what you want.

These emotions are associated with the instinct of self-preservation. Their mission is to protect us, preventing dangerous situations. Fear “paints” pictures of unpleasant surprises and obstacles, our failure, bankruptcy. But its goal is not to disturb you, but to help: to warn of danger, to show the real situation, to indicate the hidden pitfalls, so that you are ready for the difficulties. It is necessary to find a grain of truth in these emotions. Then they change the polarity, charge us with energy and motivate to action.

It occurs when multiple efforts to achieve something do not bring the desired results. Desperation is a deep depression, which gives us the excuse to desist from further attempts.

This is a mild form of rebellion against something. As a rule, it manifests itself in those who do not have the power or the ability to rebel openly. It is a passive manifestation of force and disagreement.

It is also a form of acceptance of control. It is when you fall out of the flow of life, and the others can get nothing from you, so they take over your duties. Sometimes depression is a passive way of expressing anger. It becomes an instrument of sophisticated manipulation of others, and works perfectly, creating a sense of guilt for the person to whom it is addressed.

It may signal that you have to afford to take time off work. Or there is a persistent inner need to give up something. Maybe you’re just tired.

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8 Weird But Effective Exercises for Brain Power

In 1936, the American writer Dorothy Brandt in her book «Wake Up and Live» offered some fun exercises for the brain training to help you make your mind sharper and more flexible. These exercises are aimed to get you out of your usual environment, show a different perspective (even a different reality, if you want) and create a situation that will require ingenuity and creative solutions.

1. Spend 1 hour a day without saying anything, just answering direct questions in your usual surroundings, without creating the impression that you are offended or in a bad mood. Behave as normally as possible. Do not make any comments and do not give in to attempts to extract information from you.

2. For 30 minutes a day, think of one and only subject, being completely focused on it. You can start with five minutes.

3. For 15 minutes a day keep conversation without using the words “I, me, my, mine.“

4. Allow your interlocutor to talk only about himself without realizing it. Using polite questions, get him back to the mainstream of mutual conversation so that he does not feel any pressure or negative emotions.

5. Try to talk only about yourself without boasting, without complaining and without making your interlocutors get bored.

6. Make a strict plan for two hours a day and follow that plan.

7. Give yourself 12 random tasks, such as walking 20 miles from home without using any means, stay 12 hours without food, have breakfast in the most unexpected and unlikely place that you can find, not to talk all day except of giving answers to the questions.

8. During the day, say “yes” to all questions and suggestions (within reasonable bounds).

These exercises may seem silly and useless, but in fact they can bring much new in your life and get to know yourself better.

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The Two Islands: An Unusual Personality Test That Will Surprise You!

Read the story below and answer as spontaneously and quickly as possible.

There are two neighboring islands. In the first one live two men: an uncivilized savage and a civilized man. In the other island there are several people, among them a girl who is in love and has a relationship with the civilized man.

The girl wants to go to the opposite island to meet her lover. She asks the only boatman of the island how much he wants to take her there. The boatman says that he does not want money and he will take her to the other island if she is naked in the boat.

The girl is shocked… not knowing what to do she goes to the wise man of the island to ask for help. He listens to her story with attention and gives the following advice: “Do what your heart tells you, my child…” So the girl decides to accept the proposal of the boatman in order to meet her beloved man.

So, they go to the other island. But when they arrive, the savage is on the seafront and gets crazy at the sight of the naked woman so he rapes her… At the same moment the civilized man comes and sees the scene. He goes mad and tells the girl that he does not want her anymore and she must leave immediately…

Evaluate the 5 characters of the story (savage, civilized man, girl, boatman, wise man) from the best to the worst, so that the number 1 is the character that you believe to be the best person of the story and the 5th is the worst of all.

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Each character of the story represents a priority in your life:

Savage = how important is sex for you;

Civilized man = importance of other people’s opinion;

Girl = your need for emotional relationship;

Boatman = your need for earning money;

Wise man = how much you rely on logic.

