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OCTOBER ISSUE â€˘ 2011
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Also in this issue More than one in 10 Americans use antidepressants................2 Adult Acquired Flatfoot Deformity................................3 Singing May Help Some Stroke Victims Regain Speech ...........4
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More than one in 10 Americans use antidepressants
Are Cooking Oils Good for You? .......................................5 Twitter Reflects World's Changing Moods ....................6 FAU Welcomed the Inaugural Class of its New Medical School with a Time Honored White Coat Ceremony .............7 Interior Design for
Are Cooking Oils Good for You? PAGE 5
Chemotherapy for breast Cancer ....................................8 JFK Medical Center Welcomes Dr. Marcos Nores..................10 Genital Herpes: Don't Let it Embarrass Youâ€Ś Get Treatment!! ...........................11 Lots of Coffee Might Lower Depression Risk: Study ........12
Venezuela's Chavez turns to shamans to fight cancer PAGE 10
Medical Community Business Networking ...........................13 Will the Flu Kill Your Child This Year? ....................................14 Laughter Might Be Good Medicine for Alzheimer's Will the Flu Kill Your Child This Year? PAGE 14
More than one in 10 Americans over the age of 12 takes an antidepressant, a class of drugs that has become wildly popular in the past several decades, U.S. government researchers said. PAGE 2
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2 OCTOBER ISSUE
More than one in 10 Americans use antidepressants More than one in 10 Americans over the age of 12 takes an antidepressant, a class of drugs that has become wildly popular in the past several decades, U.S. government researchers said.
Health Statistics. The team analyzed data on more than 12,000 Americans who took part in the National Health and Nutrition Examination Surveys between 2005 and 2008. They found that antidepressant use in the United States jumped nearly 400 percent in the 2005-2008 survey period compared with the 1988-1994 period, with 11 percent of those over age 12 taking the drugs. The increase followed the U.S. approval in 1987 of Eli Lilly and Co's Prozac or fluoxetine, the first of a newer class of antidepressants known as selective serotonin reuptake inhibitors or SSRIs. According to the survey, U.S. women are 2-1/2 times more likely than men to take antidepressants, and whites are more likely than blacks to take the drugs, researchers. Once prescribed, many people
ntidepressants were the third-most common drug used by Americans of all ages between 2005 and 2008 and they were the most common drug among people aged 18 to 44, according to an analysis by the U.S. Centers for Disease Control and Prevention's National Center for
continue taking antidepressants, with more than 60 percent of Americans who use the drugs report being on them for 2 years or more. And about 14 percent of Americans taking antidepressant medication have done so for 10 years or longer. Patients who take the drugs often get them from their regular doctor rather than a so-called mental health professional. According to the survey, fewer than a third of Americans taking one antidepressant drug and fewer than half of those taking more than one have seen mental health professional in the past year. Although first introduced for depression, several antidepressants are now used to treat a host of problems, including anxiety disorders, obsessive compulsive disorder, bulimia and even post traumatic stress disorder.
Profanity on TV linked to kids' aggression Middle-school kids who hear swear words on TV or in video games may act more aggressively toward their peers, physically or otherwise, a small study suggests.
he findings, published in the journal Pediatrics, add to the controversial question of whether media violence and aggression -- and now, aggressive words -- actually affect kids' behavior. In a study of 223 kids at one U.S. middle school, researchers found that those exposed to more profanity-laced TV shows or video games tended to use blue language themselves. And kids who used profanity, in turn, reported more instances of aggression -- anything from throwing punches to spreading gossip. None of that proves that bad language in the media makes for bad kids, according to lead researcher Sarah M. Coyne, a professor of family life at Brigham Young University in Utah. "This study shows a correlation," she told Reuters Health, and does not prove cause-and-effect. What's more, if media profanity plays any role in kids' aggression, it's not clear how much of an impact it would have. "There are lots and lots of things that contribute to aggressive behavior," Coyne said. It's more likely, she added, that bad language on TV and in video games could affect kids' own lan-
guage -- but the ultimate impact on their behavior could be much more complicated. That said, Coyne pointed out, "profanity itself can be a form of aggression." She suggested that parents "pay a little more attention" to the language in the programs and games their kids are sitting down to. "We tend to be passive viewers," Coyne noted. "We're so used to hearing profanity all over the place, we might not even notice it (on TV)." That fact also points to a limitation of the study. Is it media profanity, specifically, that's related to kids' language and behavior? Or do kids exposed to swear words in TV shows and video games also have parents and friends who cuss -and is that the important influence? "This study isn't rigorous enough to rule out other explanations (for the correlation)," said Christopher J. Ferguson, an associate professor of psychology at Texas A&M International University who was not involved in the research. "This isn't enough to show a robust correlation, let alone causeand-effect," Ferguson told Reuters Health. He said that a number of studies into media violence and kids' ag-
gression have found that once you control for factors like parents' and friends' influences, as well as a child's mental health, the link between media violence and behavior disappears. "There's really nothing in (the new findings) that parents need to worry about," said Ferguson, whose own research has found no link between media violence and kids' odds of aggressive behavior. Coyne acknowledged the limitations of the study -- which also include the fact that the students were surveyed at one time point, which leaves the familiar chickenand-egg question. It's possible, Coyne said, that kids who already use bad language are drawn to profanity-laced TV shows and games. She and her colleagues did try to
approach the question from that angle too. But when they did, they saw much weaker statistical correlations -- which suggests that it's more likely the media exposure came first. The findings are based on questionnaires given to 223 middleschool students who were 12 years old, on average. The students listed the number of hours they spent watching TV or playing video games on an average day. They also named their three favorite shows and games, and rated the amount of profanity in each. Overall, Coyne's team found, the more media profanity children reported, the more likely they were to say it was OK for them to talk that way. And the more permissive that attitude, the more likely the child was to use swear words.
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Finally, kids who used bad language were more likely to say they were physically aggressive against other people, or were prone to non-violent aggression -- like gossiping to hurt other kids' reputations. It could be helpful, according to Coyne, to do a study that follows kids over time to see how mediaprofanity exposure corresponds to aggressive behavior later on. Or, she said, lab studies could look at whether hearing four-letter words affects people's own language afterward. But Ferguson was more skeptical about the wider body of research into the effects of media images and words on kids' behavior. "I think this is more of a moral agenda than a scientific one," he said.
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Florida Health News is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2010, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.
