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Aug. 2, 2004 -- Girls who are overweight may be more likely to start kindergarten with behavioral problems already established than their non-overweight peers, according to a new study.

But contrary to popular belief, researchers found being overweight doesn't increase the risk of developing new behavior problems among both boys and girls during the early elementary school years.

Researchers say psychological problems are among the most serious consequences of being overweight during childhood. Overweight children who are teased or ridiculed may suffer from low self-esteem and poor social skills.

Despite these well-known problems, researchers say most studies on the relationship between overweight and mental health have focused on older children and adolescents.

"There has been considerable attention on overweight status recently, often under the assumption that this can cause psychological problems for children and prevent learning," write researcher Ashlesha Datar, PhD, and colleagues at RAND in Santa Monica, Calif. "However, our results show that overweight girls already have more behavior problems before kindergarten; therefore, focusing on mental health and overweight is important in the early years."

Weight-Related Behavior Problems Start Early

In the study, researchers looked at the relationship between overweight and behavior problems in young children as they entered kindergarten and whether they developed more problems over time.

Information on height, weight, and parent- and teacher-reported behavior problems were collected three times during the first two years of elementary school for nearly 10,000 children.

The study showed that about one in 10 kindergarteners was overweight when he or she started school in 1998. The percentage of overweight boys was slightly higher than girls (11.7% vs. 10.6%).

Researchers found that overweight boys were no more likely to have behavior problems at the start of kindergarten compared with non-overweight boys.

However, overweight girls were much more likely to have behavior problems, as reported by parents or teachers, at the beginning of kindergarten compared with girls who were not overweight.

Researchers say that may be at least partially due to other factors such as the fact that overweight girls were less likely to be white and more likely to have a family income of less than $25,000, have mothers with a high school diploma or less, have fewer siblings, come from single-parent families, and have a higher birth weight than their non-overweight peers.

In particular, overweight girls had an 81% increased risk in teacher-reported externalizing behavior problems, such as arguing, getting angry, or disturbing class. Overweight girls also had an about 50% increased risk of teacher- and parent-reported internalizing behavior problems, such as anxiety, feeling sad, and low self-esteem.

But Weight Doesn't Increase Risk of Developing Problems

When researchers looked at the risk of developing behavioral problems over time, they found no proof that being overweight increased the likelihood of developing new behavior problems in either boys or girls.

Instead, they found that low family income and having a mother who was depressed were much stronger risk factors for children developing new behavior problems by the end of the first grade.

For example, the odds of developing externalizing behavior problems during the first two years of school were three times greater for girls whose family incomes were in the lowest quarter compared with girls whose family incomes were in the highest quarter.

The results of the study appear in the August issue of the Archives of Pediatric & Adolescent Medicine.

Jan. 21, 2004 -- The SSRI class of antidepressants don't increase suicide in children and teens, a medical group says.

SSRIs -- selective serotonin reuptake inhibitors -- include the popular antidepressant drugs Prozac, Paxil, Zoloft, and Celexa.

Reports of suicide in young people treated with these drugs last October led to an FDA warning about the drugs. The FDA's warning followed a stronger action by the U.K. Medicines and Healthcare Products Regulatory Agency. The British agency advised doctors not to use the drugs in children and teens.

Both the U.S. and U.K. are currently studying the issue. An FDA advisory panel will consider the issue at a Feb. 2 meeting.

But the American College of Neuropsychopharmacology -- an expert group of psychiatrists and pharmacologists -- convened its own task force on the issue. That task force today released its own findings. Its co-chair, J. John Mann, MD, is professor of psychiatry and radiology at Columbia University and chief of the neuroscience department at New York State Psychiatric Institute.

"Our conclusion is that when you look at the SSRIs as a group, there is evidence they are effective for treating depression in children and adolescents," Mann tells WebMD. "Instead of being a risk for suicidal behavior, they are potentially therapeutic. Doctors must go on treating depression, and SSRIs appear to be a reasonable choice."

"No SSRI/Suicide Report" Still Preliminary

The ACNP task force looked at all available published information. But the panel stresses that it did not have access to "a substantial amount" of unpublished data -- including detailed findings held by drug companies -- that will be made available to the FDA panel.

Mann will be a member of the FDA panel. He says he's keeping an open mind.

"The FDA is examining the data we looked at plus it is examining in more detail the data provided from pharmaceutical companies in terms of the type of suicidal behaviors that have occurred," Mann says. "That is new evidence. Based on how that is assessed, the FDA is attempting to look in a uniform way across seven or eight kinds of antidepressants. That will offer a unique opportunity to look at the data individually and collectively."

Still, Mann says, there's a critical need for more research. People enrolled in clinical trials tend to be less suicidal -- and given much better, much more detailed care -- than those treated in real-world settings.

"What are needed are new studies of the efficacy of SSRIs in depressed kids who are suicidal," Mann says. "Most studies actually excluded kids with suicidal behavior. So we must study the effect of SSRI treatment on those suicidal thoughts and behaviors in a way that's up front in the design of the clinical trials."

When Junior and his mother walk into the doctor's waiting room, there are two seats available: a big chair for grown-ups and a stool for kids. Junior takes the adult seat, and starts to throw a tantrum after Mom asks him to move. With resignation, she squats onto the little seat.

This scenario is not so uncommon, says Barton Schmitt, MD, a pediatrician at the Children's Hospital in Denver. In his office, he sees kids wield power over their parents at least a couple of times a week. Sometimes it's a preschooler who's emptying out his mother's purse, taking out all of her credit cards. Another day it's a tot who's stretching out her father's glasses. In each instance, the kid gets his way, even after some parental protest.

Some people may call these children spoiled.

Schmitt suspects that about 5% of kids are spoiled in that they lack discipline, are manipulative, and are generally bothersome. His estimate, however, may be far too generous, if one author's research proves accurate.

In 2000, Dan Kindlon, author of Too Much of a Good Thing, interviewed more than 1,000 parents, and roughly 650 teenagers, and found that 60% of parents thought their kids were spoiled, and 15% of teens thought they, themselves, fit the bill.

Defining "Spoiled"

Kindlon did not ask his subjects what they thought the term "spoiled" meant, but he believes that they would all have different answers -- as did many of the child-development experts interviewed by WebMD.

"A spoiled child has the 'I want, I want, I want' syndrome," says Charles L. Thompson, PhD, professor of educational psychology and counseling at the University of Tennessee in Knoxville. "His philosophy of life would sort of be 'Life is not good unless I'm getting my own way.'"

The word "spoiled" has many different meanings in different cultures, says Lane Tanner, MD, associate director, division of developmental and behavioral pediatrics at the Children's Hospital and Research Center in Oakland, Calif.

"Very often a grandparent will shake her head with a grin, and say 'My daughter is spoiling that baby so bad,' and that's praise," says Tanner.

A spoiled kid is someone who sits inside on a cold day -- sipping hot chocolate and watching TV -- while her dad shovels snow in the driveway, says Kindlon. He notes that such children often feel entitled not to have to contribute to responsibilities. They also usually have parents that emotionally indulge them -- for example, excusing them from chores because they already have a tough school schedule.

"What's spoiled for one parent may not be for another," says George Cohen, MD, a member of the American Academy of Pediatrics' committee on the psychosocial aspects of child and family health. "Many parents think what their kid is doing is okay. Others are much stricter."

Whatever one's primary definition of spoiled is, arguably, there are children who could use a bit more discipline. They usually find it hard to share, wait their turn, appreciate what they have, and accept that they cannot always get their way.

Life, for these kids, is often difficult, says Schmitt. "They are constantly in a tug of war with their environment," he explains. "They keep smashing into walls because they are living in a world that's different from the real world."

March 15, 2005 -- Vitamin E harms more than it helps, a large study shows.

Vitamin E is a powerful antioxidant, thought to clear the body of harmful oxygen compounds called free radicals. By soaking up free radicals, researchers hoped that vitamin E would prevent cancer and heart disease.

That doesn't happen, finds Eva Lonn, MD, of McMaster University in Hamilton, Ontario, and colleagues. Lonn led a seven-year-long, international study that enrolled thousands of people at high risk of heart disease. The findings added to suspicions raised by prior studies: Vitamin E isn't worth it.

"We saw definitely no benefit, and at least the potential for harm," Lonn tells WebMD. "Now the overwhelming evidence from many studies is that vitamin E provides no protection against heart disease, stroke, or cancer."

Lott and colleagues report their findings in the March 16 issue of The Journal of the American Medical Association.

Vitamin E Harm: Slight but Significant Risk

Lonn's study enrolled nearly 10,000 people with heart disease, peripheral artery disease (also commonly called poor circulation, a disease of blood flow through the arteries) or diabetes. This put them at very high risk of heart attack and stroke. All were over age 55. Half got high-dose vitamin E -- 400 IU every day (about 400 milligrams) -- and half got fake pills that looked the just the same.

After four years, those who took vitamin E had no fewer heart attacks, strokes, cancers, or cancer deaths.

But many experts wondered whether that was long enough for vitamin E to help. So Lonn and colleagues extended the study for another three years.

"But we saw no benefit at all on cancer and no benefits for heart outcomes -- a composite measure of heart attack, stroke, and heart death," Lonn says.

Unexpectedly, they did see one difference. Patients taking vitamin E had significantly more heart failure.

Vitamin E was linked to a 13% higher risk of heart failure and a 21% increased risk of hospitalization for heart failure. That's a pretty small risk. But since the vitamin did no good at all, it's a risk not worth taking.

"If there is no benefit from taking something, you shouldn't take even a small risk of harm," Lonn says.

There is no need to worry if you take a multivitamin that contains recommended amounts of vitamin E. But Lonn advises people not to take pills containing high amounts (400 IU or more) of vitamin E.

Is Vitamin E Dead?

B. Greg Brown, MD, PhD, head of the atherosclerosis research lab at the University of Washington School of Medicine, was one of the first scientists to suggest that vitamin E and other antioxidant vitamins may not work the way they were supposed to.

"Vitamin E has been very clearly shown to be of no benefit to the general problem of cancer or heart disease," Brown says. "Studies are still looking at whether vitamin E can help prostate cancer, [mouth and throat] cancer, and severe macular degeneration. But all in all, there is relatively little hope for a major effect. There's not a lot of hope for vitamin E. It's proven to be without benefit."

Brown's editorial accompanies the Lott study in the March 16 issue of JAMA.

The Real Vitamin E Harm

What worries Lonn and Brown isn't heart failure caused by vitamin E.

"The scary thing is not that vitamin E will cause harm. It's that people will take something that does no good instead of something we know will help," Lonn says. "Often people think, 'Well, I am going to be fine because I am taking a bunch of vitamins.' We see that even in people who have had two or three heart attacks already. They won't take their medications, but a bunch of vitamins they will take. That is where the damage lies rather than in the small risk from the vitamin E pill itself."

Brown, a cardiologist, says he far too often sees the same thing.

"The one thing that is really of concern is that a person will say, 'I am taking a vitamin, so I don't have to exercise or quit smoking or take a cholesterol-lowering drug," he says. "So that can be harmful in turning people away from proven therapies toward those with no benefit. Maintaining that position of zealotry can be more harmful than simply taking the vitamin itself."

This oil's got history going for it, that's for sure. One of the oldest known cultivated trees in the world, the olive tree is native to Asia Minor. It is thought to have spread to the Mediterranean region -- now well-known for its use of olive oil -- about 6,000 years ago.

You can buy domestic olive oil (using mostly Californian grown olives) or imported oils from France, Greece, Spain, and Italy.

This uniquely green and flavorful oil can be less green and less flavorful, depending on the type you buy. If you want to use it at high temperatures or in baking, try one of the "light" olive oils. This type goes through a fine filtration process, producing lighter-colored oil that lacks the classic olive flavor.

What if you want a fragrant and flavorful oil, for salad dressings or for adding to a dish after cooking? Olive oil that's extra-virgin and cold-pressed (a chemical-free process that involves only pressure, producing an oil with low acidity) is considered the fruitiest and finest type, according to The Food Network's online encyclopedia.

More and more people are cooking with olive oil, perhaps because Mediterranean cuisine is in vogue, or because of the oil's distinctive flavor, or its potential health benefits. How about all of the above?

May 24, 2004 -- Obese and overweight women are at increased risk of getting suspicious results from screening mammograms, research shows.

Mammograms don't miss any more cancers in heavy women than in thin women. But the more a woman weighs, the greater the risk that her mammogram will have false positive results. That means more tests - and more anxiety.

Joann G. Elmore, MD, MPH, of the University of Washington in Seattle, and colleagues analyzed more than 100,000 mammograms from nearly 70,000 women. The report their findings in the May 24 issue of Archives of Internal Medicine.

"Compared with underweight or normal weight women, overweight and obese women were more likely to be recalled for additional tests," Elmore and co-workers write. "Obese women had more than a 20% increased risk of having a false positive mammogram result."

At the personal level, it's not a huge increase in risk. Overall, a woman faces about one in 10 chance of getting a false positive result on a screening mammogram. Obesity increases that risk from 10% to 12%.

But those extra tests add up fast. For an estimated 10 million obese women in the U.S., this means some 200,000 false positives. At $600 per retest, that adds up to an extra $120 million in U.S. health-care costs. And that doesn't even begin to measure the personal costs.

"We cannot put a quantitative value on the resultant anxiety these 200,000 women would additionally experience," Elmore and colleagues note.

Even so, obese women need mammograms more than skinny women. That's because a breast examination is more likely to miss small tumors in women with very large breasts.

The researchers suggest that larger mammography plates may help get better images of women with large breasts. They also suggest that weight loss may lower the likelihood of an unnecessarily traumatic experience when it's time for a routine mammogram.

Dec. 15, 2005 -- A virus, called RSV, is spreading through the southern U.S. and will send thousands of kids to the hospital.

There's no vaccine. So why aren't there scary headlines? Maybe because it happens every year.

The virus is RSV -- respiratory syncytial virus. Every year it puts 51,000 to 82,000 Americans in the hospital. Most of them are young children, although the virus ravages the elderly as well.

Last year, RSV season started in the South in late October. By mid-November it had spread to the Northeast and West, and to the Midwest in late December. RSV season peaked in December in the South and Northeast, in January in the West, and in February in the Midwest.

And now it's back. The CDC reports that widespread RSV infections began in the South in mid-October. Infection rates climbed through November. And preliminary data suggest that cases are rising toward the "widespread" level in the Northeast. The data appears in the Dec. 16 issue of the CDC's MMWR: Morbidity and Mortality Weekly Report.

RSV Symptoms

If you're old enough to read this, you've almost certainly had more than one RSV infection. Most of us catch it for the first time before we're 2 years old.

You catch it by coming into contact with what the CDC delicately refers to as the "respiratory secretions" of an infected person. Usually this means close contact -- for example, sharing a drinking cup -- with an infected person. You probably can also get an RSV infection by touching a virus-contaminated surface and then rubbing your eye, scratching your nose, or touching your mouth.

RSV illness begins with a fever, a runny nose, a cough, and, sometimes, wheezing. Most adults experience RSV infection as a bad cold.

It's a different story for children. Among kids who catch RSV for the first time, 25% to 40% come down with symptoms of a severe lung infection: pneumonia or bronchiolitis (inflammation in the small air passageways of the lung). As many as two in 100 kids infected for the first time are hospitalized.

High-Risk Kids

The virus is particularly dangerous for some children, including:

• Kids younger than 2 years who've recently been treated for chronic lung disease.
• Kids with heart disease.
• For their first RSV season, premature infants born at less than 32 weeks' gestation.
• For their first RSV season, premature infants born at 32-35 weeks' gestation who have two of these additional risk factors: attending day care; exposure to environmental pollution; having a school-aged sibling; being born with abnormal airways; or neuromuscular disease (such as muscular dystrophy).

These high-risk kids may benefit from preventive treatment with monthly doses of an anti-RSV antibody product called Synagis.

RSV Treatment and Prevention

Kids with mild RSV infection need nothing more than symptomatic treatment. For example, they might take acetaminophen (Tylenol is the most common brand name) to reduce fever.

Kids with severe RSV disease may need oxygen therapy and treatment with an antiviral drug called ribavirin. Sometimes mechanical ventilation is needed. Kids with immune deficiencies and severe RSV disease may be treated with intravenous anti-RSV immune globulin and ribavirin.

And it's not only kids who are at risk. Elderly people, and people with compromised immune systems also risk serious RSV disease.

For a disease this common and this serious, you'd think there would be a vaccine. But making an RSV vaccine has turned out to be a major problem. One reason is that the normal immune system may overreact to RSV. That's why a simple RSV vaccine tested in the 1960s was a disaster. It made this immune storm worse, so kids with RSV exposure actually got sicker.

The quest for a safe RSV vaccine continues. Meanwhile, there's one good way to avoid RSV infection: Wash your hands. Yes, this means frequent hand washing, with soap and warm water, gently scrubbing the hands for the time it takes to sing the alphabet song.

Unfortunately, it doesn't do any good to keep kids with colds out of school or day care if they're feeling well enough to go back. RSV spreads typically during the early stages of infection.

Oct. 15, 2004 -- None of the more than 48 million flu vaccine doses held up in a British manufacturing plant are fit for use in the U.S., dashing hopes that any of the doses can be salvaged to help fill a huge flu vaccine shortage in the U.S. supply, federal health officials confirmed Friday.

Acting FDA Commissioner Lester Crawford told reporters that inspections and testing in the Liverpool, England, plant owned by Chiron Corp. showed that none of the flu vaccine can be shipped here for the 2004-2005 flu season.

"We believe all of the lots produced here, produced by that plant, are suspect at this point and we cannot allow them to be used in the United States in the interest of public health," Crawford says.

Flu Vaccine Fears Confirmed

Public health officials had held out little hope that any of the Chiron flu vaccine would prove safe for use. Friday's announcement confirms their fears that the U.S. will have only about half the flu vaccine needed to protect approximately 100 million persons thought to be at high risk if they catch the flu.

British regulators suspended Chiron's manufacturing license on Oct. 5, citing poor manufacturing practices and bacterial contamination in nine of 100 lots produced at the plant. More FDA inspections this week found that the contamination occurred during the process of filling flu vaccine vials, Crawford says.

The CDC reacted to the flu vaccine shortage by issuing updated vaccination guidelines limiting recommended flu vaccines for persons over 65, babies between 5 and 23 months, those with underlying health conditions, caregivers of sick persons, and those who share a household with an infant. Women who will be pregnant during flu season and some health workers are also on the list.

The shortage has caused long lines for flu vaccines all over the country as well as reports of price gouging on the part of distributors and clinics.

The two senior members of House Committee on Government Reform called on the Federal Trade Commission Friday to launch an investigation into the widespread price gouging reports.

Flu Vaccine Redirected

CDC Director Julie M. Gerberding, MD, says the CDC plans to redirect some 4 million doses of vaccine made by Aventis Pasteur to Veterans Administration hospitals, nursing homes, acute care hospitals, and private doctors who care for young children.

Gerberding urged consumers to avoid standing in long lines waiting for a flu vaccine and instead to contact local and state health departments to find out when and where the vaccine would be available for high-risk persons.

"They are the ones in the best position to know who has the vaccine," she says.

Meanwhile, officials say they are trying to locate other foreign flu vaccine providers in an effort to find more flu vaccine for the U.S. market. It still remains unclear if or how U.S. authorities could clear flu vaccines out of their regulatory control for use in the U.S.

"Literally every known manufacturer of flu vaccine in the world is being contacted," Crawford says. "We do not want to create false hope, but we want to explore every option."

April 18, 2005 (Anaheim, Calif.) -- Certain cholesterol-lowering drugs may help prevent prostate cancer, according to evidence presented at a meeting of cancer experts, while other studies showed the benefits of nutrients to fight lung and colon cancers.

Statins Cut Prostate Cancer Risk

In the latest research to show that the popular cholesterol-lowering drugs known as statins are good for more than the heart,statins are good for more than the heart, a 10-year study of more than 30,000 men shows that statins may slash the risk of advanced prostate cancer in half.

"The results are promising," says Elizabeth Platz, ScD, MPH, a cancer epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore. "The longer the men took the statins, the lower the risk of advanced prostate cancer."

Statin use did not appear to lower the chance a man would develop early cancer that was still confined to the prostate itself, she tells WebMD.

Statins used to treat high cholesterol include Crestor, Lipitor, Pravachol, and Zocor.

Advanced Prostate Cancer Falls 50%

The new study, presented at the annual meeting of the American Association for Cancer Research, included more than 34,000 men who were free of prostate cancer in 1990.

Every two years, the men were asked whether they took cholesterol-lowering drugs -- statins or other drugs -- and if they had been diagnosed with prostate cancer. "If they said they had cancer, we confirmed the diagnosis," Platz says.

By 2000, 2,074 men had developed prostate cancer. Of these, 283 cases were advanced prostate cancer, with many of them having already spread outside the prostate.

Compared with men who didn't take cholesterol-lowering drugs, those who did take them had nearly one-half the risk of developing advanced prostate cancer. Risk decreased with increasing duration of use, Platz notes.

So how did she know that statins -- not other cholesterol-lowering drugs -- were responsible for the protective effects?

"We can't rule anything out," Platz says. "But on the 2000 questionnaire, we specifically asked about statins and found that 90% of men on a cholesterol-lowering drug were on a statin."

Plus, some laboratory and animal studies hint of a biological rationale for using the drugs, she says. For example, statins may promote cancer cell death.

June 26, 2000 -- Wes is 71 and has been driving a car for all of his adult life. His wife, Joyce, says that his most recent job was driving rental cars back to an agency at the airport in St. Louis. Walter, 83, a retired steel company executive, also loved to drive, especially around the suburban streets of Naperville, Ill., says his daughter Susan.

In addition to a love of the open road, Wes and Walter share something else: Both men have dementia, and both have frightened their family and friends with their on-the-road escapades.

According to the Alzheimer's Association, approximately 4 million people in the U.S. have Alzheimer's disease, and it is estimated that the number could increase to 14 million by 2050, making the prospect of sharing a lane with an Alzheimer's afflicted driver not such a remote possibility.

The risk that these drivers pose to themselves and others is serious enough that the American Academy of Neurology is now telling physicians when to take away a patient's driving privileges. In the new guidelines, issued in the June 27 journal Neurology, the academy says that a person with Alzheimer's disease and moderate dementia has a "substantially increased accident rate" and should not drive.

Neurologists consider a person with moderate dementia to be one who has some difficulty remembering recent events, such that the difficulty interferes with everyday activities. For example, this person might no longer be able to balance a checkbook or may stop a hobby such as woodworking. The person can take care of normal activities such as showering but may need some prompting to initiate the task.

Richard M. Dubinsky, MD, tells WebMD that the AAN's quality standards subcommittee reviewed more than 200 published studies to develop the new guidelines. The evidence is clear: People with moderate or worse dementia "pose a significant traffic safety risk," says Dubinsky, who is lead author of the AAN guideline report.

Dubinsky, an associate professor and vice-chair of the department of neurology at the Kansas University Medical Center in Kansas City, says that people with very mild dementia "are impaired but may continue to drive if they are closely monitored." He says that the guideline recommends that these patients have their driving skills evaluated every six months.