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5 Tips That Will Help You Believe in Yourself

Most people on the planet are divided into two types: people who believe in themselves and those who don’t. The one category of people goes with the flow, while the other one achieves positive results in life.

Here are a few tips that will help you discover your potential and believe in yourself:

With the help of simple logic we can conclude that our faith in our abilities has a great impact on our inferences that affect our choices and decisions. If a person on a subconscious level persuades himself that he cannot solve a problem, he will fail just because he has no faith in his own abilities. Be sure that any problem can be solved, and much depends on your attitude to it. The easier your attitude to life is, the faster you will overcome the difficulties you are facing.

Some people have a habit to compare themselves to those who have tried to do something and failed, thus not giving themselves the opportunity to resolve the problem they are facing. Remember that only you can find out if you can cope with this task or not because you are different from the others. Do not give up too soon! And if you choose to compare yourself with someone else, make sure that the other person’s experience in solving a specific problem is similar or equal to yours.

To rebuild belief in yourself, sometimes it is useful to recall the situation when you achieved tremendous success in a particular field. Successes of the past do not give you a guarantee of success in the future, but they encourage you and give you confidence, which is important for your future achievements.

Respect and self-confidence come when we achieve more than we can. Anyone would be glad if he amazes with his success a professional, not a child. It is important that your belief in yourself is not weakened, so always seek to improve yourself in the field of your work. Solving more complex problems, you believe in your potential and capabilities more and more, thereby getting the recognition of others.

Often on a subconscious level we compare ourselves with the child we were. For example, if in youth you had bad experiences with the other sex, it does not mean that being adult you will have face the same situations. Escalating the situation and persuading yourself that you are not worthy to be happy in the romantic relationship can result in serious emotional problems. Of course in childhood and adolescence, we are very hard to accept our failures, as people in this period have not yet formed as a mature personality.

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5 Simple Components of a Perfect Morning

Cannot bring yourself to wake up and go to work? Each morning turns into a nightmare? Tired of looking for a suitable motivation technique for waking up and still every morning you hate the whole world? To make your morning good, these 5 simple but effective components are needed:

It is not necessary to immediately turn into a professional athlete and put a bunch of unrealistic goals such as the number of sit-ups and push-ups or a certain distance to run. Start simple: each morning in all weather and at any mood, 10 minutes after waking up out of bed do a little workout with smooth movements, and then gradually increase the pace. The load, number and variety of exercises should be gradually increased every 3 days by adding new elements and movements. Strength exercises and heavy loads should be left for the second half of the day: do not try to wake yourself up with strength training. A proper morning exercise works better than any coffee and antidepressants or stimulants.

Morning shower should last no longer than 15 minutes. This is a quick way to refresh your mind and body, finally wake up and reinforce that boost of energy you got after 15-30 minutes of morning warm-up exercises.

Always take your breakfast, since it is the most important meal and the start of your day. Not only your mother and grandmother agree on the importance of the breakfast, but also eminent dieticians, therapists and doctors working with athletes and the military.

Emotional charge for your body is no less important than food. Something invigorating, rhythmic but unobtrusive should be your background music. Avoid listening to the radio or watching the TV with their advertising and news about politics and accidents! Start your morning with positive music, not with disturbing and negative influences of the media.

It is the final component of a good morning on our list, but not the least in importance. Even if you need just 20-30 minutes to get to your place of work or study, prefer to make this journey on foot.

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People Treat You According to What You Think about Yourself

Once Sir Francis Galton, one of the most notable figures in the history of psychology, decided to conduct a kind of experiment. Before his daily walk through the streets of London, he persuaded himself: “I am a disgusting person and everyone in England hates me!” After that, he concentrated on this belief for a few minutes and then went for a walk as he usually did.

However, it just seemed that everything was going as usual. In fact, the following happened: at every step, Francis caught queasy and contemptuous glances of passers on him. Many turned away from him, and a couple of times he heard coarse language in his address. In the port one of the movers, when Galton passed him by, hit the scientist with his elbow so much that he plopped down in the mud.