OCTOBER ISSUE • 2011
Adult Acquired Flatfoot Deformity
Dr. Juan Sardina
dult Acquired Flatfoot Deformity is a common and often undiagnosed condition that affectes the Posterior Tibial Tendon DDysfunction (PTTD). This occurs when the tendon is stretched or is torn, which can be caused by wear and tear and bad hindfoot alignment. Loss of function of the Posterior Tibial Tendon Dysfunction (PTTD) causes the arch to collapse and the posterior (Hindfoot) part of the foot to turn out or pronate. Causes of PTTD can attributed to inflammatory, degenerative, and traumatic conditions. Treatment are based on the severity of the symptoms and how advanced is the disease. The Posterior Tibial Tendon originated from the posterior aspect the calf area and sharply turns around the inside of the ankle to
attach to the inside of the middle of the foot. The Posterior Tibial Tendon is the dynamic stabilizer of the arch of the foot. The area of the sharp turn of the tendon as it comes around the inside of the ankle has a very bad blood supply due the anatomy of the blood vessels. This area or poor blood supply makes it difficult to repair very small damages to the tendon which leads to the small tear becoming large ones and causing the malfunction of the tendon. The Posterior Tibial Tendon is also responsible for turning in the foot and ankle and helping with propulsion forward with walking. Patients presents with slow on set of pain on the inside of the foot and ankle. Walking on uneven surfaces cause the pain to worsen as well as walking for long distances. Conditions like obesity, high blood pressure, diabetes, inflammatory arthritis, steroid use, and traumatic injuries are associated with Posterior Tibial Tendon Dysfunction. Later in the disease the pain also shifts to the outside of the foot and ankle. The disease can be classified into four stages. Stage I have pain of the inside of the foot and ankle with or without inflammation. Inflammation of the tendon is present and patients can perform
Surgical treatment should be considered after conservative treatments have been exhausted. The surgical treatment will be guided depending on the stages and the condition of the tendon, as well as how advance the arthritis is in the foot. Surgical treatment can range from repairing the tendon to tendons transfer with relocating the posterior aspect of the foot. Once arthritis has set in and is devilitating to the patient fusion of the posterior joints of the foot can accomplish pain relief.
a heal rise (to get on your tippy toes) with one leg with minimal pain, but repetitive one leg heel rise causes pain. Stage II patients have significant pain or are unable to perform a one leg heel rise and the tendon is becoming weaker. Stage III had a rigid posterior part of the foot as the foot arthritic changes are taking place. The patient cannot perform one leg heel rise. Stage IV includes everything from Stage III but the ankle joint is involved with the foot turn out and patient walks with a duck type gait.
Diagnosing begins with a good physical examination as well as standing xrays. MRI is also a valuable tool in diagnosing and evaluating the diseased tendon. Non surgical treatment range from orthotic which help restore the arch and stabilized the foot. Also Ankle Foot Orthosis can be used in the later stages. Immobilization is also tried before surgical intervention. Physical therapy is also valuable tool is strengthening the Posterior Tibial Tendon as well as supportive tendons that stabilize the arch.
Not all posterior foot and ankle pain is attributed to Posterior Tibial Tendon Dysfunction, but is a common under recognized condition which is treatable by foot and ankle surgeon. Properly treating the condition can prevent the later stages and avoid more invasive surgery as well as improving ambulation.
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4 OCTOBER ISSUE
Singing May Help Some Stroke Victims Regain Speech More study needed to see if rhythm and formulaic phrases could lead to improved speech therapies.
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inging helps some stroke patients suffering from non-fluent aphasia -- severe difficulties with speech -- relearn how to speak, according to a new study. Researchers in Germany pointed out, however, it's the rhythm and formulaic phrases associated with singing -- not the melodies -- that seem to make the difference. The lyrics and phrases the patients were most familiar with had the biggest impact on the their articulation -- even when they were just spoken and not sung, the investigators found. They concluded that the findings could lead to the development of new therapies for speech disorders. Speaking difficulties are common among people who suffer strokes that damage speech areas in the brain's left hemisphere. But the right side of the brain, which supports important functions of singing, often remains intact in these patients. Previous research suggested singing would stimulate areas in the right hemisphere that would take on the speech functions of the damaged areas. To explore this idea further, the researchers asked 17 stroke patients with non-fluent aphasia to sing or recite several thousand syllables with rhythmic or arrhythmic accompaniment. The phrases selected were similar but very different in how familiar they were to the patients and how formulaic they were.
The study authors found that singing the phrases did not produce better results than speaking them rhythmically. "The key element in our patients was, in fact, not the melody but the rhythm," Benjamin Stahl, researcher at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, said in an institute news release. "The positive effect was greatest in patients where deeper brain areas, known as the basal ganglia, were affected. These areas are known to be crucial for rhythmic processing." The researchers pointed out that familiar song lyrics and formulaic phrases were the easiest for the patients to articulate. The reason for this, they suggested, is that these words may involve other brain mechanisms than spontaneous speech, including those involved in long-term memory. More research is needed to determine how rhythmic and formulaic speech can be used in rehabilitative therapies, the study authors noted. "Even small gains in the ability to speak can mean a lot to aphasics, who sometimes have been unable to communicate easily for years," added Stahl.
Antioxidants Not Behind Red Wine's Healthy Effect on Heart: Study
any studies have shown that a glass or two of red wine a day is heart-healthy, and much of the benefit has been attributed to the anti-hypertensive effects of antioxidants found in red wine called polyphenols. But a new Dutch study suggests that these polyphenols, at least in isolation, may not lower blood pressure after all. Study author Ilse Botden, a graduate student at University Medical Center in Rotterdam, said the new findings "do not support" a lowering of blood pressure by polyphenols as the source of red wine's benefits to the cardiovascular system. The findings are slated presented at the American Heart Association's High Blood Pressure Research meeting in Orlando, Fla. The new research involved 61 people averaging about 61 years of age, all of whom had borderline high blood pressure. Participants were given dairy beverages that contained either the red wine polyphenols or a harmless placebo. Botden's team found no difference in blood pressure levels between the two groups after four weeks on the regimen. "Red wine drinking may still be beneficial to prevent cardiovascular diseases. However, this apparently occurs in a blood pressure-independent manner," Botden said. Dr. William O'Neill, a professor of cardiology and the executive dean for clinical affairs at the University of Miami Miller School of Medicine, agreed that the findings do not mean that red wine, in moderation, isn't heart-healthy.
"We know that moderate consumption of red wine helps decrease a person's risk for heart disease and heart attack," said O'Neill, who was not involved in the study. Instead, this research seems to say that wine does not decrease heart risk through the mechanism of lowering blood pressure. Instead, red wine may have anti-inflammatory properties that lower cardiovascular risk, he said. Another theory is that something in red wine help decreases the "stickiness" of blood and decreases the risk of a blood clot that could cause a heart attack, O'Neill said. "We always want to get out a magic potion, and put it in pill form, but this study shows us that it's more complicated," he said. Dr. Suzanne Steinbaum is a preventive cardiologist at Lenox Hill Hospital in New York City. She noted that the people in the study had borderline high blood pressure, and the results may not apply to people with higher blood pressure levels. The study also only lasted a month, she said, and the benefits from polyphenols might take longer to accrue. "There are multiple components in red wine and taken together, these ingredients have been shown to decrease blood pressure and prevent clotting and heart attacks," Steinbaum said. Moderate consumption of red wine is also part of the Mediterranean diet or lifestyle, which is rich in fruits, vegetables, whole grains and lean proteins. "This lifestyle is good for heart health," she said.