Although he is reluctant to make blanket statements about driving ability, John C. Morris, MD, professor of neurology at Washington University School of Medicine, agrees. "These patients need to be re-evaluated every six months because eventually every Alzheimer's patient will be an unsafe driver," he says. Morris was not involved in drafting the guidelines but says he served as a reviewer for the guidelines.

Louise H. Allen, PhD, says it slowly became apparent to her that her husband's driving days were winding down. He was in the early stages of Alzheimer's disease and he was having trouble recognizing his children. Her clandestine reviews of the checkbook showed that he had trouble keeping track of the finances.

For the first three months after the diagnosis, he continued to drive -- but not alone. "I pretty much insisted on being with him," Allen says.

But she also had a long-term plan that would curb his driving. When his driver's license renewal came in the mail, she hid it until the renewal time expired. That meant her husband, a retired professor at the University of Illinois, would have to go down to the motor vehicles department and re-take his tests. When it became obvious he could no longer pass the written test, he decided it was time to sell his car.

Not all drivers hang up their keys this gracefully, especially when they may be the primary drivers in their household. "I was very lucky," says Allen, herself a retired professor from the same university.

Joyce Bascom says her husband's driving skills also seemed to diminish very silently. "Wes was first diagnosed about five years ago," she tells WebMD. For some time he continued driving and working at the rental car agency with no problems, she says. Then one day she had to take her car in for repairs, so he followed her in his car.

"He was just driving very, very slowly so I told him that I would drive his car back. When I got in the car I discovered there were no brakes. None. That's when I knew he had to stop driving," she said.

Soon after this incident, her husband took the family van very early one morning. "I found out about that when I got a call from a woman who told me that my husband had pulled into a gas station, lost. He asked her to call home and gave her a phone number. It was his mother's phone number," says Bascom. In a final misadventure, her husband drove to the airport; once there, he became confused and was detained by airport security, she says.

Her husband's car is now being kept at another location, and Bascom says she plans to sell it. "He sometimes asks me, 'Where is my car?' and I just tell him it's in the shop being fixed," she says.

Bascom's story is typical, says Dubinsky; driving is a very emotional issue, and taking away driving privileges can severely limit mobility.

"We have a big problem nationwide because we don't have good public transportation, and it can be quite difficult to live an independent life without driving," says Dubinsky. Nonetheless, he says that physicians need to step in and tell the patient that he or she can not longer drive. Since the issue is so emotionally charged, "it's better for the physician to 'take the blame,'" he says.

Susan, who asked for anonymity, says taking the blame is a big issue. She says that her father, Walter, deteriorated over a very brief period of time, during which he made several desperate attempts to "get home -- home being the south side of Chicago where he [lived] many years ago," she says. His children were terrified by what could happen to him.

After one such episode, one of Susan's sisters exercised a durable power of attorney and had Walter admitted "to a secure Alzheimer's unit. ... Our whole family has been in upheaval," says Susan. She says that she is glad the AAN is issuing guidelines so that "other families may be spared."

Dubinsky adds that some states require physicians to inform the departments of motor vehicles about the need to prohibit driving. In California, for example, Alzheimer's disease is a diagnosis that must be reported to the DMV, which automatically revokes the patient's license. Patients are, however, allowed an appeal.

In addition to issuing the new guidelines, the AAN says that research is still needed to determine if there are a subsets of patients with Alzheimer's with moderate dementia who can drive safely, or who can drive safely with enforceable restrictions," such as non-highway driving or driving within a limited geographic area.

While the Alzheimer's Association agrees that people with milder Alzheimer's disease should be discouraged from driving, it released a prepared statement in response to the guidelines, saying "the final determination is one that should be made with full involvement of the individual with the disease, their caregiver, and their health care provider."

"It is very appropriate for the AAN to have some guidelines, and I think these guidelines are very reasonable," says Morris, who on the Alzheimer's Association board of directors. "The problem is that guidelines do not apply to every individual case."

"There are not many studies of people with defined Alzheimer's who have actually been assessed on their ability to handle an automobile in every day, real life situations," he adds. In his own work he has used driving instructors and other "driving evaluators" to assess driving skills. As a result, he says, there are people with mild dementia who are considered safe drivers by professionals who have evaluated their actual driving.

Morris says that a broad application of the new guidelines could "result in some individuals who would have their mobility restricted prematurely." He urges taking an individualized approach for patients whose families or caregivers are not reporting driving problems. He says that driving evaluations can usually be "arranged through occupational therapy departments."

Allen has her own suggestions for coping. She says when it comes to getting loved ones with Alzheimer's disease to stop driving, there are some important things to remember. Cars equal freedom, and the desire to drive is deeply connected to a good lifestyle. See how much of the patient's lifestyle you can keep intact by researching the public transportation available in your community, she says. Some towns offer discounts to seniors, and under the Americans With Disabilities Act, Alzheimer's patients may be entitled to some type of transportation, she says. Also, groups like the American Red Cross offer regular trips to the grocery store in a van with a certified driver.

For a fee, a service called Safe Return will give you a stylish -- but hard to remove -- bracelet for your loved one that has an identification code and two 800 telephone numbers. Should the loved one wander off, bystanders can notify the service.

Finally, doctors and lawyers can be a resource too. "The doctor needs to be brought into it early on," Allen says, noting that doctors can give you an idea of the disease's progression, along with ways to deal with it. Local lawyers who handle Alzheimer's-related cases may know the services available in your community, she says. The local chapter of the Alzheimer's Association also is a good place to start checking out possible resources.

Vital Information:

• The American Academy of Neurology has issued new guidelines on when Alzheimer?s patients should and should not be allowed to drive.
• Patients with moderate dementia should not be allowed to drive. Most of those with very mild dementia may be ok to drive, but they should be re-evaluated every six months.
• Driving can be an emotional issue for many patients, because not being able to drive can take away a person?s independence.

Nov. 22, 1999 (Atlanta) -- Researchers may have moved a step closer to understanding one of the central mysteries of Alzheimer's disease -- and that is the role of plaques, those small clots of tissue debris found in the brains of those who suffer from the disease.

For the first time, a team of researchers has found a way to see the plaques using an X-ray-like technique known as magnetic resonance microscopy (MRM). Previously, plaques were only viewable after Alzheimer's patients had died, by taking small pieces of brain tissue and viewing them under a microscope.

The research, conducted at Duke University and published in today's edition of the Proceedings of the National Academy of Sciences, is but a small step towards eventual use of the technique on live humans. So far, the technique has only been tested on brain samples of Alzheimer's patients who have died, and the next step is to perfect its use on mice. But even that is still a year or two away.

"Mice can fit into the very high field magnet [used in the Duke study]," says Michael Weiner, MD, director of the magnetic resonance unit at the San Francisco VA Hospital, "so the techniques are not so difficult to translate to a mouse brain." But Weiner says translation to human subjects won't be so easy.

Still, the apparently long road of this research could answer one of the most baffling questions about Alzheimer's disease: what role do plaques play? They are considered the 'hallmark' of the brain-wasting disorder, but no one is sure why. Do they cause the disease? Or are they result of it? The researchers hope that by being able to "see" the disease progressing, they can answer that question, or, at the very least, can use the technique to guide the development of new Alzheimer's drugs.

"It's possible that this could lead to an important technological breakthrough," Weiner says. But he cautions "it's not an easy leap" to apply it to the many people with Alzheimer's disease.

Vital Information:

• Plaques are small clots of tissue debris found in the brains of Alzheimer's patients that, until now, could only be seen during an autopsy.
• A new technique using magnetic resonance microscopy (MRM), an X-ray-like technique, may allow physicians to view the plaques.
• Although the application in humans is still far off, researchers hope the new tool will help advance the understanding of Alzheimer's, possibly answering the question of whether the plaques are the cause, or just symptoms, of the disease.

May 19, 2006 -- Cruciferous vegetables -- which include broccoli and cauliflower -- may help prevent polyps that can lead to colon cancer.

The finding comes from a study of mice, not people. All of the mice had a mutation on their adenomatous polyposis coli (APC) gene. Mutations of that gene have been linked to higher risk of colon cancers in people.

The researchers included Ah-Ng Tony Kong, PhD, a pharmaceutics professor at Rutgers, the State University of New Jersey. The study appears in the May 4 online edition of Carcinogenesis.

Kong's team didn't try to feed broccoli or cauliflower to mice. Instead, they added sulforaphane, a natural chemical found in cruciferous vegetables, to the diet of some of the mice.

The point was to see if sulforaphane might help stave off polyps in mice that were genetically at risk for colon cancer. Advances Against Colon Cancer

3 Different Diets

The researchers split the 8-week-old mice into three groups:

• Normal diet with added sulforaphane (300 parts per million, or ppm)
• Normal diet with even more sulforaphane (600 ppm)
• Normal diet with no added sulforaphane (comparison group)

The mice followed those diets until they were 11 weeks old. After that, the scientists checked the mice for intestinal polyps.

Mice in both sulforaphane groups had fewer and smaller polyps than those in the comparison group. The group with the fewest, smallest polyps had gotten the diet richest in sulforaphane.

The polyps of mice in the sulforaphane groups showed greater apoptosis (programmed cell death) and seemed less likely to spread, the researchers report.

The researchers studied the mice for a brief time -- three weeks. They didn't follow the mice to see which ones developed cancer, how long any of the mice lived, or if sulforaphane affected those results.

It's too early to know if the results apply to people. But eating plenty of fruits and vegetables is widely recommended by health experts, so there's no reason not to put some cruciferous veggies on your plate.

Besides broccoli and cauliflower, cruciferous vegetables also include kale, turnip greens, cabbage, and brussels sprouts.

Feb. 1, 2002 -- Video games have been fingered as the cause of various health problems, including obesity from lack of physical activity. But now, here's something that could really shake things up: Researchers are announcing the first-ever report of a 15-year-old boy who developed hand-arm vibration syndrome from hours of game time.

In the past, several different types of injuries have been reported from use of computer or video games -- joystick digit, mouse elbow, and palm blisters.

In this case, the boy had been feeling pain in his hands for two years. His hands became white and swollen when exposed to the cold. Then they turned red and painful when they warmed up again.

Many different things could cause these symptoms. But doctors ruled out underlying diseases. This sort of condition also can develop in adults who operate heavy equipment with their hands, such as chainsaws or highway-maintenance equipment.

But the boy's symptoms started after prolonged use of a home video game system -- Sony Playstation. He spent up to seven hours a day playing the game. That alone could cause some ill effects on his health, but in addition, he enjoyed driving games with the vibration mode activated on the hand-held controller.

The boy's symptoms are typical of what's often seen in cases of hand-arm vibration syndrome some adults get on the job. Due to lawsuits, tools have been developed that limit vibrations and workplace improvements have been made.

The full report appears in the Feb. 2 issue of the British Medical Journal.

Although the boy's seven hours of playing time is excessive, the researchers wonder if this injury is more common than we may think.

"We believe that, with increasing numbers of children playing these devices, there should be consideration for statutory health warnings to advice users and parents," they conclude.

Parents should closely monitor the amount of time their children are playing these games. And the vibration mode -- when used for prolonged periods -- may have particularly damaging effects.

March 24, 2006 -- Respiratory diseases such as asthma, pneumonia, and bronchitis are leading reasons why American kids go to hospitals.

Government data show that in 2003, more than 6.4 million kids aged 0-17 years were hospitalized. Normal births accounted for the vast majority of those cases.

Here are the top 10 U.S. hospital diagnoses for kids in 2003, along with hospital discharge numbers for each diagnosis:

1. Newborn infant delivery: 3,918,129
2. Asthma: 165,755
3. Pneumonia: 162,891
4. Acute bronchitis: 153,745
5. Fluid and electrolyte disorders (mainly dehydration and fluid overload): 119,702
6. Appendicitis: 80,563
7. Affective or mood disorders (depression and bipolar disorder): 78,975
8. Other conditions occurring around the time of birth: 68,432
9. Epilepsy, convulsions: 67,777
10. Other infections of the upper respiratory tract (nose, throat, trachea): 55,468

Further down on the list were intestinal infections (in 15th place with 40,165 cases), fracture of a lower limb (in 23rd place with 30,174 cases), and poisoning by medications and other drugs (in 41st place with 17,211 cases).

The data came from the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services.

Sept. 2, 2003 -- New research shows that prevention -- with a flu shot -- may be key to keeping costs down for treating the flu in older adults.

This is the first study that looks at which method gives the most bang for the buck when it comes to treating seniors with the flu. It points out that treating seniors with available anti-flu drugs is cost-effective, but giving the flu shot -- to stop the virus before it starts -- does even more good. The findings are published in the September 2 issue of Annals of Internal Medicine.

The flu shot decreases both the chances of contracting flu and the severity of the virus -- thus decreasing hospitalizations and deaths from the flu.

In this study, researchers compared seniors who got flu shots with those who didn't.

For high-risk patients over 65 who hadn't received the flu shot, using a newer, anti-flu drug called Tamiflu without first testing for flu was the most cost-effective treatment. For vaccinated or low-risk patients, rapid testing followed by treatment with Tamiflu for patients who tested positive for the flu virus was most cost-effective.

Researchers say, however, that older, less expensive, anti-flu drugs, which only fight influenza A (and not B) are good alternatives if a patient can't afford more expensive, newer drugs. Costs for new drugs can range from $48 to $60 for five days of treatment, the study shows.

Prevention Best Option

Researchers found that -- as in younger people -- anti-flu drugs are cost-effective for treating older flu patients but say prevention is still the best option.

"The best advice for older adults is to get a flu shot every year because vaccination decreases the probability of getting the flu and reduces the severity of the illness," says Michael Rothberg, MD, MPH, internist at Baystate Medical Center, Springfield, Mass.

Typically, health professionals recommend an annual flu shot for people most vulnerable to illness, including:

• Adults over 65
• Children younger than 4
• People with lung or heart diseases or heart failure
• People with medical conditions that weaken their immune system

Most of the people who die from the flu are older than 65, the study reports.

"Doctors are often hesitant to prescribe anti-flu drugs because they're expensive and won't work if the patient has a virus other than influenza," Roth says. "But for people over age 65, influenza is so dangerous that treatment with antiviral drugs is very cost-effective, even when the doctor isn't sure of the diagnosis," he says.

Dec. 1, 2006 -- Women who undergo long-term weight training have more active forms of bone- and muscle-strengthening growth hormone.

That finding comes from a detailed study of different forms of growth hormone seen in young women who underwent various weight-training regimens.

The study, by researchers from several U.S. sites, was led by William J. Kraemer, PhD, of the University of Connecticut at Storrs.

In the study, women who underwent six months of moderate- or high-intensity training and aerobic exercise had increased levels of various forms of growth hormone.

Moreover, the types of growth hormone were more biologically active than growth hormone variants found in women who did not regularly exercise.

The conclusion?

"Women need to have heavy-loading cycle workouts in their resistance training routines, as it helps to build muscle and bone," Kraemer says in a news release.

The findings appear in the December issue of the American Journal of Physiology-Endocrinology and Metabolism.

Growth Hormone Important for Women

The pea-sized pituitary gland at the base of the skull makes growth hormone.

This molecule has the remarkable ability to break down and reform into more than 100 variants.

Researchers are only beginning to understand that these variants can have very different actions.

For women seeking to build and maintain bone and muscle, growth hormone plays a more important role than it does in men.

That's because men's bodies rely more on the male sex hormone, testosterone.

In the study, Kraemer's team looked at 74 healthy women who had not worked out regularly for at least a year. On average, the women were 23 years old, just under five-and-a-half feet tall, and weighed just under 141 pounds.

A third of the women did not enter an exercise regimen and served as a control group.

The remaining women were divided into four exercise groups.

One did moderate intensity, whole-body weight training to build strength. A second group did high intensity, whole-body weight training to build muscle.

The third and fourth groups did only upper-body training, either at moderate or high intensity.

All the training groups also did 25-35 minutes of aerobic exercise three days a week.

After six months, the different exercise groups had different kinds of increases in different growth-hormone variants.

It's not yet clear what these differences mean. But overall, weight training significantly increased the women's biologically active growth hormone levels.

"This study shows that not every form of growth hormone responds in the same way, but is dependent upon the exercise protocol," Kraemer said.

"This may forever change the way we look at growth hormone in the circulation with exercise and training," he says.

Dec. 23, 2003 -- Time spent in sports keeps kids from getting sick -- and it melts body fat, all of which improves children's health, a new study shows.

It's another reason to get children away from computers and TV, and send them outside for exercise.

Habitual physical activity of more than three hours a day gives children the best defense against infections such as colds and flu, writes researcher Thomas J. Cieslak, with Brock University in Ontario, Canada. His study appears in the current Journal of Applied Physiology.

Exercise has positive impact on the immune system, the body's defense against infection, writes Cieslak. Studies show that moderate exercise and physical activity enhance immunity and reduce the rates of upper respiratory infections such as colds. . Moreover, stress and obesity suppress the immune system -- although studies have mostly looked at this in adults, he explains.

"It has long been suspected that the younger the individual, the less effective the immune defense," writes Cieslak. However, a child's immunity is still developing until the ages of 9 to 11, he says. Also, studies of children's health and immunity haven't taken into account diet, climate, and living in densely populated areas.

Effects of the child's physical activity level have also not been studied. However, one recent study found that teens that spend less time in sports activities have more colds and flu, writes Cieslak.

Canadian Fifth Graders Tell the Tale

In this study, Cieslak looked at immunity, physical fitness levels, stress levels, and body fat in a group of fifth graders -- all 10 and 11 years old -- while they were in school from May through June. This is a moderate to high infection season in Canada.

Researchers found that 22% of boys reported getting less than three hours physical activity daily, compared with 32% of girls.

Also, children's health was affected:

• Children getting less than three hours a day had significantly lowered immune system, more body fat, and reported more sick days than more fit and active children.
• 40% of these less-active children had more than 25% body fat; they also reported more colds and flu than other kids.

The results mirror findings in studies of teens and adults -- that less activity increases susceptibility to infections. "The results of the present study suggest that this may also be true in children," writes Cieslak.

Child's Immune System Complex

However, because a child's immune system is more complex, other factors such as time of day or year -- or whether they're in school or not -- could also affect their immune systems, he says. Winter or colder temperatures may lower a child's immunity.

In fact, physical activity may play a greater role than stress in a child's immunity. Other studies point to different effects from exercise and stress on immunity, he explains.

Nevertheless, the study shows that children who spend more time in sports and other high-aerobic activities report fewer sick days, he says. And obese kids have many more sick days. Parents who want to improve children's health must get them involved in regular physical activity.

SOURCE: Cieslak, T. Journal of Applied Physiology, December 2003; vol 95: pp 2315-2320.

As another year comes to a close, lots of promises to get in shape and lose weight remain unfulfilled. Let's face it, most of us have the same resolution over and over again, like vowing to give up junk food and start exercising on New Year's Day only to find ourselves on the sofa enjoying a bag of chips within a few days. While lots of folks will abandon their efforts in just a few days or weeks on the treadmill, others may find themselves obsessed with finally trimming the fat for good.

But how do you know when you've taken things too far? Is ordering your dressing on the side or having a daily weigh-in a sign of obsession, or are these just examples of some of the small ways you can help achieve your weight loss goals? We asked two experts to weigh in on some of the warning signs that you've taken your fitness or diet routine too far, and they offered tips for preventing obsessive thoughts and behavior.

Remember the Weight of Water

You might want to try scaling back when it comes to weighing yourself. In fact, you might want to skip the scale all together, says Olivia H. Beckman, MD, who is the medical director of the eating disorders program at Walden Behavioral Care. The only reason to have a scale, she says, is to monitor your weight for medical reasons. Otherwise you can leave it to your health care provider to monitor your weight even if you're trying to lose a significant amount. After all, it's natural for our weight to fluctuate by a few pounds on a monthly, even daily basis, especially for women. Beckman says if you find yourself basing your daily fitness and diet on what the scale says in the morning, you're likely to make unhealthy and unnecessary decisions, namely skipping meals or working out excessively. The solution to scale obsession might be as simple as throwing it away, and instead using how your clothing fits -- and how you look and feel physically -- as a weight barometer or guide.

If you need a little motivation for giving up your scale, keep in mind that often minor weight fluctuations aren't as real as the numbers would have you believe. "Quick weight loss is rarely fat loss that stays off but rather a loss that is a mixture of water weight, lean protein mass, and some fat," says Susan Mitchell, PhD, a registered dietitian working with a program to help promote the dietary intake of fruits and vegetables.

Eat Based on Nutritional Value Instead of Calories

"Portion size determines total calorie intake, but if all the calories are from marshmallow peeps, your body will not run like the fine-tuned machine it is designed to be," says Mitchell. "You may lose weight but you may also lose hair, have dry skin, awful nails, and that's just what you see on the outside." Mitchell says you can also lose muscle and bone mass from vitamin and mineral deficiencies, which can lead to osteoporosis.

April 1, 2005 -- It sounds too good to be true but an increasing number of Americans are buying into the notion that a dietary supplement called conjugated linoleic acid, or CLA, can help them both lose weight and increase muscle mass.

A new study funded by the leading manufacturer of CLA suggests just that. But experts tell WebMD that the claims about the supplement far outweigh the science. The researcher who discovered CLA says that while it can help people replace fat with muscle, it is no miracle weight loss aid.

"I have been telling people for years that this is not a weight loss product," Michael W. Pariza, PhD, tells WebMD. "If someone takes CLA to lose weight but doesn't change their diet or exercise patterns they are going to be disappointed."

The Research

CLA is a natural occurring fatty acid found in meats and dairy products, with claims of helping people lose fat, maintain weight loss, retain lean muscle mass, and control type 2 diabetes -- the type of diabetes that is often associated with obesity.

Early animal studies following its identification by Pariza and colleagues in the late 1970s raised hopes that it could be used to fight human cancer.

The popular dietary supplement is now sold in health food stores and on the Internet.

In a study published last Maystudy published last May involving 180 people who were overweight, those who took CLA for a year lost between 7% and 9% of their body fat even though they did not change their lifestyles or eating habits.

But CLA users lost only a modest amount of weight -- 4 pounds during the yearlong study. And the investigation did little to silence concerns about the long-term safety of the supplement. The volunteers taking CLA had changes in certain heart disease risk factors.

CLA users had slightly higher LDL "bad" cholesterol and slightly lower HDL "good" cholesterol than nonusers. And the CLA group had higher white blood cell counts and lipoprotein (a) levels -- also known as lipoprotein little (a). Both are markers of inflammation linked to heart disease.

In this follow-up study, 134 of the overweight participants either continued taking CLA for another year or could start taking the supplement if they had been in the placebo group. Both groups took 3.4 grams of CLA a day and continued their normal lifestyle habits. They ate what they wanted without restricting calories and continued their usual amounts of physical activity.

The study was funded by the company that markets Tonalin CLA, the largest selling brand of the supplement. The findings are reported in the April 1 issue of The Journal of Nutrition.

The group that had already been taking CLA lost no more weight or body fat, but they maintained the body fat losses seen in the previous year. People who began taking the supplement during year two of the study lost an average of 3.5 pounds and also saw reductions in overall body fat.