It seemed that even the animals had this hostile attitude towards him. As the scientist passed by a harnessed horse, it kicked him in the thigh, so that he fell to the ground again. Galton tried to elicit some sympathy from eyewitnesses, but to his surprise, people were on the side of the animal.

Galton hurried home, without waiting until his thought experiment would lead to even more serious consequences.

This true story is described in many psychology textbooks. From it we can draw two important conclusions:

1. People treat you according to what you think about yourself.
2. No need to inform others about your self-esteem and emotional state. Be sure that they feel it anyway.

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New Guidance Will Up Statin Use by 13 Million (CME/CE)

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Published: Mar 20, 2014 | Updated: Mar 21, 2014

Millions more people are now eligible for statin therapy under the 2013 guidelines from the American College of Cardiology and the American Heart Association.The increase comes mostly from those who would be eligible to take statins for primary prevention, mostly in adults ages 60 to 75, and would be expected to result in many fewer cardiovascular events.

An additional 12.8 million Americans ages 40 to 75 are eligible for statin therapy under the latest prevention guidelines from the American College of Cardiology and American Heart Association, researchers estimated.

That represents an increase from about 43.2 million individuals (37.5% of that age group) eligible for statins under the previous guidelines released about a decade ago to about 56 million (48.6%) under the new guidance, according to Michael Pencina, PhD, of the Duke Clinical Research Institute, and colleagues.

Most of the additional coverage would occur in the primary prevention setting and in individuals 60 and older, they reported online in the New England Journal of Medicine.

"I think this current study emphasizes the fact that if we were to fastidiously apply the new guidelines to the current population of patients we should all in our practices be expanding the indication for statins pretty significantly," commented Sahil Parikh, MD, an interventional cardiologist at University Hospitals Harrington Heart & Vascular Institute in Cleveland.

The authors acknowledged, however, that the estimates assumed that everybody eligible for statin therapy under the guidelines would actually receive a prescription even though "the new guidelines call for an informed risk-benefit discussion between the patient and physician before the initiation of statin therapy."

And that's a key consideration because the discussion should include information on lifestyle and other risk factors, potential adverse effects and drug-drug interactions, and patient preferences, Neil Stone, MD, of Northwestern Memorial Hospital's Bluhm Cardiovascular Institute, in Chicago, told MedPage Today.

"In older adults especially, even if they had a [10-year cardiovascular disease] risk of 7.5% or more, the risk estimator doesn't prescribe a statin, the discussion does," said Stone, who served as chair of the expert panel in charge of the cholesterol guidance. "Some patients whose only risk factor is age may decide with their clinician not to pursue statin therapy. Others who are slightly under the 7.5% but have other important factors mentioned in the report may decide to be on a statin."

"We hope, if careful attention is paid to the guidelines, that we're treating those people more likely to benefit," Stone added.

The ACC/AHA prevention guidelines, which were released in November, include guidance on better assessing the risk of atherosclerotic cardiovascular disease and on managing lifestyle, cholesterol, and weight. But the cholesterol guidance received the most attention because it moved away from treating to LDL cholesterol targets and toward treating the level of risk.

Concerns also were expressed about the increase in the number of individuals who would be deemed eligible for statin therapy in the new guidelines compared with the previous recommendations from the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program first released in 2001 and then updated in 2004.

To estimate the actual increase, Pencina and colleagues started with data from 3,773 individuals ages 40 to 75 who participated in the National Health and Nutrition Examination Surveys of 2005 to 2010.

Of those individuals, 42% were receiving or would be eligible for statins based on the ATP III criteria, a figure that increased to 56.6% using the criteria from the new guidelines.

That information was then extrapolated to the population of 115.4 million U.S. adults ages 40 to 75 to identify the increase of 12.8 million who would be eligible for statin therapy under the new guidance. Of the newly eligible people, the median age would be 63.4 and 61.7% would be men. Also, the median LDL cholesterol would be 105.2 mg/dL, which is lower than the median of 120.4 mg/dL for those eligible under the ATP-III criteria.