OCTOBER ISSUE • 2011
Are Cooking Oils Good for You? Nutritionist Joy Bauer, RD, shares all the information you need to know about fats and oils, including learning how hydrogenated fat is hidden on labels and the difference between virgin and extra-virgin olive oil. Armed with these essential tips, you'll be ready for any situation in the kitchen. Q: Are there any oils I should avoid totally? Yes: The worst type of oil is an ingredient in packaged foods including some stick margarines, baked goods, chips, crackers and candy. I’m talking about partially hydrogenated oils—or trans fats, which is how they’re listed on Nutrition Facts panels on labels. Partially hydrogenated oil is vegetable oil that has been chemically altered so it’s less likely to spoil. Food manufacturers often add it to their products because it can help foods stay fresh longer. But even in very small amounts, partially hydrogenated oil can wreak havoc on your heart health. It lowers levels of HDL (“good”) cholesterol and raises LDL (“bad”) cholesterol, and it even increases your risk for diabetes. The American Heart Association recommends that no more than 1% of your total daily calories come from trans fat. This translates to less than 2 grams for women, who typically need fewer than 2,000 calories per day. If a food contains trans fat,
sold in a tub has even fewer calories—about 60 to 70 per Tbsp, thanks to the air that’s been incorporated into the mix. And tub “light” margarine spreads have only 30 to 50 calories per Tbsp.
it’ll be listed below Saturated Fat in the “Total Fat” column. Q: For the record, which is better: butter or olive oil? From a health standpoint, olive oil is the better choice. But butter still has its place. All oils are a mixture of fats including monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and saturated fatty acids (SFA)—but in each oil (and in butter, too, which is basically a solidified oil), one type of fat dominates. Olive oil is predominantly rich in heart-healthy monounsaturated fat, which decreases your risk for cardiovascular disease by lowering LDL cholesterol and increasing HDL cholesterol. On the other hand, butter is mostly saturated fat, which increases LDL cholesterol and causes inflammation in your body. So generally, it’s best to use olive oil. However, the distinctive smell, flavor and consistency of butter works best in certain baked
goods—including cakes, cookies and pastries—so it’s OK to make these occasionally and enjoy the butter. Another butter-vs.-oil difference: Because butter is solid at room temperature, you have more control over how much (or how little) of it you spread on bread; with olive oil, it’s difficult to gauge how much oil is absorbed. So dip lightly! Q: What’s the difference between regular olive oil, virgin and extra-virgin? Simply put, olive oil is made by crushing olives to make a paste that’s then put under a press. If the oil that comes out has a low acidity and a good taste and smell, it’s labeled extra-virgin or virgin. (Virgin is slightly lower quality than extra-virgin.) These types are ideal to use for bread dunking, drizzling on veggies and other foods, and making salad dressings, since their delicate flavor and aroma will be lost when heated (some chefs still
prefer to use extra-virgin for cooking). The deeper the color, the more intense the olive flavor. If the oil is highly acidic or not great quality, it’s refined and mixed with virgin or extra-virgin oil to make “regular” olive oil; this allpurpose oil is good for cooking. The heart-health benefits of all types of olive oil are pretty much the same, although the virgin and extra-virgin ones have extra antioxidants. Q: How can oils be healthy if they’re so fattening? Oils may be “fattening” in the sense that they’re pretty high in calories compared with other foods. All oils have around 120 calories per Tbsp, so you can easily gain weight if you use too much. Even butter has fewer calories than oil (100 per Tbsp of butter) because of its water content. What’s more, “whipped” butter
But since oils contain fats that are good for you, you’re better off getting that 120 calories from a healthy oil rather than stick or tub butter. By the way, if you’re inclined to cut out fats entirely, don’t: We do need some fat to be healthy. Without it, our bodies can’t absorb fat-soluble vitamins like A, D, E and K, and we miss out on fatty acids that are essential for the health of your skin, hair, heart and brain—and just about every other part of your body. Q: How should I store oils? Heat, light and oxygen degrade oils, which makes them turn rancid more quickly and actually promotes the formation of cancercausing compounds called free radicals. The more polyunsaturated fats an oil contains, the more susceptible to rancidity it becomes. When you’re shopping for oils, reach for bottles at the back of the shelf, since that’s where they are more protected from harsh lighting that can make them go bad. Check the bottle for an expiration date (most oils have one), and every time you open a bottle, give it a whiff to make sure it doesn’t smell rancid.
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Twitter Reflects World's Changing Moods Global truths: people are happier on weekends, grumpier as workday drags.
sing Twitter to track people's moods from every corner of the globe, new research suggests that folks seem to awaken in good cheer and get grumpier as the workday progresses, regardless of where they live. The novel study by Cornell University social scientists monitored the attitudes of 2.4 million people in 84 countries over two years, finding that work, sleep and amount of daylight help shape cyclical emotions such as delight, distress, enthusiasm and anger. Two daily peaks of positive attitudes recorded by "tweets" on the social networking website -- in early morning and near midnight -- indicated that work-related stress may also play a role in mood, the study authors said. "Not a large proportion of sociologists see the Internet as being a source of social science data, but I really think it's a playground for the social sciences," said study co-author Scott Golder, a doctoral student in sociology. "For generations, social scientists have wanted to know how entire societies work, or how relationships patterned over time, which are all hard to do [on a large] scale. That proved extraordinarily difficult until the Internet." The study is published Sept. 29 in the journal Science. Tracking tweets with language monitoring software, Golder and co-author Michael Macy, a professor of sociology, observed that positive tweets were more abundant on weekends -- and delayed by two hours, suggesting people slept later -- whether the weekend was defined as Saturday and Sunday or another two-day stretch. For example, the traditional work week in the United Arab Emirates runs from Sunday through Thursday, where positive tweets and latemorning mood peaks were more prevalent on Fridays and Saturdays. The 509 million tweets used in the study were sorted to gauge "positive affect" such as alertness, enthusiasm or activeness, or
"negative affect" such as distress, fear, guilt, anger or disgust. The Twitter entries were time-stamped and posted in "real time," so they were likely to more accurately represent people's moods than recollections based on memory or extracted by interviewers, Golder said. "We see the same daily rhythm across seven days, which suggests something more fundamental going on, such as biological or circadian rhythms," Golder said. "We also saw the same basic pattern all across the globe. We are all human beings and subject to [the] same psychological factors, we're all refreshed by sleep, and this is something that is just part of us." Sonja Lyubomirsky, a professor of psychology at University of California, Riverside, said the study innovatively used technology to monitor people's moods and "gets at some questions we wouldn't get at" by following millions of people. However, while Twitter boasts about 175 million account users, that's still a small number worldwide, Lyubomirsky said, and isn't a representative sample of adults. "It's very descriptive and a nice use of new methodology," she said, "but it's not revolutionary." Golder agreed that study participants didn't represent a random sample, since Twitter users tend to be younger, highly educated and slightly more affluent. "It's important to remember that even though the Internet is largely mainstream, large groups don't have access to it or use certain aspects of it," he said. "And we're only measuring what people tweet aboutâ€Ś they're much more likely to tweet about making coffee than using the bathroom."
Brain Continues to Develop Beyond Adolescence
Brain development doesn't stop in adolescence, but continues until people are well into their 20s, a new study says.
he finding challenges a long-held belief that brain development is completed in the teen years.
For their study, the University of Alberta researchers used MRI to scan the brains of 103 healthy people aged 5 to 32. Each volunteer was scanned at least twice. The results showed that the brains of young adults were still developing wiring to the frontal lobe, which is involved in complex cognitive tasks such as inhibition, highlevel functioning and attention. This continued development of brain wiring may be due to the abundance of life experiences in young adulthood, such as going to college or university, starting a career, gaining independence, and developing new social and family relationships, the researchers suggested in a university news release. The study was recently published in the Journal of Neuroscience. The researchers also found that some people showed reduction in white matter integrity over time, an indication of brain degradation. They said this observation requires further study because it may help improve understanding of the link between psychiatric disorders and brain structure. Many psychiatric disorders develop in adolescence or young adulthood.