The safety picture for those who took the supplement for two years was somewhat reassuring. Total cholesterol and LDL cholesterol were reduced slightly, while HDL cholesterol, triglycerides, and fasting blood glucose levels remained unchanged.

But there were consistent increases in lipoprotein levels associated with CLA use. Lipoprotein levels are believed to be independent predictors of heart disease risk.

CLA use was also associated with increases in white blood cells and blood platelet counts, which suggested an inflammatory response to use of the supplement. Inflammatory responses like these are believed to lead to blood vessel damage seen in atherosclerosis and cardiovascular disease.

Researcher Jean-Michel Gaullier and colleagues concluded that the role of CLA in cardiovascular risk is still "equivocal."

"Further studies are needed to determine if there is an effect of CLA on cardiovascular risk and inflammation in humans," they wrote.

Others Agree

In a review of the CLA research, published last year, California nutritionists Lisa Rainer, MS, RD, and Cynthia J. Heiss, PhD, concluded that while the animal studies on CLA are promising, the research in humans remains inconclusive.

"The existing studies of CLA supplementation in human beings are difficult to interpret because of the different parameters measured and the variances in dosage, duration of administration, and subject characteristics," they write.

In an interview with WebMD, Rainer said she would not recommend CLA supplementation for weight control on the basis of the studies she has seen.

"More trials need to be done in human beings before we really know the long-term benefits and safety," she says.

But Pariza, who began taking CLA when it became available in supplement form almost a decade ago, believes strongly that long-term use by healthy people is not only safe but beneficial.

He says CLA may have merit as a weight loss supplement when combined with another weight-reducing treatment or may singularly promote loss of body fat and maintenance of muscle. He says the supplement also can subsequently reduce the risk of weight regain.

May 24, 2004 -- Obese and overweight women are at increased risk of getting suspicious results from screening mammograms, research shows.

Mammograms don't miss any more cancers in heavy women than in thin women. But the more a woman weighs, the greater the risk that her mammogram will have false positive results. That means more tests - and more anxiety.

Joann G. Elmore, MD, MPH, of the University of Washington in Seattle, and colleagues analyzed more than 100,000 mammograms from nearly 70,000 women. The report their findings in the May 24 issue of Archives of Internal Medicine.

"Compared with underweight or normal weight women, overweight and obese women were more likely to be recalled for additional tests," Elmore and co-workers write. "Obese women had more than a 20% increased risk of having a false positive mammogram result."

At the personal level, it's not a huge increase in risk. Overall, a woman faces about one in 10 chance of getting a false positive result on a screening mammogram. Obesity increases that risk from 10% to 12%.

But those extra tests add up fast. For an estimated 10 million obese women in the U.S., this means some 200,000 false positives. At $600 per retest, that adds up to an extra $120 million in U.S. health-care costs. And that doesn't even begin to measure the personal costs.

"We cannot put a quantitative value on the resultant anxiety these 200,000 women would additionally experience," Elmore and colleagues note.

Even so, obese women need mammograms more than skinny women. That's because a breast examination is more likely to miss small tumors in women with very large breasts.

The researchers suggest that larger mammography plates may help get better images of women with large breasts. They also suggest that weight loss may lower the likelihood of an unnecessarily traumatic experience when it's time for a routine mammogram.

Jan. 3, 2003 -- Houston is the couch potato capital of the U.S. and Honolulu is the fittest city, say the editors of Men's Fitness magazine.

The "America's Fattest City" award goes to Houston for the third year, uh, running. The ratings are based on a major city's score in several categories such as fruit/vegetable consumption, sports participation, smoking, drinking, air quality, and percentage of overweight/sedentary residents.

"Given the region's climate (hot and humid), air quality (abysmal), and relative lack of outdoor recreation, staying active presents a Texas-sized challenge," the magazine states. "And with its love of junk food, Houston is a vastrodome of bad nutrition."

If you don't live in Houston, don't let out your belt just yet. The annual ratings are meant as a wake-up call to stop what the CDC calls a national epidemic of obesity. Two in every three Americans have a serious weight problem.

Here's the magazine's list of America's 10 fattest cities:

1. Houston
2. Chicago
3. Detroit
4. Philadelphia
5. St. Louis
6. Cleveland
7. Atlanta
8. Columbus, Ohio
9. Dallas
10. Charlotte, N.C.

And its list of the 10 fittest cities:

1. Honolulu
2. Seattle
3. San Francisco
4. Colorado Springs, Col.
5. San Diego
6. Portland, Ore.
7. Denver
8. Virginia Beach, Va.
9. Tucson, Ariz.
10. Sacramento, Calif.

If you've got diabetesdiabetes, the right meal plan can help you keep blood sugar under control. Fruits and vegetables, lean protein, whole grains, and low-fat dairy products -- even sweets now and then -- all have a place in your plan.

"A meal plan provides a specific approach to controlling blood sugar," says Dianne Davis, RD, LDN, CDE, a dietitian with the Vanderbilt Eskind Diabetes Center in Nashville, Tenn. "If you have diabetes, a meal plan is necessary."

That's because a meal plan helps ensure you eat a balanced diet high in fiber and low in fats. It can also "help you lose weight, by controlling portion sizes and calories," Davis says.

Which Diabetes Meal Plan Is Right for You?

Your lifestyle and the type of diabetes treatment you're getting -- whether you're taking premeal insulin or not -- will determine the type of meal plan best for you, says Davis.

Carbohydrates, proteins, and fats are all factored into a plan. But carbs are an especially important component since they have the biggest impact on blood sugar.

"Your meal plan can also include your favorite foods," Davis adds. "No food is off-limits -- it's a matter of how much you eat, when you eat it, and what it will do to your blood sugar."

With that in mind -- and understanding you should talk with your doctor before making big changes in your diabetes diet -- here are four meal-planning systems.

The Diabetes Food Pyramid

The diabetes food pyramid is similar to the USDA food pyramid you see on food labels. It is a pyramid in which a healthy diet means eating more grains, fruits, and vegetables, and less meat, sweets, and fats.

The diabetes food pyramid's general recommendations are:

• Grains, beans, and starchy vegetables: 6 or more servings/day. One serving: 1 slice bread; 1/2 small bagel; 1/2 cup cooked cereal, pasta, rice; 3/4 cup ready-to-eat cereal; 1/2 cup cooked beans, corn, peas.
• Fruits: 2-4 servings daily. One serving: 1 medium-size fresh fruit; 1/2 cup canned fruit; 1/2 cup fruit juice.
• Vegetables: 3-5 servings a day. One serving: 1 cup raw vegetable; 1/2 cup vegetable juice.
• Meat, Fish, Cheese: 2-3 servings/day. One serving: 2-3 ounces cooked lean meat, skinless poultry, or fish; I egg; 2 tablespoons peanut butter; 2-3 ounces cheese.
• Milk and Yogurt: 2-3 servings daily. One serving: 1 cup (8 ounces) milk or yogurt.
• Fats, Sweets, and Alcohol: eat these in small amounts. One serving: 1 teaspoon butter, margarine, or mayonnaise; 1 tablespoon cream cheese or salad dressing; 1/2 cup ice cream.

Combined foods, like eggplant lasagna, for example, will include servings from several food groups (1 vegetable, 1 meat, 1 fat).

This meal system has limitations, says Davis. "When you follow the diabetes food pyramid, you are not controlling specific grams of carbs and might not be able to achieve very tight blood sugar control," she tells WebMD. "However, the pyramid helps you see which foods are carbohydrates -- to get you acquainted with them."

July 26, 2006 -- Multitasking may make you more productive, but it also makes it harder for your brain to learn, according to a new study.

Researchers found people had a harder time learning new things when their brains were distracted by something else, like talking or listening to music.

"When distractions force you to pay less attention to what you are doing, you don't learn as well as if you had paid full attention," says researcher Russell Poldrack, PhD, and UCLA associate professor of psychology, in a news release. "Even if you learn while multitasking, that learning is less flexible and more specialized so you cannot retrieve the information as easily."

Poldrack says distractions appear to affect the brain's learning processes, and tasks that require more attention -- like learning calculus or reading Shakespeare -- are particularly hampered.

Multitasking Disrupts Learning

In the study, published in the Proceedings of the National Academy of Sciences, researchers used functional magnetic resonance imaging (fMRI) to examine brain function and activity while adults (average age, 26) learned a new task.

The 14 participants were asked to make predictions after seeing a series of clues about cards with various shapes. With one set of cards, they learned the classification task without any distractions. In the second set, they learned while listening and keeping track of a series of high and low beeps.

The results showed that multitasking didn't reduce the accuracy of the predictions immediately, but it did hurt participants' ability to remember knowledge about the task later.

Researchers found that when participants were asked questions about the cards at a follow-up session, they did much better on the task they learned without any distractions.

When asked about the task they learned with the distraction, they couldn't extrapolate, or their knowledge was less flexible about the task.

Distraction Affects Memory

The fMRIs showed that when the participants learned without distraction, an area of the brain known as the hippocampus was involved. This part of the brain is critical to the processing and storing of information.

But when they learned the task while multitasking, the hippocampus was not engaged. Instead, an area called the striatum was activated. The striatum is involved in learning new skills like riding a bicycle.

Researchers say the results show that learning while distracted or multitasking alters the brain's learning processes and changes the way people learn.

Multitasking when performing certain tasks -- like listening to music while exercising -- may be helpful. But Poldrack says tasks that distract you while you try to learn something new are likely to negatively affect your learning.

"The best thing you can do to improve your memory is to pay attention to the things you want to remember," says Poldrack.

When Judith Orloff was a child, her doctor parents became so frustrated with her vivid premonitions -- on everything from illnesses to deaths to earthquakes -- they finally told her not to mention them again.

"I grew up believing something was wrong with me," says Orloff, now a board-certified psychiatrist, assistant clinical professor of psychiatry at UCLA, and author of Second Sight and Dr. Judith Orloff's Guide to Intuitive Healing: 5 Steps to Physical, Emotional, and Sexual Wellness. As a result, Orloff says she strayed far from her intuition (without much difficulty) as she pursued her medical studies. It wasn't until she was in private practice that she once again learned to trust her intuitive skills. Orloff recalls that she had been treating a woman for major depression who was responding well to antidepressants and conventional therapy. Seemingly out of the blue, though, Orloff had an image of the patient committing suicide.

"I didn't say anything because I had learned not to listen to myself," says Orloff. "Several weeks later the woman overdosed and was in a coma for weeks."

Fortunately, the patient recovered, and Orloff says she learned to pay attention to her own intuitive abilities.

Orloff says she believes that we all have an intuitive sense, although not everyone realizes it can be accessed. "Intuition is that still, small voice inside of you," she says. "It's your inner wisdom that can help you deal with anything from health issues to relationships to death and dying."

Orloff prefers to call herself an intuitive, rather than a psychic or clairvoyant, because she believes those terms have been too "tarnished" in our society and evoke images of sideshow acts.

In her practice -- which has a waiting list of 6,000 patients -- and in her workshops for healthcare professionals around the country, Orloff teaches people to develop their own intuition.

Sept. 20, 2004 -- Fixing a defect in cancer cells makes them die a natural death, a study in mice shows.

The finding means that a series of new anticancer drugs already in development are likely to work. They may work very well indeed, the study suggests.

When normal cells reach the end of their useful life, they self-destruct. This suicide process is called programmed cell death or apoptosis. But cancer cells have a defective self-destruct program. They make too much of a molecule called BCL-2, which gobbles up the chemical messengers that activate cell suicide.

Anthony Letai, MD, PhD, Stanley Korsmeyer, MD, and colleagues at Dana-Farber Cancer Institute wondered what would happen if they stripped cancer cells of their BCL-2 armor.

"What better way to kill cancer cells than targeting the molecules that directly control their survival?" Letai asks in a news release.

To see what would happen if cancer cells didn't have BCL-2 protection, the researchers created a strain of genetically engineered mice whose BCL-2 could be switched off by a common antibiotic. The mice also carried a gene that gave them leukemia.

By the age of 7 weeks, all 28 test animals had leukemia. All 14 mice that continued making BCL-2 died of leukemia by 100 days of age. But the 14 treated animals, who received the antibiotic in drinking water, had their BCL-2 cut off. All of them had fewer leukemia cells, and their white blood cells numbers became normal within days of therapy. Five of these mice lived for more than 200 days, and one lived for more than a year.

That's exciting news. Until this experiment, nobody was sure that simply removing the barrier to cell suicide would result in cancer-cell death.

"Abnormalities in genes affecting [programmed cell death] have been found in nearly every cancer, suggesting they may be necessary to develop cancer," Letai and colleagues write in the September 2004 issue of Cancer Cell.

Several drug companies are working on treatments that would block BCL-2. BCL-2 is crucial for proper immune function. But the mouse studies suggest that humans could tolerate a temporary BCL-2 block long enough for such future drugs to have an anticancer effect.

Senior study author Korsmeyer serves on the scientific advisory board of IDUN Pharmaceuticals, which is developing cell-death therapeutics.

March 3, 2000 (Washington) -- More than 70% of Americans, regardless of political affiliation, support a patients' bill of rights with a right to sue managed care companies, according to national surveys. But that specific provision remains one of the major divides between the House and Senate managed care reform bills passed last year. In an appearance Thursday, President Clinton -- joined by consumer and medical interest groups -- emphasized that the House bill, which offers the right to sue, is "so far ... the only bill that can make its way to my desk." Clinton noted that "this is not a partisan issue anywhere else in the entire United States."

While the Senate bill has no comparable provision, Senate Republicans have acknowledged that some right to sue is inevitable.

Hammering out a final "patients' bill of rights" by the end of the month is the goal, according to House/Senate conference committee chairman Sen. Don Nickles, R-Okla. "We're going to work real hard" to meet that "aggressive" timeline, he said at the panel's first meeting Thursday. If the conference committee can get agreement, Congress would send President Clinton a bill to sign into law.

Staffers are already close to deals on several items. For example, aides have agreed on language that will allow parents to designate a pediatrician as a primary physician for their children. And a Nickles spokeswoman tells WebMD that staffers are close to agreement on standards to guarantee coverage of emergency room visits and to allow women direct access to ob/gyns during pregnancies and in other situations.

"I feel very positive about it," Rep. Charlie Norwood, R-Ga., tells WebMD. "There is no reason this can't happen." At the same time, he acknowledges, "In this town, anything can blow up on you." Norwood was a chief architect of the House-passed bill, but Republican leaders kept him off the conference committee in favor of lawmakers who back less aggressive legislation.

Despite the early progress, numerous negotiations remain over, for example, general patient access to specialists, allowing patients to go out of managed care doctor networks, permitting individuals to continue seeing a physician even if the doctor stops contracting with a health plan, and giving patients access to drugs not on a plan's formulary.

And there are even huger differences between the two bills beyond the right to sue. The scope of the House bill, for example, is far larger than that of the Senate. It would cover all 161 million Americans with employee-sponsored health insurance, while the Senate would largely apply to just 48 million Americans -- those in plans that are not governed by state laws. Senate Republicans have argued that states should regulate the other health plans.

The two bills also have major differences in the appeals processes they would establish for individuals over care denials and other grievances.

Significant haggling over the details is certain, but the question is, according to conferee Rep. Bill Thomas, R-Calif., "Can the Senate come far enough for the House to accept it?"

If the Senate comes, it may be kicking and screaming. The Senate Republican Policy Committee put out a document touting estimates that the House bill would jack up premiums so much that 1.2 million Americans would lose their coverage. The policy committee was citing data generated through employer and insurance groups.

And Nickles said Thursday that the top consideration for a final bill was that it "do no harm," such as raising costs and increasing the number of uninsured Americans. "Let's try to take the best of both bills," he said.

The conference committee plans to hold its second meeting on March 9.

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Dec. 7, 1999 (New York) -- A new study has found a possible link between abnormal electrical activity in the brain and violent behavior -- a topic of interest to both doctors and lawyers alike.

Electroencephalography (EEG) is a process whereby the brain's electrical activity is measured by placing electrodes on a person's head. According to a study in the fall issue of the Journal of Neuropsychiatry and Clinical Neurosciences, 13% of a group of violent criminal offenders had evidence of abnormal brain activity based on EEG readings. Those prisoners who had even more specific problems within the brain's left hemisphere committed significantly more violent offenses.

"Our findings lend some support to the concept of a connection between left hemispheric cerebral lesions and the propensity for violence. At the same time, they indicate that this association may be caused by a relatively small subgroup of subjects," write Frank Pillmann, MD, and colleagues in the department of psychiatry at Martin Luther University Halle-Wittenberg in Germany.

The investigators studied over 200 defendants seen at a university clinic for pretrial assessment and evaluation of criminal responsibility. More than 90% of the subjects were male and the average age was 30 years old (ages ranged from 15 to 77 years). Two-thirds of the group were charged with violent offenses such as murder and manslaughter, aggravated assault and battery, robbery, and sexual offenses.

Of the 151 with histories of violence, about one-third had abnormal EEGs. Twenty subjects (13%) had specific types of localized damage, 10 in the brain's right hemisphere and 10 in the left. The average number of violent offenses was slightly higher in those with EEG abnormalities than in those without abnormalities. Breaking it down even further, those who had some type of damage to their left hemisphere, in a specific region of the brain called the temporal region, had significantly higher rates of violent criminal acts than those with damage to the right hemisphere.

Can criminals with certain brain abnormalities use this kind of research as part of their criminal defense? "It's a complex area," Thomas G. Gutheil, MD, tells WebMD in an interview seeking objective commentary. "In determining criminal responsibility, the issue is criteria. You might have extremely powerful evidence that a neurological condition exists but ... the question is whether the condition impinges on a person's functioning enough so that it meets legal criteria which are usually about understanding wrongfulness and inability to control one's actions." Gutheil is with the program in psychiatry and the law at Harvard Medical School in Boston.

"In the United Kingdom, temporal lobe epilepsy is called the defense of desperate cases. No one is absolutely clear that it has, in fact, a role in criminality," says Gutheil.

Angela M. Hegarty MD, who is affiliated with NYU Medical Center and director of forensic services at the Sagamore Children's Psychiatric Center, agrees. "Just because someone has a history of seizures per se, that has minimal or no relevance to their ability at the time of the crime. Most crimes involve complex activities and behaviors. ... It would be hard to imagine a scenario where the fact that one has EEG abnormalities or seizures would actually effect [the committing of] a homicide."

"Abnormal electrical activity in the brain cannot be taken to explain alone why somebody is violent," Hegarty tells WebMD. She suggests that neurological dysfunction in general may lead to cognitive dysfunction that, in turn, may increase the likelihood that somebody would resort to violence because of frustration, inability to concentrate, or other problems.

While Hegarty believes having a history of a seizure disorder would not help an insanity defense, it might be considered as a mitigating factor. "If someone has mental retardation, seizures, and gets explosive and does something unfortunate in that context, that's clearly a very different picture than someone who calculatingly plans a homicide," says Hegarty.

Hegarty suggests that a more meaningful study would have compared focal EEG abnormalities in violent and nonviolent offenders. "The take-home message for clinicians is that neuropsychiatric studies like this one really tell us more about process than content. They tell us there is some brain dysfunction and they tell us to look further. But there are plenty of people with EEG abnormalities who are not violent and there are many people who are very violent but do not have EEG abnormalities. The EEG abnormalities per se cannot be causally linked to violence."

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May 18, 2004 -- Full recovery after a bone marrow transplant to treat leukemia or lymphoma may take years, not months, according to new research.

The study shows physical recovery often happens long before a bone marrow transplant recipient bounces back psychologically or is ready to go back to work. The study showed that the majority of patients took as long as three to five years to fully recover and return to work.

Researchers say bone marrow transplants are commonly used to treat cancers of the blood, such as leukemia and lymphoma.

Survival rates after the painful procedure have improved considerably in recent years, which researchers say increases the need to understand the recovery process better and identify ways to avoid pitfalls or risks and improve functional recovery.

Bone Marrow Transplant Recovery's a Long Road

In the study, researchers followed 319 bone marrow transplant recipients who had the procedure to treat leukemia or lymphoma. Of the 99 long-term survivors, 94 remained free of cancer recurrence during the follow-up of five years.

The results appear in the May 19 issue of The Journal of the American Medical Association.

The study showed that physical recovery happened much sooner than psychological recovery or a return to work. Only 19% of the patients had recovered on all three measures within a year after the transplant. But 63% of recipients had no major limitations by five years following the procedure.

Among the survivors:

• 84% returned to full-time work within five years.

• 22% suffered from symptoms of severe depression during recovery, and 31% had mild depressive symptoms.

• Women were more likely to suffer depression, posttreatment distress, and delay returning to work.

The study also showed that several characteristics of the patients before the bone marrow transplant were related to how they fared after the procedure:

• Patients with slower physical recovery had higher medical risk and were more depressed before the procedure.

• Those with lower social support had a slower recovery.

• Higher levels of physical impairment before the transplant were tied to a more difficult physical and emotional recovery after the procedure.

• People who had more experience with cancer treatment before the bone marrow transplant recovered faster from depression and treatment-related distress.

"These results are both encouraging and cautionary," write researcher Karen L. Syrjala, PhD, of the Fred Hutchinson Cancer Research Center, and colleagues. "Patients, families, and medical teams depend on accurate recovery data when planning for posttransplant needs.

"Expectations that contradict actual experience cause stress for survivors and potential conflicts with family, work, and the medical team," write the researchers. "To facilitate realistic planning, clinicians and patients should understand that full recovery requires more than a year for most survivors."

Dec. 19, 2002 -- A woman transmitted West Nile virus to her baby while pregnant in apparently the first case of intrauterine transmission of the disease, according to the CDC.

The baby girl was born last month in Syracuse, New York to a 20-year-old mother who first became ill with West Nile virus in August, but was not diagnosed until October. The baby was delivered normally but an MRI showed severe brain abnormalities. CDC officials characterized the infant as having severe neurological damage, and tests conducted shortly after birth showed that she had the infection.

They say that this case does not prove a direct relationship between infection and the brain abnormalities, but they have found no other explanation for it.

"It is very possible that the West Nile virus was the cause of this baby's neurological deficit, but with only one case it is impossible to determine cause and effect," CDC West Nile expert Lyle Peterson, MD, said during a teleconference held Thursday afternoon.

Several other cases of West Nile infection among pregnant women have been identified since the mosquito-borne virus was first reported in the U.S. in 1999. In one case a woman delivered a healthy baby who was not infected, and in the other cases the babies have not yet been born, the CDC officials said.

This single case that we report does not prove that West Nile virus infection causes adverse birth outcomes," Dan O'Leary, MD, said. "But pregnant women should take precautions to reduce their risk of West Nile virus and other mosquito-borne viruses by avoiding mosquitoes when possible, using protective clothing, and repellents containing DEET as per manufacturers' directions."

O'Leary said transmission through breast milk is believed to have occurred in at least one instance. In that case a woman became infected though a blood transfusion she received shortly after giving birth, and apparently passed the infection to her infant before she knew she was sick.

O'Leary and Peterson are with the CDC's Division of Vector-Borne Infectious Diseases branch in Fort Collins, Colorado.