Most of the increase in those deemed eligible for statin therapy (10.4 million) would occur in adults without cardiovascular disease (primary prevention) and in those in the upper end of the age range (60 to 75).

"Since the prevalence of cardiovascular disease rises markedly with age, the large proportions of older adults who would be eligible for statin therapy may be justifiable," the authors wrote.

They also determined that the increases would occur both in adults who would be expected to have future cardiovascular events and those who would not. Thus, sensitivity rises and specificity drops.

Still, they calculated that about 475,000 cardiovascular events would be prevented using the new guidelines instead of the older ones, assuming full adoption and adherence.

"I think what we'll look forward to seeing is what the economic impact of this is," Parikh said. "In the current era of [the] Affordable Care Act and accountable care organizations I think we're all looking very carefully at resource allocation, and we'll have to see -- is it, in fact, worth the extra money on a population basis to expand the indication for statins when it comes to event reduction?"

Pencina and colleagues noted some limitations of their analysis, including the reliance on NHANES data, the extrapolation of data from a relatively small sample to the larger population, the assumption that the new guidelines would be universally adopted and implemented, and the lack of information on treatment adherence.

The study was supported in part by the Duke Clinical Research Institute's research funds and unrestricted grants from M. Jean de Granpré and Louis and Sylvia Vogel.

Pencina disclosed relevant relationships with McGill University Health Center and AbbVie. One of his co-authors disclosed relevant relationships with Janssen, Eli Lilly, and Boehringer Ingelheim.

From the American Heart Association:

Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University.

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BMI Loss Lasting With 3 Bariatric Surgery Options (CME/CE)

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Published: Mar 20, 2014 | Updated: Mar 21, 2014

At 5-year follow-up in a meta-analysis, bariatric surgery appeared to provide sustained effects on weight loss.Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.

Three commonly performed bariatric surgery procedures led to substantial and durable weight loss with a low mortality risk, concluded the authors of an expansive review and meta-analysis of both randomized clinical trials (RCTs) and observational studies.

Five years after surgery the 161,756 patients included in the analysis maintained 26% to 37% of the loss from baseline body mass index (BMI). Results from 37 randomized clinical trials (RCTs) showed a 30-day mortality of 0.08% and mortality beyond 30 days of 0.31%.

Complications remained fairly common (17% overall), and the reoperation rate was 7%.

Consistent with previous studies, gastric bypass resulted in the greatest weight loss, and adjustable gastric banding was associated with the lowest complication rate. The newer sleeve gastrectomy procedure seemed to offer the best combination of weight loss and safety, as reported online in JAMA Surgery.

"We observed higher mortality in observational studies than in RCTs, which could be attributed to longer follow-up time in observational studies or a higher chance that mortality recorded in observational studies was not associated with surgery," Su-Hsin Chang, PhD, of Washington University in St. Louis, and co-authors reported.

"We also found higher complication, reoperation, and comorbidity remission rates in RCTs. This could be explained by more detailed monitoring and reporting of outcomes in RCTs because of smaller sample sizes and shorter follow-up times. Despite these differences, the direction of the effects is the same in all aspects."

As the database for clinical outcomes in bariatric surgery has grown, several issues have emerged regarding generalizability. Early clinical trials provided data for specific procedures performed in different sets of patients. Some of the better known reviews did not include studies conducted after 2003, the authors noted in their introduction.

Recent meta-analyses focused on RCTs and excluded data from early publications. Moreover, advances in surgical technology and increased experience of surgeons are not adequately represented in previous reviews, the authors continued.

Chang and colleagues performed a systematic review and meta-analysis aimed at quantifying risks and benefits of specific bariatric procedures in adults. They defined risks as perioperative and postoperative mortality, complications, and reoperation rates. Benefits comprised weight loss and remission of obesity-related diseases.

The review encompassed studies reported from Jan. 1, 2003, to March 31, 2012.