OCTOBER ISSUE • 2011
FAU Welcomed the Inaugural Class of its New Medical School with a Time Honored White Coat Ceremony During the ceremony, 64 students received their first doctor’s white coat— the preeminent symbol of physicians for more than 100 years.
represent most of the major colleges and public universities in Florida and 20 colleges around the country, including Princeton, Cornell, Vanderbilt, Duke, Notre Dame, Brigham Young, Wellesley and University of California. Fifty percent are women—a little higher than the national average of 49 percent. Nearly 80 percent of the incoming class is from Florida. Although 75 percent of the class majored in traditional pre-med subjects, the class is also made up of students who have non-science majors such as environmental engineering, Asian studies, English, French, philosophy, business, finance, economics, art history and math. Six of the members of the class have degrees beyond the bachelor’s degree.
OCA RATON, FL – In the presence of more than 500 guests, the 64 students who make up the inaugural class of Florida Atlantic University’s new Charles E. Schmidt College of Medicine received their first white coats at a ceremony held this month to symbolically confirm their commitment to the profession of medicine. The doctor’s white coat has served as the pre-eminent symbol of physicians for more than 100 years. At the conclusion of the ceremony, the students recited in unison an “oath” they collectively wrote, which will serve as a code of conduct they are committed to following throughout their education and as physicians after medical school. Michael L. Friedland, M.D., vice president for medical programs and dean of FAU’s Charles E. Schmidt College of Medicine addressed the class during the ceremony. “The white coat is our robe of profession and when you wear
The inaugural class of FAU’s new medical school in the Charles E. Schmidt College of Medicine.
it, others will expect knowledge, expertise, care and compassion,” said Friedland. “You are joining a profession like no other. Listen, explore, examine, inquire, but most importantly, care.” The event program included remarks from FAU President Mary Jane Saunders; Dr. Richard Reynolds, dean emeritus of the Robert Wood Johnson Medical School; and a keynote presentation by Dr. Edward C. Halperin, dean of the School of Medicine,
professor of medical education and professor of radiation oncology, pediatrics and history at the University of Louisville. The White Coat Ceremony took place in the Barry and Florence Friedberg Lifelong Learning Center and was followed by a reception in the Live Oak Pavilion on FAU’s Boca Raton campus. The 64 students in the inaugural class come from all walks of life, but they share the drive and passion to become physicians and
help patients. Among the class members are a football player, a patent lawyer, a second lieutenant in the U.S. Air Force, a former bio-defense scientist, a philosopher, martial artists, musicians, two students with exceptional research backgrounds who have been admitted to the FAU/Scripps Florida M.D./Ph.D. program, a science teacher, and the youngest member who is only 19 years old. Ranging in age from 19 to 34, the newly minted medical students
A symbolic event introduced in 1993, the White Coat Ceremony was established after a group of distinguished physicians, medical educators and community leaders formed the Arnold P. Gold Foundation. The Foundation concluded that the beginning of a student’s journey into medicine is the best time to influence standards of professionalism, humanistic values and behavior. More than 100 medical schools in the United States now hold White Coat Ceremonies. FAU’s White Coat Ceremony was made possible through the generous support of The Arnold P. Gold Foundation.
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8 OCTOBER ISSUE
INTERIOR DESIGN FOR CHEMOTHERAPY FOR BREAST CANCER By Donna Kleban, MD, FACS
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fluid is removed during surgery or biopsy and sent to the ChemoFx© lab. The cancer cells are grown in the lab and treated with a number of chemotherapies. A report is sent to your physician that details how your cancer cells responded to each type of chemotherapy. Your doctor can use the report to help determine your treatment regimen. This enables you and your physician to know which chemotherapies are more likely to be effective before you are treated.
Feel flat again by Friday with these nine easy tips:
Season Food Differently You may be attracted to your saltshaker, but water is too. When you take in higher-than-usual amounts of the salty stuff, you’ll temporarily retain more fluid, contributing to that sluggish feeling, a puffy appearance, and extra water weight. Avoid salt, overprocessed foods, and salt-based seasonings. Gans suggests you also ditch the frozen microwaveable meals while you’re de-bloating—they’re packed with sodium. Instead, she recommends a simple turkey sandwich or a salad with chicken for lunch this week. And eat plenty of fruits and vegetables that are packed with water. Add zest to your dinner recipes with fresh herbs and salt-free seasoning blends such as the Original and Italian Medley Mrs. Dash.
Trim Down Carbs Stay away from heavy carbs such as bagels and pasta. When you decrease the carbs in your diet, you temporarily train your body to ac-
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Ways to flatten your belly in one week It’s best to eliminate that occasional glass of wine, beer, or hard alcohol this week while you’re on a skinny jeans crusade—all are high-acid beverages that can irritate your GI tract and cause swelling.
Another reason to hate Mondays? Tight post-weekend waistbands. Unless you spent the past 2 days living like a monk, the cocktails, movie snacks, and dinners out can all add up to one thing: belly bloat. If you wake up bloated on Monday morning, your weekend food choices are likely to blame,” explains Keri Gans, RD, author of The Small Change Diet. “In fact, overindulging for two days straight can easily cause a gain of three pounds. Fortunately, this weight gain is usually temporary and easy to get rid of in less than a week.”
ovarian, endometrial, cervical, lung and colorectal.
Do Some Activity Every Day cess stored carbohydrates called glycogen and burn them off, while also eliminating excess stored fluids.
A study from Spain's Autonomous University of Barcelona suggests that mild physical activity clears gas and alleviates bloating. That's because increasing your heart rate and breathing stimulates the natural contractions of the intestinal muscles, helping to prevent constipation and gas buildup by expediting digestion. Take a short walk after meals or pedal lightly on a bike at the gym to help relieve bloat.
Trim back on your daily carbs by having eggs for breakfast, making your sandwich open-faced with only one slice of bread, and packing protein-rich snacks such as turkey slices, low-fat string cheese, seeds, and nuts. Switch Your Starch If your belly bulges after a highcarb meal like pasta, complex carbohydrate-rich foods may be the cause of your bloat, says Jackie Wolf, MD, author of A Woman’s Guide to a Healthy Stomach. Most starches, including potatoes, corn, pasta, and wheat, produce gas as they are broken down in the large intestine. Rice is the only starch that doesn’t cause gas, so have a ½-cup serving of brown rice (which has more fiber) if you want carbs with dinners.
Stop Milking It If you’ve ever felt gassy, crampy, or bloated after dairy, you may be one of 30 to 50 million Americans with lactose intolerance. This occurs in people whose bodies lacks the ability to break down and digest the sugar in milk, resulting in digestive issues like gas, bloating, cramping, and diarrhea. Try lowerlactose foods (such as hard cheese or yogurt) or lactose-free dairy products (such as rice milk and almond milk), or take a lactase enzyme to help break down lactose. Dr. Wolf recommends soy milk as a dairy alternative but warns that
More Remedies For Belly Bloat some people experience gas and bloating from soybeans as well.