On Thursday, the CDC also released official figures on West Nile incidence in the United States this year. Between January and November there were 3,389 reported cases of illness linked to the virus occurring in 37 states and the District of Columbia. The peak of the outbreak occurred in August, and 201 deaths were reported.

Roughly two-thirds of the illnesses involved West Nile encephalitis. Symptoms of this severe form of infection include headache, high fever, neck stiffness and disorientation, and can progress to paralysis, coma, and death.

The four states with the most infections -- Illinois, Michigan, Ohio and Louisiana -- reported 67% of the total West Nile cases. Among the almost 2,300 counties reporting West Nile virus, 62% reported that infected dead birds were the first indicator of activity, while 29% reported that the virus was first spotted in horses.

The 12th annual beach report from the Natural Resources Defense Council (NRDC) found there were 19% more beach closures and advisories in 2001 than in 2000. That translates to at least 13,410 closures and advisories at ocean and fresh water beaches across the U.S.

Researchers say the rising numbers are partly due to better monitoring of water quality at beaches by local agencies. But the authors say one of the most disturbing findings is that local authorities admit that they don't know the source of pollution responsible for more than half of the closures and advisories.

"The reporting agencies don't know the source of pollution because, in many cases, no one is systematically tracking it down and attempting to do anything about it," says Sarah Chasis, an NRDC senior attorney and director of the organization's water and coastal program, in a news release. "It's important not only to regularly monitor beaches and notify the public of contamination, but also to identify and control the pollution sources."

When the source of pollution was known, contamination from storm water runoff and raw sewage discharges were the most frequent causes of closures and advisories.

Even though the NRDC says states are doing a better job of keeping tabs on water quality at beaches, there are no consistent standards for monitoring nationwide. For example, two states, Oregon and Louisiana, do not have any regular beach monitoring system or public-notification program.

The council also published a list of its "beach bums" -- 70 communities that do not monitor beaches for swimmer safety, do not notify the public when health standards are violated, do not follow the EPA's recommended standards, and have known pollution sources affecting their beaches.

On the positive side, the NRDC singled out several communities for continuing to closely monitor beach water and taking steps to reduce beach pollution with its annual "beach buddy" award. This year, the awards were given to Branford, Conn.; Key West, Fla.; Salem, Mass.; and the Los Angeles County and San Diego County regional water quality boards.

For a complete list of "beach bums" and ratings of more than 2,400 U.S. beaches, visit the NRDC web site at www.nrdc.org.

July 30, 2001 -- "The nail that sticks up gets hammered down," says a proverb from Japan, a nation where conformity to the social norm is prized.

In the U.S., we like to think we celebrate the individual and are tolerant of different ideas, cultures, and ways of living. But the mirror we hold up to ourselves was shattered in 1998 by the news that Matthew Shepard, a 21-year-old freshman at the University of Wyoming, had been savagely beaten, lashed to a fence, and left to die on a desolate prairie outside of Laramie -- ostensibly for the purpose of robbery, but in reality for the crime of being gay.

Matthew Shepard is just one prominent example of many thousands of school-aged lesbian, gay, bisexual, and transgender Americans who say their daily lives are carried out under a cloud of fear and violence. And although few suffer such extreme fates as Shepard, a majority, say human rights experts, suffer from verbal, emotional, and physical abuses each day.

'Tie the faggot to the back of the truck'

"One day in the parking lot outside his school, six students surrounded him and threw a lasso around his neck, saying, 'Let's tie the faggot to the back of the truck.' "

Dylan N. from Nevada related this experience to members of the nonprofit organization Human Rights Watch (HRW), who included it in a recent report titled Hatred in the Hallways: Violence and Discrimination Against Lesbian, Gay, Bisexual, and Transgender Students in U.S. Schools.

As troubling as the incident was to Dylan, he was equally disturbed by the response from school officials:

"He escaped from his tormentors and ran inside the school. Finding one of the vice-principals, he tried to tell her what had just happened to him. "I was still hysterical," he said. "I was trying to explain, but I was stumbling over my words. She laughed."

In 1990, researchers from Columbia University reported that in a study of minority, working-class, and homosexual youths who had experienced physical assault, nearly half said the assault was gay-related, and that 41% of the girls and 34% of the boys had attempted suicide because of it.

According to a 1993 report from the Massachusetts Governor's Commission on Gay and Lesbian Youth, 97% of students in public high schools report regularly hearing homophobic remarks from their peers, and 53% of students report hearing such comments made by school staff.

Oct. 10, 2006 -- Whooping cough may be more common in states that make it relatively easy for students to skip required vaccines.

That news appears in the Oct. 11 issue of The Journal of the American Medical Association.

"States should examine their exemption policies to ensure control of pertussis [whooping cough] and other vaccine-preventable diseases," write the researchers.

They included Saad Omer, MBBS, MPH, of Johns Hopkins Bloomberg School of Public Health.

Omer and colleagues studied states' vaccine requirements for students aged 18 and younger, as well as states' whooping cough rates as reported to the CDC from 1986 to 2004.

Nationwide, all students entering school are required to "provide documentation that they have met the state vaccine requirements," the researchers write.

But all over the U.S. -- except in Mississippi and West Virginia -- students may skip vaccines for nonmedical reasons, Omer's team notes.

Most of the states allow vaccine exemptions for "religious" reasons. Fewer states allow exemptions for "personal belief."

Vaccine exemptions are easier to get in some states than in others, the researchers also point out.

Whooping cough rates were higher in states with "personal belief" exemptions and in states with easier vaccine exemption processes, the study shows.

The CDC's data might not reflect all whooping cough cases, which often go unreported. That could have swayed the results, Omer's team notes.

The researchers call for a balance between personal freedom and public health, with regard to vaccine policies.

"States must balance parental autonomy with the tremendous public health benefit of vaccines when considering the types of exemptions allowed and how policies are implemented," write Omer and colleagues.

Oct. 12, 2005 (Washington) -- That schoolyard bully who pushes, punches, and threatens other children may in turn commit assault behaviors later, says a Washington-based pediatrician.

Bullying is a growing problem, with the average number of school-based violent events involving multiple victims increasing from one event per school year in 1992 to more than five events per year in 1998, according to a HELP Network fact sheet.

Studies have shown that the prevalence of bullying is about 30% in school-age children, says Joseph Wright, MD, associate professor of pediatrics, emergency medicine, and prevention & community health at Children's National Medical Center. According to the National Youth Violence Prevention Resource Center, approximately 30% of youths are involved in bullying by either being the victim, the bully, or both.

Girl Bullies on the Rise

The researchers cited other studies that showed that at age 11, 25% of boys and 14% of girls report bullying others. And at least 22% of boys and 26% of girls report being bullied.

"While bullying once was seen as an activity of boys, there has been a burgeoning increase in the number of girls who bully," Wright says. "Girls now threaten, use innuendos, and tease others about their clothes as ways to interact together. They are joining in. Many are bullying through the format of 'cyber bullying' through emails, instant and text messaging, and camera phones."

Styles of bullying range from the direct of pushing, punching, spitting, and tripping to the more indirect of threats of teasing, spreading rumors, and shunning, he says.

Bullying is associated with higher rates of frequent fighting and injuries and weapon carrying, with the associations being stronger for bullies than targets, he told those attending the American Academy of Pediatrics National Conference and Exhibition.

"This isn't a low-morbidity activity," notes Wright. "Bullying behavior presents the risk of serious behaviors down the stream. Bullying is weapon carrying, frequent fighting, and injuries."

Bullies More Likely to Carry Weapons

Previous studies have shown that children who were bullied at school and outside of school on a weekly basis were four times more likely to carry a weapon and 3.8 times more likely to bring a weapon to school, he says.

The chances of carrying a weapon were even higher in those children who bullied others weekly in school, he says. "Those who bullied children out of school were more than five times as likely to carry a weapon to school."

Direct bullying also is linked with depression and suicidal ideation in girls, he says. "This fact seems to say that boys fight and get it over with, but girls become depressed."

The American Academy of Pediatrics is attempting to attack the problem of bullying and other violent behavior through a program called Connected Kids: Safe, Strong, Secure. The program trains and provides the nation's pediatricians with tools to help stop violent behavior both in families and children.

The new program provides more than 21 pamphlets for doctors to give their patients as well as education and information to doctors on how to query their patients and families about violent behaviors.

"This is an important issue," Utah pediatrician R. Joe Jopling, MD, tells WebMD. "Kids have been bullying one another since back when I was a kid. But there is increasing awareness of the health and societal risks."

The new AAP program will help combat bullying and other forms of violence, he says. "It's a great tool to help both children and parents."

SOURCES: American Academy of Pediatrics. Joseph Wright, MD, associate professor of pediatrics, emergency medicine and prevention & community health, Children's National Medical Center, Washington. R. Joe Jopling, MD, pediatrician, Salt Lake City. HELP Network Fact Sheet, HELP Network web site. National Youth Violence Prevention Resource Center web site.

Feb. 17, 2005 -- When violence appears on TV, in a movie, or on computer screens, it can color the thoughts, emotions, and behavior of the kids who see it.

For years, experts have debated whether (or how) media violence affects kids. Now, two British experts from England's University of Birmingham add to the debate.

"There is consistent evidence that violent imagery in television, film and video, and computer games has substantial short-term effects on arousal, thoughts, and emotions," write Kevin Browne, PhD, and Catherine Hamilton-Giachritsis in The Lancet's Feb. 19 edition.

The pair reviewed six studies on kids and media violence. All of the studies were done in North America. Two papers focused only on TV and movies; the other four projects also included violence in videos and computer games.

Violent imagery increases "the likelihood of aggressive or fearful behavior in younger children, especially boys," write the researchers, who work at the university's Centre for Forensic and Family Psychology.

Media violence's long-term impact and effects on older children and teens are less clear, write the researchers. They also found only weak evidence directly linking media violence to crime.

Many studies have given a thumbs-down review to media violence. Some note that the consequences of violence are rarely shown. In one U.S. report, 42% of the violent scenes studied were played for laughs. That could give impressionable young kids unrealistic ideas about violence, say critics.

Which Kids Are Most Affected?

Some kids may be more affected by media violence than others. Besides age, personality could play a role.

The sex of the children also matters. Boys were more affected than girls, but more work is needed in that area, write the researchers.

Mental health problems might also make a difference. Little research has been done in that area, the researchers write.

Viewers' families are important. It's been suggested that dysfunctional families affect responses to media violence, write the researchers.

"For example, growing up in a violent family and being a victim of violence or witnessing violence between others is known to have a strong effect on a person's predisposition to act aggressively," they write.

Media violence isn't just tied to aggressive behavior. It can also frighten children. For young kids, that was especially true for news programs depicting disasters such as the Sept. 11 terrorist attacks.

Putting Media Violence in Perspective

Ideally, producers would be sensitive to the power they wield, and parents would know what their kids are viewing, write the researchers.

But in the real world, it can be hard for parents to monitor their children's media habits. With TV, movies, videos, and computer games, many parents don't know what their kids see every day.

"The availability of video film, satellite, and cable TV in the home allows children access to violent media inappropriate for their age, developmental stage, and mental health," write the researchers.

They add that computer games have become much more sophisticated, drawing the player into the games' virtual worlds, many of which are violent. "Games with human characters had more effect than abstract violence," they note.

If parents can't be censors, they should watch violent material -- fictional or factual -- with their kids and encourage them to think critically about what's shown, write the researchers.

Talk about realism, justification, and consequences of the violence, they suggest. "In this way, caregivers can reduce the effect of violent imagery."

Aug. 17, 2004 -- Want to work a little more physical fitness into your child's day by having them walk to school?

Good for you for trying to get your youngster moving. But walking to and from school might not be the most helpful strategy.

A new British study shows that walking to and from school makes no difference in a child's total weekly activity. The study is reported on the British medical web site, BMJ Online First.

The study was led by endocrinology and metabolism professor Terry Wilkin of Peninsula Medical School and Derriford Hospital in Plymouth, England. Wilkin and his colleagues compared activity levels among 275 5-year-old children as they started their first year at primary school. Some children walked to school and some were driven to school.

The children wore monitors during waking hours for five consecutive school days and a weekend to measure their physical activity.

The kids' height, weight, and body fat were also noted.

"Although children who walk to and from school record more activity in the process, the difference has no impact on total weekly activity," write the researchers. "Those driven by car matched those who walked to school in overall activity levels."

Most children in the study (84%) walked about a half-mile to school, taking an average of six minutes.

The kids did far more during the week than just stroll to and from the schoolhouse. Walking to school accounted for just 2% of their total weekly activity, write the researchers.

The study didn't examine other reasons to walk to school, such as reducing traffic and pollution or building good walking habits in children.

"There may be benefits ... but physical activity does not appear to be one of them," write the authors.

Walking to school may not overhaul students' activity levels, but it certainly won't hurt their fitness, either.

Jan. 30, 2004 -- Overweight kids suffer. Their health suffers. Their self-esteem suffers. And new research shows their schoolwork suffers as well.

Problems typically start when an overweight kid enters kindergarten, a RAND study shows. Ashlesha Datar, PhD, and colleagues analyzed data from a U.S. Department of Education study tracking a nationally representative sample of 11,192 kids who started kindergarten in 1998.

Some of the kids were overweight. This means that based on their height and weight, they were more massive than 95% of other kids their age. If they were adults, they would be called obese. But researchers don't use that word when they're talking about kids.

Datar found that when they started school, the overweight children scored significantly lower on tests of verbal and math skills. They did learn at pretty much the same rate as other children. But at the end of first grade, the overweight children still lagged well behind their less heavy peers.

"What we find is most of this is explained by sociological factors," Datar tells WebMD. "The overweight kids tend to come from poorer families with not-so-educated mothers. So when we control for these factors, this relationship between overweight and poor academic performance gets wiped out."

Datar and colleagues report their findings in the January issue of Obesity Research.

Family Factors

Being very much overweight, Datar says, is what researchers call a marker for family factors that are truly behind kids doing less well in school. But that doesn't mean that obesity isn't a problem.

"If you're an overweight kid, your friends don't understand you aren't doing well because you don't have a mother who can read to you at home," Datar notes. "In kindergarten, your friends see you as fat and performing low. There may be some social stigma."

It's a tricky problem. Targeting a child's weight isn't going to solve the problem.

"If you change kids' overweight status, you are not going to make them do better at school," Datar says. "Other interventions that get to these family characteristics might do more."

Nancy Cahir, PhD, an Atlanta-based child and family psychologist, sees obesity in children as a sign of parental neglect.

"Usually if the kid is overweight there is a cluster of stuff going on: depression, family problems, parents who aren't listening to the kid's needs," Cahir tells WebMD. "When you're seeing kids get overweight it's a sign their parents aren't watching out that they eat proper foods, that they get more exercise, that they watch less television. It is a case of parents ignoring kids emotional needs."

How to Help

Help for these children, Datar says, has to start at home. A focus on the child's home environment will do more than a focus on the child's weight.

"If you want to find a helpful intervention, go back to the home," she says. "We want to say, 'Read more to your kids, provide a more enriching home environment.' Obesity is just a marker that these things are missing."

In Woody Allen's movie Sleeper, a nerdy storeowner (played by Allen) is cryogenically frozen and defrosted after 200 years only to find that smoking, cream pies, and hot fudge, among other things, are actually healthy for you. And it seems that such an alternative universe is one that Steven Johnson, author of the controversial new book Everything Bad Is Good for You: How Today's Popular Culture Is Actually Making Us Smarter, would be comfortable and revered in.

Johnson contends that video games, certain violent TV shows like 24, and reality TV shows such as Survivor and The Apprentice are actually making kids smarter and more savvy, not more violent, aggressive, or phobic as others have suggested. He even dubs this phenomenon "the sleeper curve" as a nod to Allen's 1973 flick because just as in the movie, some of the most criticized components of society may actually be beneficial.

While some are quick to call Johnson's ideas heresy, others tend to agree with at least some of what he has to say about the learning potential of video games and television games.

In his new book, Johnson says that video games such as Tetris and SimCity actually force players to make decisions, choose, and prioritize; shows like 24 prompt viewers to make sense of what they are seeing by filling in information that is withheld or deliberately vague. What's more, certain reality shows boost emotional intelligence and teach viewers valuable lessons about what is and isn't effective at work, at home, and at play.

Pop Culture and Intelligence

"There are a number of indications that pop culture is making us smarter," Johnson tells WebMD. "The most powerful of which is the long-term trend in all modern media societies towards rising intelligence quotients (IQs)."

Johnson says that a person with an above average IQ 50 years ago would be merely average today. "A number of scholars believe that part of that increase has to do with the increased complexity of the media environment we all inhabit," he says. "Think of the kind of problem-solving and pattern recognition you have to do to operate a modern computer, compared to, say, switching channels on a radio."

Johnson says "all the major simulation games [such as] SimCity, The Sims, Age of Empires, Railroad Tycoon, etc. -- where you're simultaneously tracking dozens and dozens of shifting variables, trying to manage an entire system -- are a great cognitive workout."

"On television," Johnson notes, "it's shows like Lost, Alias, The Simpsons, Arrested Development, The West Wing, and ER that have the most challenging narrative structures."

"There is a clear trend towards increased complexity in the popular culture [including] more narrative threads (plots) per episode in a television show, more complicated social networks, increasingly layered and multivariable problems in the games and more participatory media online," he says.

For example, while Dallas, a popular 1980s nighttime soap opera chronicled the misadventures of one family, the show 24 actually tracks four families. And instead of fighting for control of the family business as they did on Dallas, the characters of 24 are trying to simultaneously save or destroy the president or the world.

Johnson has two boys, aged 2 and almost 4. "They like to watch DVDs -- all the Pixar movies, for instance, plus the classics such as Winnie The Pooh and Mary Poppins, but mostly they just want to play with their Thomas the Tank Engine train set," he says.

"In some ways, what they're doing now with the Thomas trains is what they'll be doing in a few years with their video games: mastering a complex system, learning all the different characters, building an environment, and exploring it together," he tells WebMD.

"Compared to the popular culture 30 years ago, you have to 'think' more to engage with today's entertainment: you have to make decisions, express your own ideas, analyze more complicated storylines," he says. "It's a kind of mental exercise, not unlike the mental exercise you get from, say, playing chess," Johnson says.

Lydia Hurlbut admits she was a bit nuts the first six weeks after bringing home her new baby, Kyra. She wouldn't allow children -- healthy or sniffling -- within eyesight of the newborn. She admitted adults to her home only after she carefully screened them for colds and other illnesses and even then she send them off first thing to wash their hands.

"I was a total freak about it, absolutely psychotic," says Hurlbut, who is a registered nurse in Pasadena, Calif. But she's convinced that those draconian measures -- along with breast-feeding almost exclusively for Kyra's first year -- paid off by keeping her baby healthy. "Kyra didn't even get a cold until she was 8 months old."

Pediatricians say infants typically don't get sick much in the first few months after birth, primarily because they're born with antibodies they've acquired in the womb. Breast-feeding can also help protect against certain ailments, such as ear infections and some respiratory illnesses.

Build That Immunity

Nonetheless, it's important to minimize exposure to germs in the first three months because babies' immune systems aren't developed until then, and their bodies aren't as good at battling illnesses on their own yet. Premature infants are at greatest risk of getting sick since they haven't had as long in utero to acquire their moms' antibodies.

"In those early weeks, their bodies don't respond as efficiently as they will when they get to be 3 to 6 months of age," says Dr. Lillian Blackmon, associate professor of pediatrics at University of Maryland School of Medicine and a member of the American Academy's committee on fetuses and newborns.

Even the common cold can be tough on infants since they breathe only through their noses during the first few months and can't cough to clear mucus from the backs of their throats. Their airways are smaller, too. "They get into a lot of distress," says Dr. Blackmon. "They'll be irritable, they won't feed well, they'll cry, and they won't sleep very well."

Avoiding the 'Day-care Flu'

Parents can do a lot to stave off illnesses. "Number one, wash your hands a lot because that's one of the major ways that things are transmitted," says Dr. William Kanto, chairman of the department of pediatrics at Medical College of Georgia and another AAP member of the fetus and newborn committee.

Other popular pediatrician tips:

• Stay current on immunizations
• Keep infants, especially under 3 months, away from adults and children who are sick
• Avoid crowded grocery stores, malls and other public places
• Choose child care carefully

If you have to send your little one to child care, try to find a situation that minimizes the risks -- not an easy task, since even the best day-care facilities, with the most conscientious staffs, can be awash in germs.

It will also help to limit the number of day-care providers you use: Find a good day care and stick with it, and select a place that separates infants from other children. "Think about whether this will be a family day care with a few children or a large day care," advises Blackmon, "because every time you expand the number of families, you expand the infection risk."

March 23, 2005 -- The sooner you eat that fresh spinach in your refrigerator, the better.

You'll get the most nutritional value that way, say researchers from Pennsylvania State University. They tracked how quickly nutrients fade in a bag of fresh spinach -- and why.

Just a few days after spinach is picked, its nutritional peak starts to dip, they found. Unless your spinach comes from your backyard or a local farm, chances are good that it traveled a long way before landing on your plate. What happens on the journey -- and in your kitchen -- can make a big difference.

In fact, if you aren't going to cook fresh spinach promptly, you might want to consider frozen or canned spinach as an alternative, the researchers suggest.

Far-Flung Farms

Stroll through a grocery store's produce aisles, and you'll find grapes and plums from Chile, broccoli from California, and all sorts of good-for-you greenery from far and wide.

We ought to take advantage of it, say health experts. They urge us to eat at least five fruits and veggiesfive fruits and veggies per day for maximum benefits.

The year-round abundance relies on long-distance shipping. Along the way, produce needs TLC in the form of cool temperatures. As each day passes, it's got a little less to offer, in terms of nutrition.

That's what researchers found when they studied a simple bag of fresh spinach.

Fresh from the ground, spinach is packed with healthy nutrients. Those include folate -- which is a B vitamin that helps prevent the birth defect spina bifida -- and carotenoids, a form of vitamin A that's needed for development and may also protect against blindness and cancer.

Of all veggies, only kale (another leafy green) has more total folate and carotenoids than spinach, says the study.

But these healthy nutrients don't stick around for long. After four to eight days, spinach lost nearly half of its folate, depending on the temperature at which it was stored.

A 47% drop in folate occurred in eight days at 39 degrees Fahrenheit, the recommended refrigerator temperature. Spinach lost nearly half its folate after six days at 50 degrees and after four days at 68 degrees.

Increased temperatures also cut carotenoid levels. The spinach held onto only 54%, 61%, and 44%, respectively, in the same time and temperature conditions.

Keep an Eye on Shelf Life

"Minimally processed vegetables are attractive to consumers because of their convenience and nutritional value," says the study, which recently appeared in the Journal of Food Science.

"However, substantial losses of folate and carotenoids occurred in packaged spinach under both refrigerated and temperature abuse conditions," write the researchers, who included Penn State's Luke LaBorde, an associate professor of food science.

"Published values for these nutrients in fresh spinach may, therefore, not always accurately affect levels that are consumed."

The findings have implications for shipping spinach, says LaBorde in a news release. Meanwhile, it seems best to keep fresh spinach cool, minimize storage time, and consider canned and frozen spinach as other options.