The 164 articles included in the final analysis consisted of 62 publications from 2003 to 2007 and 102 from 2008 to 2012. A third of the studies (54) were conducted in North America, 72 in Europe, 13 in Asia, and 25 in other regions. A majority of the studies (92) had follow-up of at least 2 years.

The patients had a mean age of 44.6, preoperative mean BMI of 45.62, and preoperative mean weight of 274 pounds. Almost 80% were women.

Obesity-associated comorbidities included type 2 diabetes in 26%, hypertension in 47%, dyslipidemia in 27%, sleep apnea in 25%, and cardiovascular disease in 7%.

Observational studies reported higher mortality as compared with the RCTs (0.22% at 30 days, 0.35% >30 days). Also in the observational studies, adjustable gastric banding was associated with the lowest perioperative and postoperative mortality (0.07% and 0.21%), followed by sleeve gastrectomy (0.29% and 0.34%), and gastric bypass (0.38% and 0.72%).

Meta-analyses of complications comprised data from 64 studies. Complication rates were 17% in 16 RCTs and 10% in 48 observational studies. Similar rates were associated with each of the three surgical procedures evaluated.

Re-operation rates were similar in RCTs and observational studies (7% and 6%). The re-operation rate was lowest for gastric bypass (3%) in RCTs, whereas sleeve gastrectomy was associated with the lowest re-operation rate in observational studies (3%). Adjustable gastric banding had the highest re-operation rate in RCTs (12%) and observational studies (7%).

Change in BMI at 1 year was reported by 69 studies, and 11 studies had 5-year BMI data. BMI loss within 5 years of surgery ranged from 12 to 17 across observational studies. Two reports from the long-running Swedish Obese Subjects Study showed BMI loss of 6.5 at 10 years and 7.1 at 15 years.

The analysis of comorbidity outcomes comprised data from 53 studies. Remission of type 2 diabetes occurred in 92% of patients in RCTs and 86% of patients in observational studies. Hypertension remission rates were 75% in RCTs and 74% in observational studies.

The analysis of dyslipidemia remission included five RCTs, 20 observational studies, and almost 1,800 patients. Remission rates were 76% in the RCTs and 68% in the observational studies.

Sleep apnea remission was reported in five RCTs and 27 observational studies involving a total of 9,900 patients. The apnea remission rate was 96% for the RCTs and 90% for the observational studies. Of 27 patients with cardiovascular disease 58% met criteria for remission.

The study represents an important update of outcomes with different bariatric surgery procedures, said Vivek Prachand, MD, of the University of Chicago. The analysis relied on information published since 2003, whereas previous publications involved older studies.

The use of data from both RCTs and observational studies also distinguishes the analysis from prior reviews, most of which relied on RCTs.

The analysis shows that "bariatric surgery, overall, appears to be a very effective treatment for severe obesity, and it is a safe treatment in terms of mortality rate and complication rate," Prachand told MedPage Today.

"The fact of the matter is, there are several different operations that are being performed and there are differences in outcomes, differences in complications that need to be taken into account when recommending any particular procedure for any individual patient.

One caveat, he added: Chang and colleagues included data from the Swedish trial, which evaluated outcomes with bariatric procedures that are no longer used.

The study was supported by the National Cancer Institute, Foundation for Barnes-Jewish Hospital, and the American Cancer Society.

The authors disclosed no relevant relationships.

Working from Houston, home to one of the world's largest medical complexes, Charles Bankhead has more than 20 years of experience as a medical writer and editor. His career began as a science and medical writer at an academic medical center. He later spent almost a decade as a writer and editor for Medical World News, one of the leading medical trade magazines of its era. His byline has appeared in medical publications that have included Cardio, Cosmetic Surgery Times, Dermatology Times, Diagnostic Imaging, Family Practice, Journal of the National Cancer Institute, Medscape, Oncology News International, Oncology Times, Ophthalmology Times, Patient Care, Renal and Urology News, The Medical Post, Urology Times, and the International Medical News Group newspapers. He has a BA in journalism and MA in mass communications, both from Texas Tech University.

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