Make These Fruit Swaps Wolf recommends you eat fruits that are kinder on your belly. Berries, grapes, and citrus contain a near-equal ratio of the sugars fructose and glucose, making them easier to digest than fruits with more fructose, such as honeydew, apples, and pears. You can also eat canned fruits in natural juice or small portions of dried fruit, such as raisins and dried plums.
Hold The Hot Sauce IF you love four-alarm food, lay off the Tabasco, barbecue sauce, and garlic for a few days while de-bloating. Spicy foods stimulate the release of stomach acid, causing irritation. Give dishes a flavor boost with in-season fresh or dried herbs such as dill, basil, mint, sage, tarragon, and rosemary. You can also use curry powder or lemon or lime juice—all perfect
with fish or chicken. Also, steer clear of black pepper, nutmeg, cloves, chili powder, onions, mustard, horseradish, and acidic foods such as catsup, tomato sauce, and vinegar.
If you want extra belly-flattening aids, consider one of these products to soothe your belly problems.
Ditch Diet Foods
• Try peppermint capsules to kill bacteria that cause bloat and aid digestion.
Avoid low-calorie or low-carb products containing sugar alcohols, which go by the names xylitol or maltitol and cause gas, bloating, and worst—diarrhea. And don’t reach for a stick of gum when you’re trying to quell that sugar craving. Instead, satisfy your sweet tooth by using a little maple syrup on your morning oatmeal or yogurt snack.
Get On The Wagon Steer clear of alcohol for the next few days to maximize your body’s belly-flattening capabilities. Alcohol causes dehydration and may slow your body’s ability to eliminate that excess weekend waste, so if you had a little too much to drink this weekend, start chugging the H20.
• Get gas relief with an over-thecounter product such as Gas-X.
• Stay regular by increasing fiber with flaxseed or a fiber supplement such as Benefiber. • Take a daily probiotic capsule. Dr. Wolf likes Align, Digestive Advantage Intensive Bowel Support, and Pearls IC Intensive Care Probiotics. A definite belly-flattening “don’t” is weighing yourself every day, says Gans. “Bloating is about how you feel. A lot of women will start weighing themselves daily—it’ll drive them crazy and could be discouraging. Go by how your clothes feel rather than letting the scale rule your week.”
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10 OCTOBER ISSUE
JFK Medical Center Welcomes Dr. Marcos Nores
Venezuela's Chavez turns to shamans to fight cancer
Mario Guillen, MD, Ishan Gunawardene, MD, Gina Melby, Shekhar Sharma, MD, and Marcos Nores, MD.
from tribes in Shamans Venezuela's Amazon jungle held a ceremony at the Miraflores presidential palace Saturday to help Venezuelan President Hugo Chavez recover from his cancer treatment.
special reception was organized on September 15, 2011 in Oliâ€™s Cuisine by JFK Medical Center to welcome their newest cardiothoracic surgeon, Marcos A. Nores, MD, FACS., a member of American Board of Thoracic Surgery.
Chavez, who insists that he was "not sick but recovering" from cancer, greeted the shamans wearing a track suit in the colors of the Venezuelan national flag and wore a crown of feathers the visitors gave him.
This event was attended by several area physicians, members of the community and area business owners. Madelyn Christopher and Dr. Michael Lakow.
Members of the Yekuana, Jivi and Wayuu communities danced, sang and prayed as they invoked their ancestors to protect the Venezuelan leader. The ritual was aimed at protecting Chavez "against enemies and bad health," said Miguel Morales, a shaman from the Jivi community. It also serves "so that he is left in peace, politically," he said. "We came from far away, from the (southern) state of Amazonas, to bless him," Morales said.
Margarita Pineda and Laura Nores.
Chavez thanked the shamans for the crown of feathers. "I consider it sacred and will keep it for my whole life," Chavez told them. "The cancer was removed, and with the power of god and all the gods it has gone and will never return," said Chavez, 57. Chavez underwent surgery in Cuba in June to remove a tumor in his pelvic area. He has offered little information on his cancer, for which he underwent chemotherapy in Cuba in July and August. A third round of chemo was done in Caracas last week. Since the operation Chavez has limited his public appearances, lost weight and lost most of his hair from his cancer treatment. The leftist populist leader on Wednesday vowed to be fully recovered by December to compete in the 2012 presidential election, when he expects "knock-out" the opposition. A recent Datanalysis survey gave him a 49-percent approval rating.
Healthy Living Can Cut Chances of Developing Diabetes Study finds risk can be reduced up to 80 percent, researchers say.
iving a healthy lifestyle can cut your risk of diabetes by as much as 80 percent, researchers from the U.S. National Institutes of Health report.
It has been clear that diet, exercise, smoking and drinking have an impact on whether one is likely to develop type 2 diabetes, but how each individual factor affects the risk had been unclear. "The lifestyle factors we looked at were physical activity, healthy diet, body weight, alcohol consumption and smoking," said lead researcher Jarad Reis, a researcher from the U.S. Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. "For each one of those, there was
benefits in lowering your risk for diabetes, he said. "It's never too late."
a significant reduction in risk for developing diabetes," he said. "Having a normal weight by itself reduced the risk of developing diabetes by 60 to 70 percent."
Diabetes expert Dr. Spyros G. Mezitis, from New York Presbyterian Hospital in New York City, said that "we have known that lifestyle factors affect prevention, development and management of diabetes."
For example, eating a healthy diet reduced the risk by about 15 percent, while not smoking lowered the risk by about 20 percent, he said.
Mezitis noted that the combination of lifestyle factors can reduce the risk of developing diabetes. "We need to look at these factors and how by modifying them you can really reduce the risk of diabetes," he said.
The more healthy lifestyle factors one has, the lower the risk for developing diabetes, Reis noted. Overall, risk reduction can reach 80 percent, he said. "Our results confirm our public health efforts to get individuals to attain and maintain a healthy diet, physical activity, an optimal body weight, not smoking, and drinking in moderation," he said. The report is published in the issue of the Annals of Internal Medicine. For the study, Reis' team collected
data on 114,996 men and 92,483 women 50 to 71 years of age who took part in the National Institutes of Health--AARP Diet and Health Study. None of these individuals had diabetes, cancer or heart disease at the start of the study.
betes, the researchers found.
Over 10 years of follow-up, 9.6 percent of the men and 7.5 percent of the women developed dia-
Reis noted that it helps to start living a healthy lifestyle at any age. Even in middle age, it will reap
However, for each additional healthy lifestyle factor the risk of developing diabetes was reduced 31 percent for men and 39 percent for women, Reis' group found.
However, Mezitis thinks changing these behaviors can be hard for people to do, especially without support from society at large. "We really need to be thinking of prevention early, and we need the help of government and business and others to achieve these goals," he said.