When it comes to buffets, diners have their choice these days: mom-and-pop ethnic eateries, national chain buffets, and splashy Las Vegas casino spreads complete with seafood bars and sumptuous desserts.

With all-you-can-eat prices dipping as low as $7 or $8 in some cities, buffets tempt both the palate and the wallet. In 2005, Americans spent more than $1.5 billion at the nation's 5,630 cafeteria and buffet-style restaurants, according to Technomic, a restaurant research firm in Chicago.

But how safe are these serve-it-yourself restaurants?

As long as buffet operators take proper precautions, they're generally safe, experts say. Occasional outbreaks at buffets have made headlines. But though the CDC collects information on food-borne illnesses at restaurants, it doesn't track the type of establishment involved. So there's no hard evidence that compares the risk at buffets to other types of eateries.

Buffets do present a couple of special challenges.

First, foods rest in steam tables, ice baths, or salad bars. If improperly tended, these buffet stations can allow disease causing bacteria and viruses to flourish.

Second, customers can come into contact with food: the man who sneezes into his palm and then handles the serving tongs, the woman who grabs a few strawberries with her bare hand, the child who pokes a slobbery finger into the tuna salad.

"If food is not handled properly; if people cross-contaminate food; if you have little kids touching the salad prior to service; the likelihood of food-borne illness is much higher," says Timothy Ong, a San Francisco Public Health Department senior inspector who has checked hundreds of buffet restaurants in his 24-year career.

WebMD quizzed Ong and other restaurant inspectors and food scientists about ways to maximize your chances of eating safely at buffets. Does the Place Look and Smell Good?

Much of food safety happens in the kitchen -- out of your line of vision. But you can still get a sense of a restaurant's attention to hygiene.

"Look at the overall cleanliness of the establishment. While that's not a definitive clue, it's an indicator that things are being done properly," says Robert Gravani, MS, PhD, a Cornell University food science professor. Are buffet areas, floors, tabletops, and bathrooms clean? Do employees look neat? Do they wear gloves while handling food? Do they wipe away spills? Is the restaurant free of unpleasant odors?

Also note how much attention employees pay to the food. "Look to see if the wait staff is coming around and maintaining the food, checking the temperature, stirring the food, replacing the food when the pans are nearly empty," says Carol Chase, senior public health sanitarian with the Tompkins County Health Department in upstate New York. Instead of pouring new food into old pans, employees should be switching out containers to prevent traces of old food from remaining on the buffet too long, she adds.

Look, too, for warning signs that food is being neglected. That dried-out pork or browned, wilted salad? Not good.

Your heart races, breath shallow from excitement, and sweat moistens your back. The road ahead looks ominously mountainous. Could a bicycle make it up that high? You don't doubt it for a second. Without a thought to the danger of falling, you go full steam ahead -- with your cheers -- along with other spectators of the Tour de France.

Throughout the three-week competition, millions of viewers follow elite cyclists through some 2,100 miles of French terrain. People root for their favorite contender and stand in awe of these amazing athletes. And for good reason.

"This is the athlete cream of the crop for bike racing in the world today," says Bob Roll, author of The Tour de France Companion. He should know. He was a member of the first American team to participate in the legendary race.

Roll likens the challenges of the Tour to the trials of everyday life. "The bike racer can slog up the mountains, plunge down the valleys, win, lose, crash, and the guy that gets to the finish in Paris, he's the guy that gets up and recovers from the setbacks."

Cyclist Lance Armstrong is a popular example of someone with an indomitable spirit. After he was diagnosed with testicular cancer that spread to his lungs and brain and was given a very low chance to live, he not only survived the disease, but he went on to win five consecutive Tours. A seventh victory would make him the only contender to ever to achieve such a feat.

Tour contestants have three times the lung capacity and half the resting heart rate. The typical Tour de France contestant reaches a maximum heart rate of above 200 beats per minute on a regular basis, compared to almost never for any other segment of the population, says Roll.

Don't worry if you feel sluggish next to these guys. Mother Nature handed them their remarkable physiology. They were genetically predisposed to have narrow shoulders, large legs, and relatively skinny arms -- the ideal profile of a competitive racer.

Since the Tour's first run in 1903, there have only been 20 to 25 Americans who have ever qualified for the event, says Roll.

But physical prowess can only take these cyclists so far. Willpower, tenacity, and a never-surrender attitude must also be in the successful racer's repertoire.

"The race throws too much at you," says Roll. "Anything can happen out in the road. The weather could be bad, the crowds can step in front of you, the food can be bad, you might not sleep because there are parties outside your hotel all night, you might crash on oil on the road, or you might be taken out by other riders that fall down."

April 12, 2005 -- Attention, party hosts: Think dainty, not hefty, for serving plates. That will help guests keep their calories in check, says a study in The Journal of the American Medical Association.

It doesn't matter if it's a formal gathering with your best china or a summertime potluck cookout with paper plates and plastic cutlery. As serving plates get bigger, calories go up.serving plates get bigger, calories go up.

Just ask Brian Wansink, PhD, of Cornell University. He helped throw a Super Bowl party that proved the point.

Party With a Purpose

Talk about mixing business with pleasure. Forty grad students attended the Super Bowl party. Upon arrival, they were told that they might be asked about "food and commercials in a party environment, such as at a Super Bowl party."

After that, they were led to one of two buffet tables. Both tables had the same snacks -- roasted nuts and a pretzel/chip mix.

The only difference between the tables was the size of the serving bowls.size of the serving bowls. One table had two big bowls of the snacks. The other had the same amount of food split into four medium-sized bowls.

Partygoers served themselves, but before they took a bite, a research assistant swooped in to weigh their plates. They weren't allowed to get drinks before serving themselves snacks.

Second helpings were out of the question. After everyone had served themselves, the food was whisked away.

What Would Miss Manners Say?

An hour later, the party got a little more unusual. Everyone completed a questionnaire, the plates were picked up, and any leftovers on the plates were noted.

People who served themselves from the large bowls took bigger helpings and ate morelarge bowls took bigger helpings and ate more of it. They took 53% more and ate 56% more than those who used the smaller serving bowls. That equaled 142 extra calories consumed.

Men ate more than women. Serving bowl size and food consumption was significant for men, but not for women.

Clue for Consumption

Serving bowl size may subtly tell guests how much they're supposed to eat, writes Wansink, who has written on marketing nutrition and mindless eating. He also directs Cornell's Food and Brand Lab, which focuses on the psychology behind what people eat and why.

Could big serving bowls of fruits and vegetables prompt people to eat more of those good-for-you foods? Good question, says Wansink, who doesn't know the answer yet. You could try it yourself and see, since most people could stand to eat more produce.

Jan. 6, 2003 -- It's the end of the season for too much TV football, too much food, and, well, too much. But now some men can put the blame for their beer guts on something else -- their parents.

Men who inherit a certain gene from both parents have a higher risk of abdominal fat, an Italian study finds.

"Overweight and abdominal [fat] were more common in men with the [certain gene type], particularly among older participants," write University of Naples researcher Pasquale Strazzulo, MD, and colleagues in the Jan. 7 issue of Annals of Internal Medicine.

Strazzulo's team looked at 959 men 25-75 years of age. Some were among a group of men first studied in 1975 and followed for 20 years.

It's known that an enzyme known as ACE plays a role in the way fat cells grow. So the researchers looked at differences in the ACE genes to see whether different forms of the gene influenced men's body types. They found that men who inherited one particular form of the gene from both parents were 82% more likely to be overweight and 76% more likely to have fat abs.

The form of the gene wasn't the only factor that increased risk of obesity. But men with this specific form of the ACE gene inherited from both parents had a greater tendency to accumulate body fat -- particularly abdominal fat -- with age.

Right now, the finding won't be of much help to men hoping to lose weight. But it's hoped that the findings will lead to a better understanding of how the body controls fat -- and to specific targets for new weight-loss drugs.

No matter how well you follow your diet or fitness routine, there is usually some cheating and lying involved -- and not just fibs you tell about what you're really eating when no one is looking. Most of us have tried at least one quick fix to drop weight for good -- fasting, or eliminating certain foods and nutrients from our diets -- only to gain the weight back, often packing on even more pounds. Unfortunately, myths about how you can lose weight can sabotage even the healthiest relationship between you and your treadmill.

It's a great rule of thumb to be suspicious of quick and easy weight loss solutions. "The biggest misconception is that doing something in the short term will have long-term results," says Elaine Magee, the "Recipe Doctor" for the WebMD Weight Loss Clinic. While you may want a magic bullet more than anything, fad dieting and gimmicks can actually do more harm than good when it comes to losing and maintaining your weight.

That's why we've enlisted two registered dietitians -- Magee and Elizabeth Pivonka, PhD, RD, president of the Produce for Better Health Foundation -- to come up with a list of lies so you can battle the bulge armed with the truth.

Myth: Snacking Is Always a Bad Idea

The good news is you don't need to starve to lose weight. "The idea that you shouldn't eat between meals is a myth," says Pivonka. When you're stomach starts rumbling, you probably hear a little voice in your head telling you not to ruin your appetite. But having snacks in between meals might actually help you eat less, and stave off the urge to overeat or binge later. In fact, dietitians often recommend that you have five smaller meals a day, instead of eating your calories all in one sitting.

One of the main reasons snacking has a bad rap is because of the choices we make from, say, vending machine that are packed with chips, cookies, candies, and other delectable -- and fattening -- treats. The good news is we're not all chomping on candy bars come 4 p.m. -- a whopping 70% of Americans use snacking as a way to incorporate fruits and vegetables into their diets, according to the Produce for Better Health Foundation.

If you tend to dive into a bag of chips when you're hungry, try having nutritious foods instead --think moderate amounts of fruits, vegetables, and nuts, for example -- and try to eat things you don't normally have during mealtime. Magee, who isn't a big milk drinker, uses snacks as a way to get her daily dose of calcium from low-fat cheese and yogurt.

Myth: No More Fast Food

Maybe the double cheeseburgers, fries, sodas, and apple pies are out, but Magee says you don't have to ditch fast food all together to stay on your diet. "It's part of our culture. I embrace it," she says. "I just lead people to make better choices in that arena."

Pivonka says she didn't recommend fast food in the past, but with better options now you usually can eat healthily and still get your grub to go. "The big problem with fast food is that the sodium content is much higher than ideal," Pivonka tells WebMD. It's a problem that might be hard to avoid, unless you stick to salads. At least try to skip the little salt packets. Here are some other healthy ideas from Magee:

• Get a salad as a starter.
• Choose the grilled chicken over fried, breaded chicken.
• Get soft tacos instead of hard, crispy ones.
• Keep the sauce and dressings on the side or scrape off as much as possible.

Sept. 12, 2006 -- Getting the recommended intake of vitamin D from diet, supplements, or even the sun may cut your risk of pancreatic cancer.

The results of two large, long-term surveys show that adults who got 300 IU to 449 IU (international units) per day had a 43% lower risk of pancreatic cancer. The recommended intake of vitamin D for adults aged 51-70 is 400 IU per day.

Researchers say the findings suggest that vitamin D, which is created in the skin upon exposure to ultraviolet sunlight, and found in fortified dairy products and other food sources, may play an important role in preventing pancreatic cancer. The cancer is the fourth leading cause of cancer death in the U.S.

"Because there is no effective screening for pancreatic cancer, identifying controllable risk factors for the disease is essential for developing strategies that can prevent cancer," researcher Halcyon Skinner, PhD, of the department of preventive medicine at Northwestern University in Chicago, says in a news release.

"Vitamin D has shown strong potential for preventing and treating prostate cancer, and areas with greater sunlight exposure have lower incidence and mortality for prostate, breast, and colon cancers, leading us to investigate a role for vitamin D in pancreatic cancer risk," says Skinner.

"Few studies have examined this association, and we did observe a reduced risk for pancreatic cancer with higher intake of vitamin D," he says.

Vitamin D May Fight Pancreatic Cancer

In the study, researchers analyzed data on vitamin D intake and pancreatic cancer risk among the more than 120,000 men (aged 40 to 75) and women (38 to 65) who participated in the Health Professionals Follow-Up and Nurses' Health studies.

Between the two surveys, 365 cases of pancreatic cancer were reported.

The Northwestern study showed people who consumed in the range of 300 IU to 449 IU per day of vitamin D daily had a 43% lower risk of pancreatic cancer than those with less than 150 IU per day.

Getting more than the daily RDA (600 IU per day or greater) had 41% lower risk than those who consumed less than 150 IU per day.

Even participants who consumed only 150 IU to 299 IU per day had a 22% lower risk than those with less than 150 IU per day.

The analysis took into account factors such as smoking history, multivitamin use, age, and body mass index (BMI).

Researchers also examined the association between pancreatic cancer and daily intake of calcium and vitamin A, but found no link.

"In concert with laboratory results suggesting antitumor effects of vitamin D, our results point to a possible role for vitamin D in the prevention and possible reduction in mortality of pancreatic cancer.

"Since no other environmental or dietary factor showed this risk relationship, more study of vitamin D's role is warranted," says Skinner.

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Whether you're the bride, an attendant, or just attending a wedding, if you wear a plus size, shopping for formal wear can be a frustrating and frazzling experience for many women.

The good news is that it doesn't have to be this way. Not only are key wedding-wear designers like Richard Glasgow, Alvina Valenta, Anne Barge, and Kenneth Pool now creating spectacular dresses especially for larger-sized women, many of the moment's most popular wedding styles look great on all shapes and sizes.

"This is clearly the year for the plus-size gal to shine because so many of the top styles are so well-suited for the larger figure -- and that goes for attendants and the mother of the bride, too," says Cindi Freeburn, spokesperson for David's Bridal, the only national chain store devoted to women's formal wear.

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To find the style that looks best on you, experts say, start by defining your body type - even before you start shopping.

"If you want to find a gown that both fits and flatters, you have to know what you want to camouflage and what you want to bring out, and don't be ashamed to share that information with your bridal consultant," says Marianne Shear, a wedding-gown designer and owner of The Dresser, a bridal boutique in Fullerton, Calif.

If you have to, make a list. And don't be shy about naming your assets!

"Every woman has something about her body that is beautiful," says Freeburn. "For plus-size gals it's often gorgeous shoulders, a beautiful neck, an elegant chest and bust line. And fortunately, these are all features you can really play up in today's wedding styles."

Jan. 31, 2006 -- The FDA and The First Years, a subsidiary of RC2 Corporation, have announced a voluntary recall of liquid-filled infant teethers due to a possible bacterial contamination of the liquid inside.

The fluid inside the teethers may be contaminated with bacteria known as Pseudomonas aeruginosa and Pseudomonas putida. If the teether is punctured -- and the potentially contaminated liquid is ingested -- it can cause serious illness in children.

No illnesses have been reported so far. However, the bacteria have been known to cause serious respiratory, urinary, and blood infections.

A company news release says consumers should stop using the recalled products immediately.

The recall applies to six different styles of liquid-filled teethers for infants (at least 3 months old) and includes the following products:

• Disney Days of Hunny Soft Cool Ring Teether -- Style# Y1447
• Disney Soft Cool Ring Teether -- Style# Y1470
• Disney Soft Cool Ring Teether -- Style# Y1490
• The First Years Cool Animal Teether/Fish, Zebra, and Dinosaur designs -- Style# Y1473
• The First Years Floating Friends Teether -- Style# Y1474
• Sesame Beginnings Chill & Chew Teether -- Style# Y3095

All six teethers have the same general construction with a vinyl exterior and clear liquid prefilled inside. Some of the teethers have designs on the exterior while others have floating characters inside the liquid-filled teether.

The teethers have been sold nationwide from July 2005 to January 2006 for $2.99 to $3.99.

The First Years says consumers should put the teether in its current condition into a sealed plastic storage bag, place in an envelope, and return to: Parent Service Center, RC2/The First Years, 100 Technology Center Drive, Stoughton, MA 02072. Consumers should include their mailing address in the envelope to receive a replacement teether and gift.

For additional information and photos of the teethers, visit www.thefirstyears.com. Or call The First Years Parent Service Center at (866) 725-4407.

Nov. 16, 2001 -- Witchcraft and wizardry, magic and mystery -- this weekend marks the opening of Harry Potter and the Sorcerer's Stone. Kids across America are crazy with anticipation.

Ask Susan Dolensky whether her 12-year-old son Joey is excited. "He's read all four books several times," says the Atlanta mom. "I've already bought our tickets online."

But there's a big upset over an advertising campaign linked with the movie -- a brouhaha that even Harry's magic wand may not dispel.

Thanks to Coca-Cola's marketing wizards, Coke has exclusive global rights to this Harry Potter movie, possibly the sequels, too. Where you see Harry, you'll likely see Coke.

It's an arrangement that has public-health watchdogs up in arms. At the heart of the issue: childhood obesity is at epidemic proportions, with studies and statistics showing soft drinks as the primary cause.

"This is the tubbiest generation in history, and kids hardly need more encouragement to consume calories -- but that's what Coca-Cola is doing," says Michael Jacobson, executive director of the Center for Science in the Public Interest, or CSPI, a Washington-based non-profit group that focuses on health and environmental issues.

CSPI has spearheaded a SaveHarry.com campaign aimed at ending Coca-Cola's use of "Harry Potter" to market junk food to kids.

"We think it's a shame that this wonderful literary creation and now movie is being used to encourage kids to drink liquid candy, junk food, pure calories," Jacobsen tells WebMD.

Statistics show the soaring consumption of soft drinks has roughly doubled in the last 20 to 30 years, he says. "Obesity has roughly doubled in kids during over the same period."

Soda also keeps kids away from more nutritious foods -- like milk, says Jacobsen. "The big statistic here is that 25 years ago, teenagers were drinking twice as much milk as soda. Now the ratio has been reversed. Anybody who doesn't see the cause-and-effect relationship is blind to reality."

Girls who drink a lot of soda don't get all the calcium they need, setting the stage for bone fractures and osteoporosis. Dental cavities are another problem. "Fortunately Americans have lower rates of dental cavities than they did 40 years ago, but drinking so much soda pop is like driving with foot on the brake and accelerator at same time," he tells WebMD. "You've got fluoride protecting teeth but soda pop eating away at them."

"The arrangement is betraying Harry Potter fans," says Jacobsen. "Kids, parents, grandparents love the books, will probably love the movie. It's a shame that this creation is encouraging them to drink more pop."

But Coke counters that in the Harry Potter promotion, Coca-Cola is marketing to families -- not to kids, says company spokeswoman Susan McDermott.

CSPI's accusations "devalue the importance of parental involvement in decisions for and with their children," McDermott tells WebMD. "Parents are involved in helping children make decisions about what they read, what movies they see, what their children eat and drink. Balance in what they eat and drink, and helping them achieve balance, is really important in addressing this issue."

She says that at least one study -- funded by the National Soft Drink Association -- finds that there is no relationship between soft-drink consumption and body fat in 12-to-16-year-olds.

Besides, the Harry Potter book and movie are aimed at children above age 10, McDermott says. "That doesn't mean that younger children won't see it, but that's up to the parents."

"Bringing the joy and magic of reading to children through a huge international book distribution program" -- that's the focus of Coke's advertising campaign, she tells WebMD. Over the next few years, the company will give "millions and millions of books to children and schools around the world."

"Harry Potter was borne from the pages of a book, and it has done a lot to excite children and re-invigorate children in terms of reading," McDermott says. "Our program is very much focused on encouraging parents to read with their children."

Even the company's promotional trip is for a family of four to London. "It's very much about putting the whole family together and having a wonderful experience," she says.

"We feel we have legitimate program that we are very proud of, that's helping spread the magic of Harry Potter and getting books into the hands of children around the word," McDermott tells WebMD. "Everything we've done is very much in keeping with respecting the way the author feels about the story and these characters. Harry Potter didn't drink a coke in the book; he's not drinking one in the movie. It wouldn't be appropriate."

Robert Baker, MD, PhD, a pediatric gastroenterologist at Children's Hospital of Buffalo, has read all the Harry Potter books. As a member American Academy of Pediatrics' committee on nutrition, he also has opinions on the Coke controversy.

More than any other "movie deal," the Harry-Coke connection is different, Baker tells WebMD.

"Harry Potter has a direct line to kids," Baker tells WebMD. "They identify more with Harry Potter than characters in other movies."

The AAP will soon release an official statement aimed at getting kids to drink less soda, he tells WebMD. "We think it's a big problem. There has been a huge increase in obesity in kids over the past two decades. That has correlated with a number of changes if dietary habits and physical activity. Kids are increasing the amount of carbohydrates they eat and amount of TV watched." They don't get any exercise to burn it off.

Will Coke's advertising affect the Dolensky kids' consumption?

"I don't allow them to drink a lot of soda anyway," Susan says. "I'm really old fashioned that way. And they don't watch a lot of TV. The kids may have noticed it on the Coke boxes -- we buy some for my husband -- but in my house, I don't think it's made a big impression."

She knows she doesn't speak for all parents. "I know there are a lot of parents who don't monitor their kids like I do."

July 6, 2005 -- Babies learn their mother's smell early in life, wiring the scent into their brains, new research shows.

That idea was tested on baby rats, not human infants. But the basic process may be similar, say the researchers.

Smell is one way that newborn animals (including humans) forge strong ties to their mothers, say researchers Kevin Franks, PhD, and Jeffry Isaacson, PhD.

Franks and Isaacson work in the neurosciences department of the medical school of the University of California, San Diego (UCSD). Their findings appear in Neuron.

Scent's Power

Smell often brings memories back to life.

"Get a whiff of chocolate chip cookies baking in the oven, and the smell may conjure sudden fond memories of grandma's kitchen," says Benjamin Philpot, PhD.

He didn't work on the study, but he wrote an editorial in Neuron about it.

"Such strong odor associations are common, but we often take them for granted," says Philpot.

"However, for a newborn infant trying to locate mother's nipple, the association between odor and experience becomes a powerful force forming the basis of a strong bond between infant and mother," he says.

Familiar Scent

The baby rats in the UCSD test were around their mothers a lot for feeding and care. Each time, their tiny nostrils took in their mothers' scent.

The odor apparently became so familiar that the rats' brain cells started to recognize it quickly. In essence, the scent became wired into their brains through repeated exposure.

When one nostril was blocked, the lopsided odor exposure was reflected in the rats' brain development. The brain receptors that pick up odor on the side of the blocked nostril were developmentally delayed.

There may be a key time frame early in life when the development of nerve pathways takes place, say the researchers.

The same pattern has been seen as babies' visual systems develop, they say.

A Dad's Perspective

Philpot wore two hats, so to speak, when he wrote his editorial.

He's an assistant professor of cell and molecular physiology at the University of North Carolina at Chapel Hill. He's also a new dad.

Other simple but important factors could explain the observed brain changes, says Philpot.

But "as a neuroscientist and a new parent, I cannot help but to wonder whether a synaptic trace is being left in my newborn daughter's olfactory cortex every time she breastfeeds," he says.

In other words, his baby girl may be engraving her mother's scent in her mind, making it one of her life's earliest discoveries.

Oct. 26, 2004 -- Magnets pose a real danger to children. Intentional or accidental ingestion may require emergency surgery, doctors say.

Children (or adults) who swallow more than one magnet need emergency medical attention, according to radiologist Alan Oestreich, MD, of Cincinnati Children's Hospital in Ohio.

It's never a good idea for kids (or anyone else) to swallow inedible objects, but it happens frequently. According to researchers, most foreign bodies (80%) that reach the stomach get passed yet 10%-20% may require direct retrieval by a doctor. Fewer than 2% of incidents can cause intestinal blockage or rupture requiring emergency intervention.

That's why Oestreich noted the magnet hazard in a letter to the editor of Radiology in the journal's November edition.

Unlike foreign bodies that can pass through the body with relatively little trouble, magnets can seriously damage the stomach or intestine by attracting each other through the lining of different loops of intestine. Ultimately, the magnets could cause a lack of blood flow in the lining and puncture the lining of the intestine.

That's why anyone who swallows multiple magnets should seek immediate medical attention, which could include surgery, says Oestreich.

The advice applies to all ages.

Babies and toddlers, for instance, have natural curiosity but are too young to know much about safety. However, older children and adults could also be hurt by ingesting magnets.

A 12-year-old autistic boy who had swallowed magnets at a summer camp suffered abdominal pain for days until an X-ray showed the magnets, which were then removed.

Likewise, a 9-year-old girl had an intestinal perforation after swallowing 12 small magnets.

Citing those two cases in his Radiology letter, Oestreich urges all radiologists to look out for magnets on abdominal X-rays.

He also warns against using magnetic resonance imaging (MRI) on any patients who might have swallowed magnets.

Magnets may be more common in homes and schools than you think. They're used as decorative and organizational items (like those on refrigerator doors), toy components, and as therapeutic health objects. Used properly, magnets should not present a problem, as long as they stay outside the body.

What fruit can you count on to be fresh, crisp, and wonderful even through the dead of winter? Apples!

While bins of other fruits can look sad and dreary around this time of year, the apple section is alive with color and filled to the brim. It's no coincidence that many favorite fall dishes feature the ever-lovin' apple. Given that I try to get at least a couple of servings of fruit into my family members each day, I depend heavily on apples (and frozen berries) to carry me through until spring.

So that we don't all get too bored with this delightful tree fruit, I try to keep things interesting. One easy way to mix things up a bit is to buy different types of apples, ranging from tart, crisp pippins, and Granny Smiths to mild-tasting, darkly colored Red Delicious.

One daughter has a soft spot for Red Delicious, while I'm a tart, green apple lover myself. But to be honest, any crisp apple will do. That's my only non-negotiable apple characteristic -- that they be crisp! Soft apples in my house end up as one thing and one thing only: applesauce, which isn't the worst thing to happen to an apple.

Another way to keep apples interesting is to slice them and serve them with fruit dips, a drizzle of caramel or peanut butter, or sliced cheese. You can also bake or microwave them with spices and a little sweetener (maybe a pinch of brown sugar or a drizzle of lite pancake syrup) for a side dish or dessert.

Don't be afraid to add them to your main dish, either; apples go well with pork tenderloin and chops as well as chicken and turkey. Apples can also add texture and flavor to your stuffing and rice dishes; just make sure the diced apples you add are cooked through. And of course, there are many great other recipes involving apples -- check out three new ones below.

Apples Pack a Nutritional Punch

I'm not sure who coined the phrase, "an apple a day helps keep the doctor away," but this person was truly inspired. Population studies have linked eating apples with a reduced risk of some cancers, heart disease, asthma, and diabetes. In the lab, apples have been found to have strong antioxidant activity, to inhibit the rapid multiplication of cells, to decrease the oxidation of lipids (fats), and to lower cholesterol -- all good things.

Here are a few more tidbits gleaned from apple research:

• Don't peel your apples! In lab studies, Cornell University researchers found that apple extract given along with apple skin worked better to prevent the oxidation of free radicals (unstable molecules that are thought to contribute to diseases) than apple extract without the skin.
• Could an apple (or 3) a day help keep breast cancer away? Breast tumor incidence was reduced by 17% when rats were fed the human equivalent of one apple a day over 24 weeks -- and 39% when they were fed the human equivalent of 3 apples a day, according to a recent Cornell study.
• Calling all apple phytochemicals! Apples offer a powerful assortment of healthful phytochemicals, including four strong antioxidants: quercetin, catechin, phloridzin, and chlorogenic acid. Procyanidins (oligomeric catechins), which you'll find in high concentrations in apples, are thought to have a protective effect on the vascular system.
• The healthiest varieties. Storage doesn't seem to affect the amount of phytochemicals in apples, but different apple varieties have different amounts of phytochemicals. When it comes to antioxidant activity, food chemist Chang Y. Lee found Northern Spy, Liberty, Crispin, Delicious, and Fuji to have the highest levels, with Idared, Jonagold, Gala, Freedom, and McIntosh showing medium activity. For one category of phytochemicals -- total phenolics -- the top three apples are Fuji, Red Delicious, and Gala, according to Cornell University researcher Rui Hai Liu. For total flavonoids (another family of phytochemicals), the top three are Fuji, Red Delicious, and Northern Spy.

March 18, 2005 -- It's never too late to benefit from exercise, a new study confirms.

Regular exercise is universally recommended as part of a healthy lifestyle. It's repeatedly been shown to help hearts, challenge muscles, improve mood, lower stress, and burn calories. Weight-bearing exercise can also build stronger bones, which helps prevent osteoporosis.

But what if you've been a little slack about exercise -- or downright sedentary? Does your window of opportunity slide shut as the years gather? If you haven't laced up your sneakers in decades, should you just skip it and leave working out to the young?

Absolutely not, say Canadian researchers. Exercise can help people well into their golden years, they say.

No matter how many candles are on your birthday cake -- or how long you sat on the sidelines -- it's to your advantage to get moving to the best of your ability, the study suggests.

A decade of data backs the Canadian study. That's how long researchers monitored two groups of adults aged 55-75, watching for changes in fitness levels, heart disease risk factors, and other health problems.

When the study started, all participants were sedentary but healthy. Fitness and medical tests showed that they were roughly in the same shape. However, there was one key difference among them -- initiative.

Some adults took it upon themselves to contact the Canadian Center for Activity and Aging. They asked to sign up for a supervised exercise program. Those adults (266 people) hadn't been ordered to do so by a doctor; it was their personal choice, not part of rehabilitation.

The other 420 participants were randomly chosen from the same community. They hadn't voiced any interest in a formal exercise program. The researchers used them as a comparison group. Those adults were free to be as active as they wanted, but they weren't part of the structured exercise group.

Your heart races, breath shallow from excitement, and sweat moistens your back. The road ahead looks ominously mountainous. Could a bicycle make it up that high? You don't doubt it for a second. Without a thought to the danger of falling, you go full steam ahead -- with your cheers -- along with other spectators of the Tour de France.

Throughout the three-week competition, millions of viewers follow elite cyclists through some 2,100 miles of French terrain. People root for their favorite contender and stand in awe of these amazing athletes. And for good reason.

"This is the athlete cream of the crop for bike racing in the world today," says Bob Roll, author of The Tour de France Companion. He should know. He was a member of the first American team to participate in the legendary race.

Roll likens the challenges of the Tour to the trials of everyday life. "The bike racer can slog up the mountains, plunge down the valleys, win, lose, crash, and the guy that gets to the finish in Paris, he's the guy that gets up and recovers from the setbacks."

Cyclist Lance Armstrong is a popular example of someone with an indomitable spirit. After he was diagnosed with testicular cancer that spread to his lungs and brain and was given a very low chance to live, he not only survived the disease, but he went on to win five consecutive Tours. A seventh victory would make him the only contender to ever to achieve such a feat.

Tour contestants have three times the lung capacity and half the resting heart rate. The typical Tour de France contestant reaches a maximum heart rate of above 200 beats per minute on a regular basis, compared to almost never for any other segment of the population, says Roll.

Don't worry if you feel sluggish next to these guys. Mother Nature handed them their remarkable physiology. They were genetically predisposed to have narrow shoulders, large legs, and relatively skinny arms -- the ideal profile of a competitive racer.

Since the Tour's first run in 1903, there have only been 20 to 25 Americans who have ever qualified for the event, says Roll.

But physical prowess can only take these cyclists so far. Willpower, tenacity, and a never-surrender attitude must also be in the successful racer's repertoire.

"The race throws too much at you," says Roll. "Anything can happen out in the road. The weather could be bad, the crowds can step in front of you, the food can be bad, you might not sleep because there are parties outside your hotel all night, you might crash on oil on the road, or you might be taken out by other riders that fall down."

Oct. 19, 2005 -- Overweight Americans who blame fast food restaurants for causing their obesity won't get their day in court if the U.S. House of Representatives gets its way.

House lawmakers on Wednesday passed a bill banning obesity-related lawsuits against restaurants and food manufacturers. More than 20 states already have such laws on the books.

Supporters said the bill was intended to prioritize personal responsibility among an increasingly obese American population.

"The bill seeks to block lawsuits by people because they ate too much and got fat," says Rep. Chris Cannon (R-Utah), one of the bill's sponsors.

"We should not encourage lawsuits that blame others for our own choices and could bankrupt an entire industry," notes Rep. Lamar Smith (R-Texas).

Fast-Food Fights

Still, there is little evidence that obesity lawsuits are threatening the food and restaurant industry. Only a handful of cases blaming restaurant food or advertising for obesity have ever been filed, and only one major case remains open.

That's a case first filed in 2002 alleging that misleading advertising by McDonald's restaurants influenced New York teenagers to eat too much of the food and become obese. If Wednesday's bill -- which passed 306 to 120 -- becomes law, the suit will be thrown out of court and all future suits would be banned.

Nearly two-thirds of American adults are classified as overweight and about 30% are obese, according to the CDC. Fifteen percent of children aged 6 to 11 are also classified as overweight.

Critics charged that courts have already functioned properly by dismissing obesity cases they found frivolous and that the bill was giving special rights to restaurants and food manufacturers.

"Congress is headed in the wrong direction with this bill, which removes any and all incentives for the food industry to improve" the healthiness of their products," says Rep. Bob Filner (D-Calif.).

The Food Products Association, an industry group headed by former Republican Congressman Cal Dooley, praised the vote in a statement that called the bill "timely and needed."

Wednesday's vote was the second time the House passed the lawsuit ban. An identical bill passed in March 2004 but was never acted upon in the Senate. The same fate could await this year's bill, as Senate Republican leaders have suggested that their docket before a scheduled pre-Thanksgiving recess is already jammed.

Nov. 11, 2004 -- If you're a parent who eats out often, you may be skimping on fruits and vegetables, according to a new study.

"The more often parents eat out, the lower their intake of fruits and vegetables, excluding French fries," say the researchers, who included Amanda Harrod of the Saint Louis University's School of Public Health.

Harrod and colleagues studied the eating habits of more than 1,200 parents of preschool children in rural, southeastern Missouri. Most of the parents were young white women, with an average age of 29 and an annual household income under $35,000 for 59% of the group. More than half (57%) were overweight, with a body mass index (BMI) of at least 25.

BMI is an indicator of total body fat. Underweight BMI is less than 18.5. Normal BMI ranges from 18.5-24.9. Overweight BMI goes from 25-29.9, and obese BMI starts at 30.

Only 35% of participants ate five or more fruits and vegetables per day, not counting French fries. It's widely recommended that people eat at least five fruits and vegetables every day for maximum health benefits.

The biggest turn-off to fruits and vegetables was taste, according to 44% of the participants. In addition, 22% said they didn't stock their kitchens with fruits and vegetables.

More than half of the group (52%) said they found it convenient to eat out, and 38% reported dining out at least 17 times per month.

The parents who didn't keep fruits and vegetables at home ate out more often, but they probably weren't ordering fruits and veggies, since produce intake fell as dining out increased.

"Efforts should be made to improve the quality of the home food environment and address barriers to fruit and vegetable intake," say Harrod and colleagues, who reported their findings at the American Public Health Association's annual conference in Washington.

July 14, 2003 -- A sugar that's naturally found in many fruits and is the main ingredient in a commonly used sweetener may be responsible for "unexplained" flatulence, bloating, pain, and other gastrointestinal symptoms in many people.

A new study, published in the June issue of the American Journal of Gastroenterology, suggests that fructose intolerance is a common yet underrecognized cause of digestive problems in some people. And the more fructose they consume, say researchers, the more likely they are to have problems.

An Abundant Sweetener

Fructose is a sugar abundant in honey and fruits such as apples, peaches, pears, and oranges. It's also the main ingredient in high-fructose corn syrup used in hundreds of juices, sodas, condiments, snacks, and other foods.

The problems occur because in many people fructose is not easily absorbed by the body. Fructose is usually absorbed in the small intestine, but for those with fructose intolerance, some travels to the colon, where bacteria ferment the fructose. This causes the release of hydrogen and methane gases, which cause pain, bloating, flatulence, and diarrhea.

Table sugar does not cause this reaction because it also contains glucose, which aids in the absorption process.

In their two-year study, researchers at the University of Iowa Carver College of Medicine studied 183 patients with unexplained digestive symptoms including flatulence, abdominal pain, belching, and altered bowel habits. None of the study participants were previously diagnosed with any digestive disorders.

Fructose Intolerance Test

Each participant completed questionnaires and took a test after drinking a solution containing the amount of fructose found in three glasses of apple juice, called a fructose breath test. The breath test measures the amount of hydrogen and methane gases produced in the intestines.

Researchers report that three in four patients experienced digestive symptoms after consuming the fructose solution. And among those testing positive on the fructose breath tests, nearly 90% had elevated levels of hydrogen while 11% had higher-than-average levels of methane.

These findings come as no surprise to two experts familiar with fructose intolerance.

"The fact that fructose is poorly tolerated has been known for long time," says Peter Beyer, RD, LD, of the University of Kansas Medical Center. "But what has happened in the last few decades is that fructose intake in the U.S. has increased as portion sizes have increased. As a result, likely so have these symptoms."

Last October, Beyer presented his own research at the annual meeting of the American College of Gastroenterology indicating that 60% of his study participants with no known digestive problems were found to be fructose intolerant at intake levels half of those used in this study's fructose solution. Beyer, who was not involved in the new research, suggests that doctors routinely give fructose breath tests in patients with unexplained digestive symptoms.

"I don't want to give the impression that people will double over in pain or have recurring diarrhea from drinking a glass of apple juice or having a soda," he tells WebMD. "But it can trigger symptoms in many people with no diagnosed [digestive] condition. And the more fructose they consume, the more problems they may have. These effects may be more severe and apparent in those with irritable bowel syndrome or other known [digestive] disorders."

Only 'Scattered Awareness'

Phil Jaffe, MD, spokesman for the American College of Gastroenterology and associate professor at the University of Connecticut School of Medicine, says that fructose intolerance has earned "scattered awareness" among his colleagues over the past decade but remains underdiagnosed.

"I don't think 75% of my patients who have bloating and discomfort are fructose intolerant, but it probably is a significant number," he tells WebMD. He routinely screens his patients for fructose intolerance.

"Not only was this study well done, but this is an important clinical issue because lots of people with bloating, gas, and other symptoms don't have a good handle on why they have these symptoms," says Jaffe, who also was not involved in the study.

"Unless you are specifically screened for fructose intolerance, you may not know it can be a cause of problems. And fructose is in virtually all processed foods because it is cheaper to use than cane sugar."

Both experts advise that if you notice digestive problems soon after eating, you should see your doctor about getting a fructose breath test. In addition to limiting high-fructose foods, spacing the amount consumed can help you side-step symptoms.

"The issue isn't that you are not able to absorb fructose entirely, it's that you are unable to absorb it in high amounts," says Jaffe. "So if you have a piece of fruit, wait a few hours before you have another if you are among those with these symptoms. If you have small amounts at a time, even if you have malaborption problems, it's likely that you'll better tolerate fructose. But life is too short to eliminate all those high-fructose foods from your diet."

The Institute of Medicine urged Congress on Thursday to tighten the law governing dietary supplements, saying that the Food and Drug Administration lacks the authority to guarantee the safety of thousands of products.

A report issued by an IOM expert panel calls on lawmakers to require that dietary supplement makers report any adverse affects associated with product ingredients to the FDA. Current law does not require manufacturers of dietary supplements to establish the safety of their products or report potentially dangerous reactions prior to marketing.

Dietary supplements are governed by a 1994 law called the Dietary Supplements Health and Education Act, or DSHEA. This law stipulates that dietary supplements are to be regulated more like foods than like drugs, meaning they are considered safe until proven otherwise. This leaves it in the hands of the FDA to establish that a product, already on the market, poses a risk to consumers before taking it off the market.

The law led to an explosion of $16 billion in annual sales in the dietary supplements market, which now includes some 29,000 products.

Experts said Thursday that the FDA could do a better job tracking potentially dangerous products if the law required manufacturers and distributors to report adverse affects when they become aware of them.

"It is very challenging to carry out the mandate of DSHEA given the limitations it imposes on the quantity and quality of the currently available scientific data related to the safety of dietary supplement ingredients," the panel's report stated.

The IOM report includes information on dietary supplements that might pose danger. For example, they say that the impact of long-term glucosamine ingestion in people with liver disease especially those who also have insulin resistant or prediabetes, is unknown.

They also report that safety issues, especially in women who consume the supplement while pregnant or nursing need to be done because they are also unknown.

The FDA has moved during the last year to ban a handful of dietary supplement ingredients because of safety concerns, including the stimulant ephedra and the steroid supplement androstenedione.

"Most products on the market are probably safe," said Barbara O. Schneeman, PhD, a professor of nutrition at the University of California, Davis, who chaired the IOM committee issuing the report. Still, "the law should require such reporting," she says of adverse events.

IOM also recommended that Congress act to require manufacturers and distributors to include contact information on their labels and also include the phone number of FDA's MedWatch adverse event reporting network. Federally funded supplement researchers should also be required to investigate and report on potential safety issues, the report stated.

Industry Opposed

Representatives of the dietary supplement industry criticized the IOM report, saying that the committee did not take companies' concerns into account.

"It doesn't seem to be balanced enough to get industry representation," says Phil Harvey, PhD, the chief science officer for the National Nutritional Foods Association.

Harvey says that his group had not yet issued an official policy on the IOM report. The industry supports a "scientifically valid" approach to supplement policing, but adverse-events reports do little to inform regulators about true risks, he tells WebMD.

Lawmakers Split

Several lawmakers have introduced bills aimed at tightening the supplements law, calling attention to 'andro' and other potentially dangerous products on the market. Those bills have yet to see action, as many key members of Congress remain opposed to changes.

But U.S. Senator Orrin Hatch (R-Utah), who authored DSHEA in 1994, said that he is reluctant to change the law to require adverse-events reports from the industry. "You're putting various companies in the industry in jeopardy through reports that can be manipulated," Hatch tells WebMD. "We don't want efficacious products to get so expensive that people can't pay for them," he says.

May 20, 2005 -- Yoga may make women feel better about their bodies, steering them away from eating disorders, a new study shows.

In fact, yoga may have an edge over other forms of exercise in that regard, according to the study in the Psychology of Women Quarterly.

The reason may be yoga's mind-body aspect, say the researchers, who included psychologist Jennifer Daubenmier, PhD, of California's Preventive Medicine Research Institute.

"Through yoga, this study suggests that women may have intuitively discovered a way to buffer themselves against messages that tell them that only a thin and 'beautiful' body will lead to happiness and success," says Daubenmier in a news release.

If backed by further research, yoga may help prevent and treat eating disorders, say researchers.

Yoga Study

Daubenmier worked on the project as a graduate student at the University of California, Berkeley. She compared women who practiced yoga regularly with those who did other forms of exercise. Women who hadn't done either form of exercise for at least two years were also included.

First, Daubenmier and colleagues studied women who were 37 years old on average. Next, they studied college-aged women.

The women completed surveys about the type of exercise they performed, how often they did it, and their feelings about their bodies. Those who practiced yoga expressed healthier attitudes toward their bodies and had less disordered eating behaviors.

Meanwhile, spending more time on aerobic forms of exercise (such as running or exercise classes) was associated with greater disordered eating attitudes, the study shows.

That's not to say that the women had eating disorders. Instead, the inclination toward disordered eating generally included "dieting behaviors, like restricting food intake," Daubenmier tells WebMD.

The researchers say body mass index didn't explain the findings because they took that into account.

Which Came First: Yoga or Body Image?

Did yoga enhance women's sense of their bodies, or did it attract women who already felt good about themselves? More research is needed to find out. Daubenmier's study didn't assign women to do any particular form of exercise.

Also, "most individuals at risk [for eating disorders] are younger" than many women in the study, says Daubenmier.

Of course, many women who exercise aerobically don't have eating disorders. Health experts encourage men, women, and children to exercise regularly and lead an active lifestyle for optimum health.

Yoga practitioners learn to tune in to the body as it moves through the poses. That could emphasize the body's abilities, instead of its appearance, say the researchers.

Tips for Yoga Novices

Most of the study's yoga fans practiced Iyengar yoga. "That invites participants to develop sensitivity and responsiveness, in contrast to more fast-paced yoga," Daubenmier tells WebMD.

"I would recommend starting with slower Iyengar yoga to develop body awareness and familiarity with the poses," she says. The slower pace should help people avoid injury while developing confidence in listening to their bodies, says Daubenmier.

Mindful Aerobic Exercise

People who learn mindfulness from yoga can also use that approach with other forms of exercise, says Daubenmier. "These are mindfulness skills that you can then transfer over to cardiovascular workouts," she tells WebMD.

Daubenmier says aerobic workouts are often driven by music or a teacher's pacing. "It's result oriented -- what the readout on the machine tells you or the rhythm of the music, rather than listening to your own body."

Daubenmier says a study could compare the same aerobic class under two conditions: driven by music and teachers, or by self-pacing, breathing, and body awareness.

That study may be done one day. Meanwhile, mindfulness can already be tapped for your next workout, whatever it may be.

Feb. 28, 2003 -- First there were The Bachelor, The Bachelorette, and Joe Millionaire -- shows that seemingly ignore the necessities for matrimonial bliss in exchange for Nielsen ratings -- and quite successfully. Now new concerns are emerging over one of the latest "reality" television shows and potential eating disorders.

In Are You Hot? The Search for America's Sexiest People, a parade of eye candy displays well-sculptured pecs and perky breasts before celebrity judges, who then detail the contestants' not-so-apparent physical flaws. Entertaining perhaps, but some say this ABC show hits at the emotional health of those who are particularly vulnerable -- teens and others prone to eating disorders.

"Individuals on this show are basically deciding that they're going to trade 10 minutes on TV for a fair amount of emotional mistreatment, but they're adults and are welcome to choose to do that. I'm concerned more about the people who watch it, because the show's theme that seems to get played out is what is really important in life is how you look," says psychologist Randall Flanery, PhD, director of the eating disorders program at the Saint Louis University School of Medicine. "People on this show are proposing they look pretty good and from what I've seen, they do, yet many still wind up getting trashed."

Flanery tells WebMD he's especially concerned about its teenage viewers, who are particularly vulnerable to the cultural ideal in this and other media that suggests the only way to look good is to be thin. "This show isn't alone, but it especially reinforces the idea that if you're not thin, you're a failure and if things aren't going right in your life, it's because you're not thin."