OCTOBER ISSUE • 2011
Quitting Smoking Could Give Memory a Boost
n addition to the many known health benefits of quitting smoking, researchers have now discovered another good reason to kick the habit -- it may help improve your everyday memory. The team at Northumbria University in Newcastle, the United Kingdom, gave memory tests to 27 smokers, 18 former-smokers and 24 neversmokers. The test involved remembering to do assigned tasks at different locations on the university campus. Smokers remembered only 59 percent of the tasks, compared with 74 percent for former-smokers and 81 percent for neversmokers. "We already know that giving up smoking has huge health benefits for the body but
this study also shows how stopping smoking can have… benefits for cognitive [brain] function, too," researcher Tom Heffernan, of the Collaboration for Drug and Alcohol Research Group at Northumbria, said in a university news release. He said this is the first study to examine the effect that quitting smoking has on memory. "Given that there are up to 10 million smokers in the U.K. and as many as 45 million in the United States, it's important to understand the effects smoking has on everyday cognitive function -- of which prospective memory is an excellent example," Heffernan said. The study was released online in advance of publication in an upcoming print edition of the journal Drug and Alcohol Dependence.
Chinese condoms too small for South Africans: report
South African court has blocked the government from buying 11 million Chinese condoms, saying they are too small, a newspaper reported Friday. The finance ministry had awarded a contract to a firm called Siqamba Medical, which planned to buy the Phoenurse condoms from China, the Beeld newspaper said.
Judge Sulet Potterill blocked the deal with Siqamba, ruling that the condoms were too small, made from the wrong material, and were not approved by the World Health Organisation, the paper said.
A rival firm, Sekunjalo Investments Corporation, turned to the High Court in Pretoria after losing the bid, arguing that their con-
South Africa has more HIV infections than any country in the world, with 5.38 million of its 50 million people carrying the virus.
doms were 20 percent larger than the Chinese ones.
Genital Herpes: Don't Let it Embarrass You… Get Treatment!! Headaches, fever and muscle aches are also symptoms that follow. The blisters that occur can later become ulcers. The ulcers become scabs that later heal. Sixty percent of people that have genital herpes have no signs and are unaware that they are infected.
Shekhar V. Sharma, M.D. Board Certified in Internal Medicine
Genital Herpes is caused by the Herpes Simplex Virus. It can affect both men and women. One of the symptoms that men have is a painful rash of the genitals: the penis.
he rash usually develops wthin 2-20 days after sexual contact, and it continues for almost two weeks. For some people the symptoms may be mild and for others it may be severe. If left untreated, one can have a lot of pain in the first outbreak, and this can last almost 3 weeks. The symptoms for Genital Herpes first starts with a tingle without any rash, followed by pain, then a rash in a patch that soon turns into water filled blisters. These blisters can be painful. Women have rash and blisters in the vaginal area. They may also have vaginal discharge with some itch and burning. Men can also have a penile discharge and burning sensation during urination.
Recurrence of the disease is generally shorter and less severe after the initial episode. Treatment is reducing stress because stress can cause frequent attacks of herpes. Prolonged stress, excessive drinking, friction to the skin, post surgery situations and conditions that affect the immune system may cause recurrences of the disease. Various modes of treatment exist with antiviral drugs. These antiviral drugs are not available over the counter. Since physicians are not judgemental about any issues, one should feel comfortable contacting one’s physician to discuss issues that may be embarrassing. Dr. Sharma's office in Belle Glade is at 1200 South Main Street, Suite 100 (opposite the Old Glades General Hospital). Dr. Sharma will be seeing patients at this location along with his nurse practitioner Grace VanDyk. He is currently accepting New Patients and the office accepts most insurances.
Call 561-996-7742 for an appointment.
Palm Beach Primary care aSSOciaTeS, iNc. Shekhar Sharma M.D. Moya Martin D.O. Grace VanDyk A.R.N.P.
State of the Art Office Building with Imaging Center, Sleep Lab Coming Up
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12 OCTOBER ISSUE
Lots of Coffee Might Lower Depression Risk: Study Women who had four or more cups a day were 20% less likely to suffer mood disorder
offee lovers, take heart: Women who drink four or more cups of caffeinated coffee daily seem to have a lower risk of depression than those who don't drink java or stop at one cup a day, a new study suggests. Although it's way too early to start recommending regular coffee consumption as a way to prevent depression, the findings may comfort those who feel guilty about their habit. "This may lessen concerns that caffeine consumption will have a negative impact," said Dr. Christopher Cargile, an associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine. "Caffeine at high doses has long been associated with worsening of anxiety and other psychiatric illness, and at times this has lead to lingering concerns that it might be best to limit its use." Cargile was not involved with the study, which appears in the Archives of Internal Medicine. The lion's share of caffeine in the world -- 80 percent -- is consumed in the form of coffee and caffeine is already the most widely used central nervous system stimulant in the world.
Researchers have probed caffeine's effect on heart health, markers of inflammation and cancer (generally the effects are benign or even positive), but there's been relatively little research into its effects on mood. What little research has been done has generally found a salubrious effect, with more coffee decreasing depressive symptoms and even being associated with a lower risk of suicide. "Caffeine has short-term positive effects on mood, subjective feelings of having more energy and being more awake in the short term," said study senior author Dr. Alberto Ascherio, who is a professor of epidemiology and nutrition at Harvard School of Public Health in Boston. It seemed natural "to see whether long-term coffee consumption associated with a lower risk of developing depression," he added. These authors tracked almost 51,000 women, averaging age 63, who were participating in the Nurses' Health Study. None of the women reported being depressed at the beginning of the study and none were on antidepressants. Depression was measured by new diagnoses accompanied by long-
Aging, Not Menopause, Raises Women's Heart Risks, Study Finds
term use of antidepressants. Women who drank four cups of coffee or more a day had a 20 percent reduced risk for depression and those imbibing two to three cups daily had a 15 percent decreased risk, compared to those drinking one cup or less daily. Decaffeinated versions of the drink didn't seem to be linked at all with depression. A relationship between caffeinated coffee and depression does make a certain amount of biological sense, experts say. "Caffeine is known to affect the release of several neurotransmitters, including dopamine and serotonin, that had been implicated in regulating mood and depression," said
Ascherio, who is also professor of medicine at Harvard Medical School. But those are short-term effects and "we [still] don't really know why coffee [over] years can decrease depression," he said. "If caffeine has some antidepressant effect, we may be able to find compounds with an even stronger antidepressant effect," Ascherio said. First, though, researchers need to determine if there is a cause-andeffect relationship at work here. "Currently there's just too much we don't know about the causeand-effect relationship that may be producing these findings," said Cargile, who is also regional associate dean of Texas A&M's BryanCollege Station campus.
here's no link between menopause and increased risk of death from heart disease, says a study that challenges a long-held medical belief that the rate of cardiovascular death in women spikes after menopause. Aging alone, not the hormonal impact of menopause, explains the increasing number of deaths among older women, according to the Johns Hopkins researchers. The new findings could affect how heart health is assessed in premenopausal women, who were previously believed to have a low risk of death from heart attack, the authors pointed out in the study. "Our data show there is no big shift toward higher fatal heart attack rates after menopause," study leader Dhananjay Vaidya, an assistant professor of medicine at the Johns Hopkins University School of Medicine, said in a Hopkins news release. "What we believe is going on is that the cells of the heart and arteries are aging like every other tissue in the body, and that is why we see more and more heart attacks every year as women age. Aging itself is an adequate explanation and the arrival of menopause with its altered hormonal impact does not seem to play a role," Vaidya added.
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OCTOBER ISSUE • 2011
Medical Community Business Networking
Dr. Daniel Ghiragossian, Dr. Ishan Gunawardene, Dr. Arthur Hansen, and Ravi Patel.
Kimberly Rodale, Debra Vanderhoff, Jeff Silkworth, and Judith Schumacher.
Patty Maczco and Karen Hodges.
Eric Baumel, M.D., Dr. Brad Cohen, Michelle Sanchez and Kristen Liebman.
The Palms West Chamber of Commerce held a get together on September 15th, 2011 of professionals from the Medical and business community at Dr. Vincent Apicella and Dr. Maria Bago’s office - Premier Center for Healthy Aging.
Angela Turner, ARNP, Katie Carlson, ARNP, Tina Dochniak, ARNP, Christine Bessette, MD, and Scott Gluckstern.
Andrew Shapiro, MD, and Kelly Conroy.
Dr. Bradley Cohen, Rebecca Sasser, Jade Harrison, Michelle Sanchez, Marnie Fisher, and Art Gasc.
Marshall Stone, Pediatric Stone, Marnie Fisher, and Dr. Jon Arenstein.
Angela Mahingly, Dr. Brad Glick, and Deborah Morawski.
Robert Champion, Michael Mikolajczak, DO, and Kerth Dietrick, MD.
Palms West Hospital Designated as Primary Stroke Center Loxahatchee, Florida - Palms West Hospital has recently been designated as a Primary Stroke Center by The State Department of Health and Human Services. The designation of Primary Stroke Center means that state authorities have recognized the readiness of Palms West Hospital to provide stroke care. Our patients will benefit from our commitment to providing the best possible care in a community setting. In order to receive this designation a facility must
demonstrate compliance with Joint Commission Standards for health care quality and safety. Our Primary Stroke Center at Palms West Hospital is staffed by a trained, multidisciplinary team 24 hours a day, seven days a week, with services available through our emergency department. The team, which is comprised of neurologists, radiologists and Emergency Physicians and Nurses, works together to diagnose, treat and provide early rehabilitation to
stroke patients. “We are pleased to provide a stroke treatment option to western community residents that can improve outcome after a stroke. It is critical to come to the hospital immediately if experiencing any symptoms of stroke," explains Neurologist, Dr. Gabriella Gerstle. Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 3 cause of death in the United States, behind dis-
eases of the heart and cancer. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. As a designated Primary Stroke Center, Palms West Hospital has dedicated the resources to effectively treat a stroke during an emergency. Anyone experiencing symptoms of stroke should call 911. These in-
clude sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination; or sudden, severe headache with no known cause. Quick diagnosis and treatment are critical for minimizing the effects of a stroke, which can include paralysis, slurred speech and cognitive impairment.
14 OCTOBER ISSUE
Will the Flu Kill Your Child This Year? We know that there are certain risk factors for the flu and that some of these can increase a child's vulnerability to the more severe consequences, such as death. Most parents are unaware, however, that simply being younger than 5 years old is one of the risk factors for severe flu. "Children only rarely die of flu. But the illness can be much more severe than most parents think. Just under half of the reported child flu deaths -- 49 percent -were in kids with no underlying illness or other risk factor for severe flu,". Do I Have to Take My Child to the Doctor? Not all cases of the flu will require a doctor's treatment for your child. It is always better to be safe than sorry, though, so calling your child's doctor is always a good
idea because the symptoms of the flu could possibly either be something else, or get bad quickly, especially in young children. Then, if your child has any underlying conditions, definitely call your pediatrician right away. These include anything from asthma to diabetes because the flu may temporarily worsen these diseases and may cause issues that a doctor needs to treat. Your child's doctor may simply tell you which overthe-counter medications to use and which signs to look out for, or she may ask you to bring your child in.
Regardless, leave the decision up to the doctor and if you feel that your child needs a doctor even though your child's doctor said not to bring him in, bring him in anyway. In a nutshell, go with your gut, to be safe. Is It the Flu? There are some general flu symptoms that you should be looking out for. These include fever, stuffy or runny nose, chills, sore throat and/or coughing, body aches and/or headache and fatigue. Closely monitor these symptoms. If they worsen or do not get better in a day or two, call your child's doctor again. If your child has a rising fever, take him to the emergency room. Preventing the Flu For children older than 6 months old, there is the flu vaccine. For most people, including children
over six months old, this vaccine is safe and effective against this virus. Talk to your child's doctor about this vaccination for full details. "More than four out of five kids who died of flu were not fully vaccinated," reports NewsFeed Researcher. That is a big number
that could certainly be reduced with vaccination. Children should also avoid other sick people, develop hand-washing habits and stay home from school when they are sick. All of these methods will help to prevent the flu, as well as major flu complications.
Less Play Time = More Troubled Kids, Experts Say Kids Can Enjoy Halloween Candy, Still Protect Teeth Sugar creates the perfect breeding ground for bacteria that cause tooth decay, expert warns. Children can enjoy some Halloween candy and still avoid sugar-related tooth decay, according to Dr. Margaret Mitchell, a Chicago dentist. Mitchell said the key to preventing tooth decay lies in limiting not only the amount of candy children eat, but also how long the sugar remains in the mouth. Brushing teeth as soon as possible after eating candy may keep harmful bacteria from developing, she said, and eating the candy quickly in one sitting decreases the amount of time it is contact with the teeth. Children and parents can take several additional steps to protect their teeth, said Mitchell, owner of the Mitchell Dental Spa. These include: Take inventory. Parents should examine their children's candy and remove anything they consider unacceptable before allowing them to eat it. Avoid anything tacky or gummy. This type of candy can stick to teeth and cause decay. Be consistent. No matter what time of day children eat candy (day or night), they should remember to have good dental hygiene. Take precautions. Before Halloween rolls around, a dentist can put sealants into children's teeth grooves to protect them against corrosion caused by too much sugar.
with their own play when they were kids. While about 70 percent of the mothers reported playing outdoors daily as children, just 31 percent said their own kids did. Mothers also said when their kids played outside, they stayed outside for less time.
Adult interference may deprive children of needed challenges, not to mention fun
rom hide-and-seek to tearing around the neighborhood with friends, playing is one of the hallmarks of childhood. But in this era of hyper-vigilant parenting, researchers find that children in the United States have far less time to play than kids of 50 years ago, a trend that may have serious consequences for their development and mental health.