That, he says, is a recipe for eating disorders such as bulimia and anorexia nervosa, which affect some 8 million Americans -- primarily teenage girls and young women.

"There is research suggesting that females who spend more time looking at thin models and comparing themselves to these models are more likely to be dissatisfied with how they look and are more committed to weight loss," Flanery tells WebMD. "This is especially true for girls between ages 13 and 18, who are trying to determine their self-identity and form the person they want to become."

Holly Hoff, program director of the National Eating Disorders Association, also has concerns about the new show, though concedes she hasn't watched it.

"The objectification of individuals based on their looks places a really unfortunate overemphasis on determining people's value and appeal based solely on their appearance," she tells WebMD. "And that sets up pressure that could be part of a very dangerous downward spiral. Girls in this country are literally dying to be thin, since anorexia has the highest death rate of any psychiatric disorder. And we know when people set out to try [to] emulate these most often unhealthy and unattainable standards that they're seeing on shows like this, they go to drastic eating and exercise behaviors that aren't necessarily healthy for them."

So what can parents do -- especially in light of a new study, in the March issue of the Personality and Social Psychology Bulletin, that finds people typically pay close attention to their own and others' attractiveness?

"Communicate with your kids on what they are watching and why," says Hoff, whose association serves as a non-profit clearinghouse for information about eating disorders. "Parents need to find out if their children are watching this show and want to look like that, where does this come from? Do they think it will make them more socially accepted? Are they concerned about their body size and shape? Do they really have a weight issue that should be addressed?"

Or follow the advice of Flanery, the father of 10: "Be assertive and say, 'This is a bad show and when I'm in the house, you don't watch it.' More importantly, parents need to stress to their kids that it's not as important how they look as how they treat other people, their values, and what they do with their life."

Both ABC Television spokeswoman Susan Sewell and Are You Hot? publicist Pat Breblick declined comment.

Rep. Patrick Kennedy's release from drug rehab puts a spotlight on people who suffer from a trying combination of health problems: substance abuse and a mental health disorder.

Kennedy -- the son of Sen. Edward Kennedy -- checked into a rehab clinic in May 2006 after a car accident near the U.S. Capitol. The younger Kennedy says he has no memory of the incident; he admits he had taken medications usually prescribed for sleep problems and to control nausea.

After his release from rehab, Kennedy told reporters he suffers from addiction and bipolar disorder.

Doctors say they are increasingly seeing patients from all walks of life who suffer from a combination of substance abuse and mental health problems. Experts estimate that at least 60% of people battling one of these conditions are battling both.

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"Mental health problems and substance abuse are often seen together because one makes you more vulnerable to the other," says Alan Manevitz, MD, a psychiatrist with New York-Presbyterian Hospital, Cornell University campus, in New York.

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Mental health problems are common in the U.S. An estimated 1 in 5 adults in the U.S. suffers from a diagnosable mental disorder, according to the National Institute of Metal Health.

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When there is a biological or genetic vulnerability to any type of mental health problem, regardless of how big or small, Manevitz says, substance use often triggers the onset of that problem.

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"The substance is not really causing the mental health problem, but it can be a precipitating factor that causes the condition to manifest," Manevitz tells WebMD.

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"In this respect, the mental health condition is already actively present when the substance abuse begins, but the patient just doesn't know it -- the problem is driving the addiction, it just hasn't yet been recognized or diagnosed," Manevitz tells WebMD.

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It is, in fact, the increasing awareness of this dual diagnosis that has opened the door to a whole new line of thinking about both substance abuse and mental health problems. Indeed, some researchers contend that certain forms of mental illness and some addictions may, in fact, be a single disease.

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Among the areas where this research is most prominent is a condition known as bipolar disorder -- a disease characterized by cycles of extreme mood swings between deep depression and high elation, or mania. During periods of mania, patients show extreme irritability, racing thoughts, little need for sleep, poor judgment, distractibility, abuse of drugs, and denial that anything is wrong. Depressive periods are associated with feelings of hopelessness, guilt, too much sleep, and thoughts of death or suicide.

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"What we have found is that people with bipolar disorder, particularly women, have an enormously high rate of alcoholism -- up to seven times that of the general population," says Mark Frye, MD, director of the UCLA Bipolar Disorder Research Program in Los Angeles.

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This is also true, says Frye, when both male and female bipolar patients are compared to those with other forms of mental illness.

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And while the reason remains unclear, Frye tells WebMD that there is at least some evidence that the two conditions share many similarities.

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Indeed, as the age of "brain science" continues to mature, a number of researchers have begun to note some startling similarities within the brain chemistry patterns of various types of mental health problems and substance abuse. Some of the more interesting discoveries had to do with animal models of addiction.

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"Research on rats showed us that there were certain pleasure centers of the brain that, when stimulated, elicited such a powerful response, the animal would opt for stimulation over food," says Francis Hayden, MD, associate director of the division of Alcohol and Substance Abuse at Bellvue Hospital in New York.

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This discovery, he says, led many researchers to question whether there was something different about the brains of substance abusers that "causes them to kind of feel not quite right -- so that when they happen upon a substance, it kind of normalizes them in a way," says Hayden.

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That feeling of "not quite right," he says, may be the mental health problem at work.

Another indication that they may be one disease: Studies that show that when one condition worsens, the other is soon to follow suit.

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"In someone who has both a mental illness and a substance abuse problem, almost without exception, an addiction relapse will worsen the mental health problem, and when the mental health problem goes untreated, or declines, it makes them more susceptible to renewing addictive behaviors," says Kenneth Skodnek, MD, chairman of the department of psychiatry and psychology and director of the addiction service at Nassau University Medical Center in East Meadow, N.Y.

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In addition, says Skodnek, it's very clear that activation of one problem frequently activates the other in those who are susceptible.

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Dec. 6, 1999 (Atlanta) -- Overcoming a lack of acceptance by the established medical profession, osteopathic medicine is gaining credibility and is proving to be a low-cost alternative for lower back pain. However, according to the November/December issue of the journal Archives of Family Medicine, a recent telephone survey of 800 HMO members suggested that the public is not yet familiar with osteopathic medicine.

Emil P. Lesho, DO (doctor of osteopathy), says the training is similar for traditional medicine and osteopathics, with osteopathics stressing the central role of the muscular and skeletal systems and normal body mechanics for good health. However, the word hasn't gotten out to the public that manipulation, the main healing technique of osteopathy, is safe and effective. Lesho writes that more research on manipulation would help educate patients.

Osteopathy dates back to 1874 when Andrew Taylor Still, MD, became disenchanted with existing medical practices, especially the liberal use of drugs and compounds for curing illnesses. Still believed the human body had an inherent ability to heal itself; he believed physicians could best promote health by ensuring that the musculoskeletal system was in as perfect alignment as possible and obstructions to blood and lymph flow were minimized or eliminated. To that end, Still developed various manipulative techniques and a philosophy of medicine similar to, but separate from, traditional medicine, also known as allopathic medicine. Presently, there are almost 42,000 licensed DOs in the U.S. making up about 5% of the physician population and providing about 10% of health care.

After reviewing 128 medical articles published between 1925 and 1993, Lesho writes that manipulation is relatively safe. "In more than 15 studies of manipulation, there were no adverse effects. ... However, determining the number of complications from manipulation is difficult because of uncertainties in the actual number of manipulative treatments performed and the number of unreported complications."

Osteopathic manipulation is proving to be particularly effective in treating lower back pain. Lesho points to several studies claiming that manipulation may shorten the duration of painful symptoms. In one 1981 study reported in The Journal of the American Medical Association, 95 patients receiving manipulation with soft tissue massage treatments had significantly more improvement in symptoms even though they reported their pain as being "severe" or "very severe."

There is even more recent evidence that supports osteopathic treatment for lower back pain. A study published in the Nov. 4 issue of TheNew England Journal of Medicine concludes that patients with chronic lower back pain can be treated effectively with manipulation. The study found manipulation to be as effective as other treatments for lower back pain and lower in cost.

During the 12-week study, patients were treated with a variety of accepted treatments for lower back pain such as pain medicine, anti-inflammatory medication, active physical therapy, Transcutaneous Electric Nerve Stimulation (a device that provides a slight electrical current to an affected area using adhesive pads), and hot/cold packs. All of these forms of treatment, including manipulation, were shown to be effective for treating lower back pain. However, manipulation was associated with lower costs and less medication.

Officials of the American Osteopathic Association (AOA) found the study proof of the validity and benefits of manipulation. "This study helps to reinforce what DOs and their patients have known for years," said Eugene A. Oliveri, DO, president of the AOA, in a written statement.

Vital Information:

• A recent telephone survey of HMO members revealed that the public is not yet familiar with the concept of osteopathic medicine.
• Osteopathic medicine is similar to traditional, or allopathic, medicine but places a greater emphasis on the role of the musculoskeletal system and normal body mechanics.
• Studies have shown that osteopathics are especially effective in treating lower back pain, but can do so at a lower cost and using less medication, when compared with other physicians.

Nov. 23, 1999 (Washington) -- Chest pain is a frightening -- and relatively common -- occurrence that sends millions of Americans to emergency rooms each year, where they wait for care, thinking all the while about heart attacks and maybe even death.

But heart disease is only one of several causes of chest pain, and the least common. A new study from England shows that anxiety and depression could be behind a substantial portion of the gripping pain.

Researchers asked over 3,000 36-year-old men and women about their experiences with chest pain. A relatively large percentage, 17.2%, reported having chest pain, but only 34 people had symptoms that definitely or probably were related to true heart pain.

The group was also asked about symptoms of psychiatric disorders, and those who had such symptoms were more than three times more likely to report having also had chest pain. Mathew Hotopf, MB, BS, MRCPsych, MSc, tells WebMD that about 20% of the study participants had psychiatric disorders or symptoms, with anxiety and depression equally composing the majority of disorders.

"I don't know how it is in America, I suspect it is the same as in England," says Hotopf. "But a lot of doctors here, they will see a patient [with chest pain] and they do their test[s]; and if they find nothing that can account for the chest pain, their job stops there. They are cardiologists. It's no longer their problem. But as far as the patient is concerned, it's not over. They want an answer. There is quite a lot that can be done for depression and anxiety, and it is important that they are picked up." Hotopf is a clinical senior lecturer in the Department of Psychological Medicine at King's College in London.

"For all cases of chest pain, psychiatric disorder could explain, at most, about 25% of the cases. In the case of chest pain [upon exercise], psychiatric disorder ... could explain nearly 60% of cases in the population, write the authors of the study, which appears in the November/December issue of the journal Psychosomatic Medicine.

"Particularly with anxiety, it is unclear whether it is causing the chest pain or people are more aware of the chest pain that they may already have," Hotopf tells WebMD. "It may be that having anxiety makes you more aware of the fairly innocent sensation ... a twinge in the chest."

"I see no particular shortcomings of the study; it strikes me as a fresh exposition of old information," Vincent Felitti, MD, tells WebMD. Felitti, a professor at the University of California, San Diego and head of the section of preventive medicine for Kaiser Permanente Medical Group in Southern California, reviewed the study for WebMD.

Felitti says that the least common cause for chest pain is actually problems with the heart. Some of the pain stems from constant tightening of certain muscles, he says. "All of this goes on unconsciously. In the scalp it's a tension headache. In the back it is chronic low back pain. In the chest it is misrecognized as heart disease."

Felitti adds that the cause of chest pain isn't usually discovered if the person goes to an emergency room. "I think in the settings in which chest pain is usually seen -- typically emergency rooms -- they are not are not likely to be of a mind to look beyond anything that is of cardiac origin; they are simply diagnosing someone as not having something, instead of having something. And that sets up the likelihood of repetition," where the person will continue to have chest pain and feel the need to seek emergency care.

Vital Information:

• A well-known symptom of a heart attack is chest pain, but heart disease is actually the least common cause of this ailment.
• A new study shows that in up to 25% of patients, chest pain is a symptom of a psychiatric disorder, usually either anxiety or depression.
• It is not known whether psychiatric disorders cause chest pain or whether these patients are just more aware of any sensation that they may have.

July 29, 2004 -- The decision to "move in" rarely implies marriage anymore. Couples rarely mention matrimony before getting keys copied, new research suggests.

"Changing ... attitudes toward premarital sex, childbearing, and marriage have helped this shift along," writes Sharon Sassler, PhD, a sociologist at Ohio State University. Her paper appears in the recent issue of the journal Marriage and the Family.

"Indeed, today's young adults may see little reason to justify their decisions to cohabit by affirming their marriage intentions," she writes. "Serious discussions of marriage often did not occur until couples had lived together for lengthy periods, generally 1 to 2 years."

This is partly due to greater opportunities that young adults enjoy today in education, employment, and intimate relationships, she writes. And in this time of rapid social change -- economic ups and downs -- living together helps young people ride out the risks.

But if not marriage, what prompts the decision to move in? Sometimes, it's a sudden change, like employment status. He loses a job and income; he moves into her place. For others, moving in signals commitment; they already spend so much time together, why not?

"Marriage is often implicitly assumed, rightly or not, to be the ultimate goal of cohabitation," Sassler writes. Yet relatively few of these couples ever tie the knot.

Talking to the Couples

To further examine this major move, Sassler interviewed 25 college students -- most in their 20s, some in their 30s. All were heterosexual and had shared living quarters with someone for at least three months -- some up to four years.

Among the students, there were three types. The "accelerated cohabitors" said the transition from romantic involvement to living together occurred quite quickly, before they had been dating for six months. Their relationship was intense from the beginning, they spent much time together, and decided that it couldn't be casual. Looking back, few thought things had progressed too quickly.

The "tentative cohabitors" moved more slowly. They dated more than 6 months before living together and felt very uncertain about making the big move. Their relationships had progressed more slowly overall, compared to the accelerated group.

The "purposeful delayers" dated a year or two before moving in. Nearly all had lived with someone before. This time around, they let the relationship progress more gradually, at its own pace, writes Sassler.

For the vast majority, practical problems -- finances, convenience, housing situation, roommate departures, parent/family problems, and "because they wanted to" -- were the prompts for moving in together.

"Interestingly enough, moving in with a partner as a trial, or a way to determine compatibility for marriage, was seldom mentioned," writes Sassler. "Future relationship goals were generally not discussed prior to moving in ... and discussions about marriage did not become serious for most until after they had cohabited for several years."

Only about one-third had discussed marriage beforehand, she reports. Most of those were purposeful delayers. "Because they were slower to move in together, these couples had more time to assess the strength of their relationship."

Also, those who lived together for about two years were more likely to discuss the future, she writes.

"In many ways, living together represented an advanced stage of dating, often preferable to living with roommates, while also having some advantages over marriage (like freedom)," Sassler writes. "Growing commitment to partners and the relationship seems to develop after moving in together."

SOURCE: Sassler, S. Journal of Marriage and Family, May 2004; vol 491: pp 491-505.

Face it -- a great kiss makes the world dissolve, makes us dizzy with desire.

"Kissing is passion and romance and what keeps people together," says Michael Cane, author of The Art of Kissing, who "lectures" on kissing at colleges around the country.

"Women say they can tell if a relationship is going to work after the first kiss, after the first night of kissing," he says. "They just get a feeling, an intuition."

And while kissing may feel oh-so-good, it also has health benefits, too. It triggers a whole spectrum of physiological processes that boost your immunity and generally spruce up that body you work so hard to keep attractive.

Kiss Me, You Fool

Among the benefits of a good wet one: That extra saliva washes bacteria off your teeth, which can help break down oral plaque, says Mathew Messina, DDS, a private practice dentist in Fairview Park, Ohio, and consumer advisor for the American Dental Association. "Still, I would not go around advocating kissing after meals instead of brushing," he says.

A serious, tongue-tangling French kiss exercises all the underlying muscles of the face -- which some say could keep you looking younger, and certainly looking happier.

Kissing might even help you lose weight, says Bryant Stamford, PhD, professor and director of the health promotion center at the University of Louisville. "During a really, really passionate kiss, you might burn two calories a minute -- double your metabolic rate," he says. (This compares to 11.2 calories per minute you burn jogging on a treadmill.)

When you give sugar, you actually burn sugar. Sex sparks a good calorie burn, Stamford says, especially "if you're passionately involved, thrashing around. If things were really hot and heavy, you might be looking at a caloric expenditure similar to a brisk walk."

But don't confuse great sex with a cardiovascular workout, he says.

"People tend to have the misconception that anything that raises your heart rate has the same effect as jogging, so it must be good for fitness. Not true," he says. "Anything can get your heart racing ... that's just adrenaline."

Kissing as Meditation

Tension relief -- that's what good lovin' brings, says Stamford. "Sex and love are probably the Rodney Dangerfield of stress management. Because of all the negative energy we take in during the day, it's a very positive benefit."

All in all, kissing and everything it engenders keeps us going strong, living long, says Stamford. "The process of being active -- and that can include kissing, sex, and any other whole-body activities -- that's what keeps you healthy."

Sex, sensuality, and sensual touch have profound effects on well-being, says Joy Davidson, PhD, psychologist and clinical sexologist in Seattle, and former columnist for an online column called "Underwire."

"Kissing is an exciting excursion into the sensual," Davidson tells WebMD. "If we happen to be connecting with someone we care about, it produces a sense of well-being and a kind of full-bodied pleasure."

Kissing is also "a sensual meditation," she says. "It stops the buzz in your mind, it quells anxiety, and it heightens the experience of being present in the moment. It actually produces a lot of the physiological changes that meditation produces."

And while kissing may be nature's way of "opening the door to the sexual experience," she says, "it also has all that lusciousness that we need to pull us out of the mundane and the ordinary and take us into moments of the extraordinary."

March 20, 2006 -- Is teen drinking more common among teens who own clothes, hats, or other gear bearing the names of alcohol brands?

Maybe, report Auden McClure, MD, and colleagues in the American Journal of Preventive Medicine. McClure works in the pediatrics department at Dartmouth Medical School in New Hampshire.

McClure's team isn't blaming alcohol-branded gear for teen drinking. But they want to see more research done on the topic. Meanwhile, a leading beer company notes the limits in McClure's study.

About the Study

The study included nearly 2,400 teens -- most of whom were white -- in rural New England. In middle school, the teens had taken surveys about smoking and drinking.

On those surveys, all of the teens denied ever drinking beer, wine, or other alcohol without their parents' knowledge. In follow-up interviews a year or two later, 15% admitted drinking beer, wine, or other alcohol without their parents' knowledge.

In the follow-up interviews, the researchers also asked whether the students owned any alcohol-branded merchandise, such as a T-shirt, hat, or backpack; 14% said yes. Teens who owned such gear were more likely to admit having drunk alcohol without their parents' knowledge.

Which Came First?

The researchers note that their study doesn't prove that owning alcohol-branded gear caused any teens to start drinking, and that they don't know whether the teens got those items before or after they started drinking without their parents' knowledge.

The surveys didn't cover alcohol use by the teens' parents or the teens' drinking habits. The findings need confirmation and might not apply to other groups of teens, the researchers state.

The study doesn't focus on any particular brand of alcohol. However, Anheuser-Busch Companies emailed WebMD a statement from John Kaestner, Anheuser-Busch's vice president for consumer affairs, about McClure's study.

Company's Response

"Anheuser-Busch is adamantly opposed to underage drinking," Kaestner states, underscoring the limits noted in the study.

"The most influential factor in teens' drinking decisions -- parents -- was not fully examined in the study, with parent alcohol use and the way in which the student acquired the alcohol-branded merchandise being unmeasured," states Kaestner.

"According to the Roper Youth Report, a nationally representative survey of youth (aged 13-17), teens say their parents are the No. 1 influence on their decisions to drink or refrain from drinking," Kaestner adds.

The study didn't represent teens nationwide, notes Kaestner.

Merchandise Intended for Of-Age Adults

"We direct our marketing to our customers, adults 21 and older," Kaestner continues.

"Our promotional clothing and merchandise are intended for adults, come in adult sizes, and are placed in adult sections of stores. The agreements we have with our licensees only permit their retailers to market, sell, and distribute our beer-branded merchandise to adults of legal drinking age."

Kaestner also mentions past research that has shown that many teens who drink say they get alcohol from their parents or other adults. "If teens can't get alcohol, they can't drink it," Kaestner states.

Oct. 1, 2004 -- The deadline ran out last night on more than $1 billion in federal money slated for children's health, forcing the cash to revert to the U.S. Treasury instead of going for low-income programs.

Congress failed to act to keep $1.1 billion targeted for the State Children's Health Insurance Plan, or SCHIP. The program provides health coverage for approximately 6 million U.S. children from families living at 200% of the federal poverty level.

The move incensed some lawmakers who lobbied for a measure that would send the money to poorer states facing shortfalls in the program. But a lack of agreement on whether the money is best spent in those states versus using it to expand enrollment to cover more uninsured children meant that the funds were no longer available to states after midnight on Sept. 30.

Sen. John D. Rockefeller IV (D-W. Va.) says that 200,000 children in seven states would lose out on health coverage without the extra money.

"These children and their families were depending on us in Congress, and we've let them down," he says in a statement.

Republican congressional leaders and the Bush administration opposed a reshuffling of the money. They argue that overall, states are projected to spend only about half of $11 billion available to them for children's health programs in the 2005 fiscal year, which starts today.

Officials from the U.S. Department of Health and Human Services also said that it would use its authority to send $660 million of money left over from 2002 accounts to states with funding gaps.

"No state will be left short and no child will lose coverage due to a shortfall, period," says HHS Secretary Tommy G. Thompson.

The Bush administration wants to spend this year's left over money on outreach programs to expand SCHIP enrollment, Thompson wrote in a letter to lawmakers. Approximately 5 million U.S. children eligible for SCHIP are not enrolled, according to federal figures.

Rockefeller and a bipartisan group of senators announced that they will continue attempts to force Congress to send the $1.1 billion to states before lawmakers reach a scheduled adjournment in mid-October.

Where the Money Goes

Meanwhile, new data show a growing gap in health spending between children and the elderly. One study published by economists at the University of Pennsylvania concludes that the government spent approximately $25.8 billion on Medicaid and SCHIP health programs for children in 2000 but spent more than eight times that on Medicaid and Medicare coverage for seniors.

At the same time, per capita social welfare and health spending grew 20% faster for the elderly than for children between 1980 and 2000, the researchers say.

Some analysts point to the difference as evidence that the U.S. is not spending enough to deliver health care to children. Lisa Simpson, a health policy researcher from the University of South Florida, points out that the U.S. has higher infant mortality rates than 24 other countries and lower immunization rates than 67 others.

"Overall children are in worse health in this country than in comparable other countries," she told an audience at a Capitol Hill briefing sponsored by the Alliance for Health Reform.

April 20, 2004 -- A dangerous antibiotic-resistant infection once primarily confined to hospitals appears to be spreading in communities, affecting children and otherwise healthy people.

In years past, methicillin-resistant staphylococcus aureus (MRSA) was seen almost exclusively among very sick hospital patients. However, in recent years, an increasing number of reports of MRSA in the community have surfaced. And this week new research detailing alarming outbreaks of MRSA infection on opposite ends of the U.S. was presented in Philadelphia at the annual meeting of the Society from Healthcare Epidemiology of America.