"Into the 1950s, children were free to play a good part of their childhood. If you stayed in your house around your mom, she'd say 'go out and play.' The natural place for a kid was outside," said Peter Gray, a research professor of psychology at Boston College. "Today, it's quite the opposite. Parents are not allowing kids the freedom to play. And even if they do, there are no other kids out there to play with, or the mother may have such restrictions on the child, such as 'you can't go out of the yard' that the kids don't want to stay out there," added Gray. When kids are allowed to play, they make up games, negotiate rules and make sure others are playing fair. All of that helps to teach children how to make decisions, to solve problems and gain self-control. Children who have too many emotional outbursts or who insist on getting their way too often quickly learn they need to change their behavior if they want to continue to be welcomed into the group, Gray said. Through free play, "they are acquiring the basic competencies we
If anything, that trend has accelerated in the ensuing decade, Gray said. So what's keeping kids indoors? Fear of abduction is a big one, followed by worries about kids getting hit by cars and bullies, surveys have found. ultimately need to become adults," said Gray, author of two studies published recently in the American Journal of Play. But since the mid-1950s, adults have played an increasingly larger role in their children's activities, to the detriment of their kids' mental health, Gray said. And, playing organized sports with a coach or other adult directing the activity doesn't replace "free" play that's directed by kids, he noted. Research suggests that today's children are more likely to experience anxiety, depression, feelings of helplessness and narcissism, all of which coincides with a decrease in play and more monitoring and managing of children's activities by parents, he wrote in this special journal issue devoted to the decline in free play. For boys, in particular, rough-andtumble play helps teach emotional regulation, said Peter LaFreniere, a professor of developmental psychology at the University of Maine, in a separate article. Boys learn that if they want to
keep their friend, they can't let things go too far or truly hurt the other child -- a skill that helps boys grow into men who keep aggression and anger in check, LaFreniere said. "It's better to make the mistakes when you're 4," he said. "Children learn there are consequences to their actions; they learn to regulate the aggression even in the heat of the moment." Despite a growing chorus from experts about the importance of play for kids' mental and physical wellbeing, research indicates the amount of time kids are playing has declined significantly. One survey Gray cited asked a nationally representative sample of parents to keep track of their kids' activities on a randomly selected day in 1981 and another in 1997. The researchers found that 6- to 8year olds of 1997 played about 25 percent less than that age group in 1981. Another study from about a decade ago asked 830 U.S. mothers to compare their children's play
Those fears have created legions of overprotective parents rearing "wimps" who are unable to cope with the ups and downs of life because they have no experience doing so, said Hara Estroff Marano, the New York-based author of the book A Nation of Wimps: The High Cost of Invasive Parenting. "The home of the brave has given way to the home of the fearful, the entitled, the risk averse, and the narcissistic," Marano said. "Today's young, at least in the middle class and upper class, are psychologically fragile," Marano said in an interview published in the journal. Hovering parents, these researchers said, also deprive their children of something else -- joy. One survey found that 89 percent of children preferred outdoor play with friends to watching TV. "Parents have to remember that childhood is this special time. You only get it once, and you don't want to miss it," LaFreniere said. "Mixing it up with other kids in an unrestrained manner isn't just fun. It isn't a luxury. It's part of nature's plan."
OCTOBER ISSUE • 2011
Laughter Might Be Good Medicine for Alzheimer's Patients
Cocaine Increases Risk for Glaucoma: Study
Humor therapy eased agitation as much as drugs, without the side effects, in Australian study.
xposing Alzheimer's patients to "humor therapy" appears as effective as psychiatric drugs in reducing the agitation that often plagues those struggling with dementia, new Australian research suggests. In a three-month period, nursing home residents who actively participated in a weekly two-hour clowning session involving music, mime and humorous props showed a significant reduction in both physically and verbally aggressive behavior. What's more, the 20-percent plunge in overall agitation, which the team attributed to humor therapy, lasted for at least 14 weeks beyond the conclusion of the clowning program, the investigation team found. "Normally, nursing homes are a little like being stuck on a bad cruise where you can't get off," said study co-author Jean-Paul Bell, creative director at the Arts Health Institute in Avalon Beach, New South Wales, and co-founder of the Australia-wide hospitalbased "Clown Doctor" program. "You are getting the creature comforts but no stimulating conversation or playful contact." Bell and his colleagues sought to implement what he called a "person-centered" therapeutic approach, coupling visual sight-gags -- such as mimicking a conversation through two tin cans -- alongside provocative and irreverent verbal humor to encourage active patient participation and reactions. The result: "The humor interven-
tion worked well for pretty much everyone," Bell noted, particularly for the "highest-care" patients deemed most debilitated by dementia. As an added bonus, the impact was achieved without running any of the risk for serious side effects, including falling and premature death, that have been previously associated with prescription antipsychotic drugs. Bell and Australian colleagues (at the Dementia Collaborative Research Centre, the University of New South Wales and Prince of Wales Hospital, among others) recently presented the findings at the National Dementia Research Forum, in Sydney. The study authors noted that between 70 percent and 80 percent of dementia patients experience some form of agitation and distress, which can include bouts of wandering, screaming and repetitive behaviors. To explore whether and how much humor might help, the authors focused on 399 nursing home residents with dementia or other "ageassociated conditions" living in one of 35 facilities in the Sydney area. All the patients had lived in their respective facilities for at least three months. However, none was considered to be in an end-of-life
situation or suffering from severe psychosis. An "ElderClown," trained to engage in humor-based therapy in a medical setting, performed the weekly humor sessions. To a large degree, the sessions relied on humorous improvisation skills, similar to those used by "clown doctors" performing for sick children. The goal: to lift the mood of the patients, while engaging them in both conversation and physical interaction. In addition, regular facility staff was partnered with these clowns, to continue to promote humor therapy between sessions. Depression, quality-of-life, social engagement and agitation behaviors were all assessed before therapy, at the end of the three-month program, and 26 weeks after therapy began. While humor therapy did not appear to affect mood or quality of life, it had a clinically significant impact on patient agitation, on par with what might be expected following administration of standard antipsychotic medications. However, while agitation itself remained lower 26 weeks following therapy launch, the boost in both happiness and positive behaviors seen during the program faded
once the program ended. Nevertheless, the team suggested that humor therapy should become a first-line treatment choice for dementia patients suffering from agitation. Sam Fazio, Chicago-based director of medical and scientific relations at the Alzheimer's Association, described the study as "very well-done" and "important." "I think that the point about it being a good alternative to pharmacological treatment is really something to consider," Fazio said. "We need more of this type of research to show that there are other ways to work with people than simply medication." Fazio added that humor therapy is just one non-pharmacological approach among a range of viable options, including both art therapy and pet therapy. He said that while all such interventions show promise, they do not replace the overall need to better understand the physiological roots of agitation. "Reducing agitation is of great benefit," he said. "And I'm not discounting this therapy at all, because it can work for a lot of folks. But we need to also look at what's causing the agitation, what the triggers are. And then decide exactly how we're going to approach it."
Abusers with the eye disease significantly younger than other glaucoma patients who did not do drugs. People who use cocaine are 45 percent more likely to develop open-angle glaucoma, the most common form of the eye disease, according to a new study. The study authors said the cocaine abusers who developed the condition were nearly 20 years younger than glaucoma patients who did not do drugs. They suggested that the findings could help doctors develop new treatments for the disease, which is currently the second most common cause of blindness in the United States. "The association of illegal drug use with open-angle glaucoma requires further study, but if the relationship is confirmed, this understanding could lead to new strategies to prevent vision loss," the study's first author, Dustin French, a research scientist with the Center of Excellence on Implementing EvidenceBased Practice at the Department of Veterans Affairs in Indianapolis, said in a news release. Although the study doesn't prove that using cocaine causes glaucoma, the researchers concluded there is significantly higher risk for the eye condition among those with a history of drug abuse -- particularly since people are usually in their teens or 20s when they start using illegal drugs. The study's authors noted more research is needed to explore the long-term effects of cocaine use on the development of glaucoma.
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