MRSA has already been dubbed "the Superbug" in England, where an 11-fold increase among children has occurred during the past decade, according to a study in last month's Archives of Disease in Childhood.

Staph aureus is a group of bacteria commonly found on the skin. When skin is cut or scraped, the bacteria can enter the body and cause a relatively common skin infection. But when these bacteria become resistant to antibiotics, as is the case with MRSA, they can spread to cause pneumonia, bone infections, or life-threatening infections of the bloodstream.

One place that MRSA has been seen more recently is among athletes in contact sports. In fact, Drew Gooden of the Orlando Magic basketball team was hospitalized last month for MRSA infection resulting from infected hair follicles on his leg. The infection was repeatedly drained and he needed three days of intravenous drug treatment.

"But now we're seeing it in people outside a hospital setting," says Nancy Church, RN, manager of infection control at Providence St. Vincent Medical Center in Portland, Ore. "We're seeing it in people being brought to our hospital for treatment for it."

Last summer, she says, 10 patients were brought to her hospital's emergency room with MRSA infection that also proved to be resistant to powerful antibiotics.

"Most were young adults," she tells WebMD. "First, we were seeing it among those who played contact sports and were IV drug users or had HIV. Then we started to see it outside the realm of contact sports and drug use, in those with no known risk factors." As with Gooden, their infections needed to be drained and treated with intravenous medications to prevent further complications.

On the other end of the country, another researcher says the number of kids brought to Children's Hospital of Philadelphia for treatment of antibiotic-resistant staph infections doubled between 2001 and 2003. About half of the 79 children had no known risk factors that would have increased their risk for MRSA infection.

What is alarming is that many of these infections developed in cuts, scrapes, insect bites, and other minor injuries that occur everyday in active young children, says Susan Coffin, MD, the facility's medical director of infection prevention and control. "It's unclear why, but these resistant bacteria now occur in children who are otherwise healthy," she tells WebMD.

Church says that it's believed that the rash of outbreaks detailed in both hospitals likely results from the overuse of antibiotics. "But it's clearly not the same genetic strains as we've seen in hospitalized patients."

Both experts say their studies should serve as a warning to prevent potential problems. Their advice:

• Thoroughly wash any open wound with soap and water, no matter how minor it appears, and continue to keep it clean.
• Wash hands frequently -- especially before touching any wound.
• Avoid sharing towels, combs, soap, and other items that touch skin.
• Get prompt medical attention for any skin wound that leads to a fever or develops a blister, boil, redness, or swelling -- symptoms of possible staph infection.

"These infections can easily be controlled if they are diagnosed early and treated with antibiotics to which they are not resistant," says Coffin. "Any serious-looking skin infection should be promptly seen by a doctor."

Would you let your son or daughter ride in a car driven by an unlicensed, unqualified driver? Of course not. The inherent risks are obvious. Sports have inherent risks, too, yet every day parents drop their kids off for practices or games where there's no one trained to handle injuries.

To get an idea of the risks involved in youth and high school sports, identify the following statements as true or false:

1. An athlete can collapse from dehydration in cool weather or while playing indoors.
2. "Playing through the pain" can cause a minor injury to become serious.
3. Many coaches in church leagues, schools, and independent youth sports organizations are not required to know first aid and CPR.
4. Overuse injuries are more common than acute injuries. Insufficient rest after injury, poor training, and lack of conditioning are contributing factors.
5. Most injuries occur during practices.
6. The incidence of injuries requiring surgery is nearly as high for high school baseball and softball players as for football players.
7. Children aged 5 to 14 account for nearly 40% of all sports related injuries treated in ERs.

If you answered "True" for all the questions you were correct.

To raise awareness about sports safety, the National Athletic Trainers Association (NATA) and American Academy of Orthopaedic Surgeons (AAOS) recently ran a public service ad campaign, asking, "What will they have longer, their trophies or their injuries?" WebMD talked to two experts committed to raising safety standards for organized kids' sports so that "trophies" will triumph over "injuries."

Sports Injuries Spiking

In 2003, more than 3.5 million kids aged 5 through 14 engaged in organized or informal sports activities were treated for injuries, according to the U. S. Consumer Product Safety Commission (USCPSC) National Electronic Injury Surveillance System. That's up from 775,000 kids in 1995. Experts cite several reasons:

• Growing number of organized sports for boys and girls of all ages and increased participation.
• Organized sports attracting a generation of kids who have great finger dexterity from video games but lower cardiovascular health than previous generations of kids.
• Specialization and year-round play in a single sport leading to overuse injuries like strains and Little League Elbow.
• Parents pushing kids to excel. "Some parents are living through their kids, and 25% of parents expect their ninth graders will be pros," says Almquist, who is also athletic training specialist for the Fairfax County Public Schools, Fairfax, Va.
• Failure to rest after injury. "Some parents will doctor shop to find one who will clear their kid to play," says Almquist.
• Parent volunteers not trained in proper coaching techniques or first aid.
• Church and independent sports leagues without plans for events such as lightning or medical emergencies. "Whereas high school teams have a limited number of players and might employ an athletic trainer, church and independent leagues might have 300 to 500 players and no medical personnel," says April Morin, executive director of the National Center for Sports Safety (NCSS) in Birmingham, Ala.

Dec. 6, 2005 - Ever-present marketing by junk food and restaurant companies is damaging the health of American children and teens and should be curtailed to promote healthier diets, the Institute of Medicine (IOM) concluded Tuesday in a report.

The study shows that food advertising targeted at kids continues to increase while promoting mostly food high in calories, fat, and sugar. Experts called for companies to substantially change their marketing practices within two years or be subject to legal intervention from Congress.

"Current food and beverage practices put kids' long-term health at risk," says J. Michael McGinnis, an IOM senior scholar and chairman of the committee that issued the report.

Ads Target Kids

Food manufacturers and fast-food restaurants spent about $10 billion advertising to children in 2004. At the same time, marketers continue to target more and more food products directly to youth, who spend an estimated $200 billion per year on consumer products.

"The turnaround required is so substantial, and the issues are so complex, that the full involvement and leadership of the food and beverage industry is essential," McGinnis says.

Experts pointed to what they said is evidence linking food marketing to people's unhealthy dietary habits and other evidence showing the direct role that high-calorie, high-fat food plays in obesity.

Nearly one-third of American children are classified as obese or overweight, a figure that public health experts warn puts tens of millions of future adults at increased risk of heart disease, diabetes, and early death. While less evidence directly ties children's exposure to food ads, the report also says that some data suggest that ads have a limited impact on causing childhood obesity.

Meanwhile, only 2% of American children regularly eat a recommended diet low in fat but high in fruits and vegetables.

"Unless we do something about it, we'll be raising the first generation of children that are sicker and live shorter lives than their parents," says Mary Story, PhD, a professor of epidemiology at the University of Minnesota and a member of the IOM panel.

Voluntary, for Now

Panelists praised the efforts of a handful of companies that have begun to alter their advertising practices and designate healthier foods on product packaging aimed at children. "There are some good-faith efforts," McGinnis says.

But the report calls on the food industry to do much more to voluntarily shift its advertising to promoting healthier foods and to alter the content of television spots aimed at minors. If it fails to do so within two years, "Congress should enact legislation mandating the shift on both broadcast and cable television," it states.

Experts also call on marketers to come up with a common national system for clearly identifying healthier foods for consumers. Companies should also limit licensing of popular cartoon characters for use in the sale of healthier foods to younger children.

Consumer groups applauded the report, saying it validates years of efforts aimed at getting marketers to alter what they see as billions of dollars of relentless messages promoting unhealthy food choices.

The report "marks the beginning of the end of junk-food marketing to kids," Margo G. Wootan, nutrition policy director for the Center for Science in the Public Interest, says in a statement. "The report sends a clear signal to food company executives and advertisers that the industry needs to completely rethink the way they do business."

Industry Reaction

Industry groups largely rejected the findings, saying that no strong evidence links advertising to obesity in kids and that marketing of junk food is on the decline.

"The shift is happening. It's happening today," says Richard Martin, chief spokesman for the Grocery Manufacturers of America. "Industry is already responding to these issues. We're interested because consumers are increasingly interested in healthier foods."

Martin called the committee's claim that television advertising was directly linked to childhood obesity "specious."

A report issued by the Federal Trade Commission shows that child-targeted food advertising on television has dropped substantially in the last several years.

But the IOM report warns of a shift to product placements, games mixing entertainment with product exposure, and so-called "stealth marketing" practices.

Those strategies are mostly outside the purview of an industry-sponsored group set up to monitor children's advertising on television. IOM experts called on industry to expand funding and jurisdiction of the group, known as the Children's Advertising Review Unit.

March 12, 2004 -- You've seen them -- those diet ads with "before-and-after" pictures of obese people. They only perpetuate hurtful stereotypes, according to a new study.

"Given that these ads reach millions of people every day, their potential for harm is vast," writes researcher Andrew Geier, a psychology graduate student at the University of Pennsylvania. His study appears in the current issue of Eating and Weight Disorders.

"Significant social stigma and weight discrimination occur in many important areas of life, including employment, medical care, and education," he says.

"Despite no clear relationship between certain character traits and weight, negative judgments are routinely made about those who are overweight." writes Grier.

A major contributor to the stigma is the impression that individual can easily control their weight and that there is a lack of self-discipline and personal failure that are responsible for excess weight. Societal messages can enhance these stigmas and contribute to antifat attitudes, he writes.

In Geier's study, 59 female college psychology students aged 18-21 completed a few questionnaires about their life satisfaction and life experiences.

Then, they were shown various advertisements. One set was a "before-and-after" diet type of ad with side-by-side pictures of obese people and slim people. The other type was a "joy of gardening" ad featuring a well-groomed, pleasant-looking person who was either obese or slim. Volunteers were not told the study involved obesity -- although a few said they suspected it was. His intention was to see the impact of exposure to "before-and-after" diet ads.

The volunteers then assigned various adjectives to subjects in each ad: lazy, motivated, ugly, good, blameless, bad.

• Overall, volunteers showed a "strong" antifat bias.
• Having a close friend or relative who was obese appeared to have a lessening effect on general antifat attitudes but it did not influence the belief that weight is controllable.
• Those who indicated greater satisfaction in their own lives showed less negativity toward the obese people in the ads.

Studies of racial stereotyping have found a similar effect -- that negativity is greatest among those who are less satisfied with their own lives, writes Geier.

His study also found that:

• Subjects rated the woman in the 'before' picture as more attractive when she was in the before-picture-only ads than when she was in the 'before-and-after-picture' ads.
• They found that the students also rated 'after' pictures as more attractive in the 'after' pictures only ads than in the 'before-and-after' ads.

One explanation for this, writes the author, is what is termed 'the caterpillar to butterfly' effect'. Once a subject has witnessed the appealing future, the present suddenly emerges as more attractive, says Geier.

"Most agree that stigma is wrong, but fewer appreciate how damaging stigma can be on the psyche and the physical health of the targeted individual," he says.

One thing that should be obvious is that shaming obese people is not the same as helping them, Geier concludes.

SOURCE: Geier, A. Eating and Weight Disorders, December 2003; vol 8: pp 282-288.

Feb. 17, 2005 -- Marital strain is a home wrecker that can endanger the heart. So says a 10-year study of 3,000 men and women aged 18 to 77.

All participants were married or living in a "marital situation." The researchers collected data on marital discord. Health was tracked for a decade to see who developed heart disease or died of any cause during the study.

For both men and women, marital strain affected their health.

Marital Strain and the Married Couple

The worst health risk was seen in women who hushed up when conflicts arose with their spouse. They said they usually or always silenced themselves in such situations.

Those women might have thought they were keeping the peace, but they paid dearly for it. Women who kept mum in marital conflicts had four times the risk of dying during the study, compared with women who spoke their minds.

For men, emotional expression wasn't the issue. Instead, their hearts suffered when they saw their wives come home from work burdened by job stress.

"Men reporting that their wives' work was disruptive to their lives were 2.7 times more likely to develop heart disease," say the researchers, who included Elaine Eaker, ScD, of Wisconsin-based Eaker Epidemiology Enterprises. The findings were reported in Orlando, Fla., at the Second International Conference on Women, Heart Disease, and Stroke.

A Health Perk for Husbands

Married men were about half as likely as single men to die of any cause during the study. That finding held true after adjusting for blood pressure, body mass index, smoking, diabetes, and cholesterol.

Single men were more likely than husbands to be smokers, says Eaker, in a news release. Past studies have also shown a health advantage for married men.

For women, marital status wasn't linked to heart disease or dying. The connection emerged when Eaker used more contemporary measures of marital strain, such as "self-silencing" behavior.

What's a Couple to Do?

Learning to handle conflict and defuse stress is a healthy idea for everyone. Counseling can help with that, with therapists available for individuals and couples. Doctors may also want to ask their patients about stress and make counseling referrals as needed, says Eaker.

Dec. 4, 2002 -- Vacations and leisure time usually provide welcome relief from the stresses of everyday life, but for some people free time may make them sick. For the first time, a new study shows "leisure sickness" may be a real issue for a significant number of adults.

Until now, Dutch researchers say only occasional references have been made to the phenomenon of leisure sickness, which they say can best be described as frequently feeling ill during weekends and/or vacations. To get a first look at the nature of the condition how common it is, they surveyed about 2,000 men and women about whether they fit that description of weekend and vacation sickness.

Their report appears in the current issue of Psychotherapy and Psychosomatics.

They found 3.2% of both men and women identified themselves as suffering from vacation illness, but more men than women (3.6% vs. 2.7%) said they suffered from weekend illness.

The most commonly reported symptoms of leisure illness included headache/migraine, fatigue, muscular pains, and nausea. Viral infections, such as cold or flu, were also frequently reported in relation to vacations.

Most people with the condition had suffered from it for more than 10 years, and the onset of the illness was often stress-related. Sufferers attributed their illness to difficulty making the transition from work to leisure as well as the stress associated with travel and vacations

Although researchers found few lifestyle differences between those with leisure sickness and those without, the study suggests people with a large workload, high need for achievement, and a strong sense of responsibility with respect to work may be especially vulnerable to the problem.

Study author J.J.M. Vingerhoets, of the department of clinical health psychology at Tilburg University in The Netherlands, and colleagues write that future studies should look at the causes of this mysterious condition and investigate potential treatments.

SOURCE: Psychotherapy and Psychosomatics, 71, 2002.

A pregnancy that has progressed without any apparent hitch can still give way to complications during delivery. Here are some of the most common concerns.

Failure to Progress (Prolonged Labor)

A small percentage of women, mostly first-time mothers, may experience a labor that lasts too long. In this situation, both the mother and the baby are at risk for several complications including infections.

Abnormal Presentation

Presentation refers to the position the fetus takes as your body prepares for delivery, and it could be either vertex (head down) or breech (buttocks down). In the weeks before your due date, the fetus usually drops lower in the uterus. Ideally for labor, the baby is positioned head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis. That way, the smallest possible part of the baby's head leads the way through the cervix and into the birth canal.

Because the head is the largest and least flexible part of the baby, it's best for it to lead the way into the birth canal. That way there's little risk the body will make it through but the baby's head will get hung up. In cephalopelvic disproportion, the baby's head is often too large to fit through the mother's pelvis, either because of their relative sizes or because of poor positioning of the fetus.

Sometimes the baby is not facing the mother's back, but instead is turned toward her abdomen (occiput or cephalic posterior). This increases the chance of painful "back labor," a lengthy childbirth or tearing of the birth canal. In malpresentation of the head, the baby's head is positioned wrong, with the forehead, top of the head or face entering the birth canal, instead of the back of its head.

Some fetuses present with their buttocks or feet pointed down toward the birth canal (a frank, complete or incomplete/footling breech presentation). Breech presentations are normally seen far before the due date, but most babies will turn to the normal vertex (head-down) presentation as they get closer to the due date. In a frank breech, the baby's buttocks lead the way into the pelvis; the hips are flexed, the knee extended. In a complete breech, both knees and hips are flexed and the buttocks or feet may enter the birth canal first. In a footling or incomplete breech, one or both feet lead the way. A few babies lie horizontally (called transverse lie) in the uterus, which usually means the shoulder will lead the way into the birth canal rather than the head.

Abnormal presentations increase a woman's risk for injuries to the uterus or birth canal, and for abnormal labor. Breech babies are at risk of injury and a prolapsed umbilical cord. Transverse lie is the most serious abnormal presentation, and it can lead to injury of the uterus (ruptured uterus) as well as fetal injury.

Your doctor will determine the presentation and position of the fetus with a physical examination. Sometimes a sonogram helps in determining the fetus' position. When a baby is in the breech position before the last six weeks to eight weeks of pregnancy, the odds are still good that the baby will flip. However, the bigger the baby gets and the closer you get to the due date, the less room there is to maneuver. Doctors estimate that about 90% of fetuses who are in a breech presentation before 28 weeks will have turned by 37 weeks, and over 90% of babies who are breech after 37 weeks will most likely stay that way.

Umbilical Cord Prolapse

The umbilical cord is your baby's lifeline. Oxygen and other nutrients are passed from your system to your baby, through the placenta and the umbilical cord. Sometimes before or during labor, the umbilical cord can slip through the cervix, preceding the baby into the birth canal. It may even protrude from the vagina. This is dangerous because the umbilical cord can get blocked and stop blood flow through the cord. You will probably feel the cord in the birth canal and may see it if it protrudes from your vagina. This is an emergency situation. Call an ambulance to get you to the hospital.

March 20, 2006 -- Is teen drinking more common among teens who own clothes, hats, or other gear bearing the names of alcohol brands?

Maybe, report Auden McClure, MD, and colleagues in the American Journal of Preventive Medicine. McClure works in the pediatrics department at Dartmouth Medical School in New Hampshire.

McClure's team isn't blaming alcohol-branded gear for teen drinking. But they want to see more research done on the topic. Meanwhile, a leading beer company notes the limits in McClure's study.

About the Study

The study included nearly 2,400 teens -- most of whom were white -- in rural New England. In middle school, the teens had taken surveys about smoking and drinking.

On those surveys, all of the teens denied ever drinking beer, wine, or other alcohol without their parents' knowledge. In follow-up interviews a year or two later, 15% admitted drinking beer, wine, or other alcohol without their parents' knowledge.

In the follow-up interviews, the researchers also asked whether the students owned any alcohol-branded merchandise, such as a T-shirt, hat, or backpack; 14% said yes. Teens who owned such gear were more likely to admit having drunk alcohol without their parents' knowledge.

Which Came First?

The researchers note that their study doesn't prove that owning alcohol-branded gear caused any teens to start drinking, and that they don't know whether the teens got those items before or after they started drinking without their parents' knowledge.

The surveys didn't cover alcohol use by the teens' parents or the teens' drinking habits. The findings need confirmation and might not apply to other groups of teens, the researchers state.

The study doesn't focus on any particular brand of alcohol. However, Anheuser-Busch Companies emailed WebMD a statement from John Kaestner, Anheuser-Busch's vice president for consumer affairs, about McClure's study.

Company's Response

"Anheuser-Busch is adamantly opposed to underage drinking," Kaestner states, underscoring the limits noted in the study.

"The most influential factor in teens' drinking decisions -- parents -- was not fully examined in the study, with parent alcohol use and the way in which the student acquired the alcohol-branded merchandise being unmeasured," states Kaestner.

"According to the Roper Youth Report, a nationally representative survey of youth (aged 13-17), teens say their parents are the No. 1 influence on their decisions to drink or refrain from drinking," Kaestner adds.

The study didn't represent teens nationwide, notes Kaestner.

Merchandise Intended for Of-Age Adults

"We direct our marketing to our customers, adults 21 and older," Kaestner continues.

"Our promotional clothing and merchandise are intended for adults, come in adult sizes, and are placed in adult sections of stores. The agreements we have with our licensees only permit their retailers to market, sell, and distribute our beer-branded merchandise to adults of legal drinking age."

Kaestner also mentions past research that has shown that many teens who drink say they get alcohol from their parents or other adults. "If teens can't get alcohol, they can't drink it," Kaestner states.

June 10, 2005 -- Television may be making it harder for kids to understand what's healthy and what's not when it comes to their diet.

A new study shows that children equate terms like "diet" and "fat free" with healthy because TV commercials equate weight loss benefits to nutritional benefits.

But what's good for helping an adult lose weight won't necessarily meet the nutritional needs of growing children.

"Given the plentitude of advertisements on television touting the health benefits of even the most nutritionally bankrupt of foods, child viewers are likely to become confused about which foods are in fact healthy," says researcher Kristen Harrison, a professor of speech communication at the University of Illinois at Urbana-Champaign, in a news release.

"We know that many American children are consuming too much fat and too many calories, but replacing the nutrient-dense foods in their diets with low-fat, low-calorie items like rice cakes and diet soda does them a disservice by depriving their bodies of the whole-food nutrients needed for growth," says Harrison.

TV Confuses Kids' Food Choices

In the study, researchers tried to measure children's understanding of which foods would help them grow by providing valuable nutrients rather than make them slimmer. The results appear in a recent issue of Health Communication.

More than 100 children in the first through third grade answered a questionnaire that assessed their nutritional knowledge, nutritional reasoning and television viewing. They completed the questionnaire once at the start of the study and again six weeks later.

To measure their nutritional knowledge, the children were asked to choose which item in six different pairs of foods was better for helping them "grow up strong and healthy." One food in each pair was more "nutritionally dense" than the other.

The study showed that the more television the children watched, the more confused they were about which foods are and aren't going to help them grow up strong and healthy.

"When they were presented with choices like Diet Coke vs. orange juice and fat-free ice cream vs. cottage cheese, they were more likely to pick the wrong answer -- the diet and fat-free foods -- than when they were presented with choices without these labels, for example, spinach vs. lettuce," says Harrison.

Researchers also found that the more TV the children watched, the less likely they were to provide sound nutritional reasons, such as "More juicy, has vitamins (referring to celery). Instead, they were more likely to give reasons like, "It won't make you fat (referring to fat-free ice cream)," or "It's diet" (referring to Diet Coke).

Overall, the study showed that the children displayed "moderate" nutritional knowledge and scored an average of about 4 out of 6 on the test.

Oct. 1, 2004 -- The deadline ran out last night on more than $1 billion in federal money slated for children's health, forcing the cash to revert to the U.S. Treasury instead of going for low-income programs.

Congress failed to act to keep $1.1 billion targeted for the State Children's Health Insurance Plan, or SCHIP. The program provides health coverage for approximately 6 million U.S. children from families living at 200% of the federal poverty level.

The move incensed some lawmakers who lobbied for a measure that would send the money to poorer states facing shortfalls in the program. But a lack of agreement on whether the money is best spent in those states versus using it to expand enrollment to cover more uninsured children meant that the funds were no longer available to states after midnight on Sept. 30.

Sen. John D. Rockefeller IV (D-W. Va.) says that 200,000 children in seven states would lose out on health coverage without the extra money.

"These children and their families were depending on us in Congress, and we've let them down," he says in a statement.

Republican congressional leaders and the Bush administration opposed a reshuffling of the money. They argue that overall, states are projected to spend only about half of $11 billion available to them for children's health programs in the 2005 fiscal year, which starts today.

Officials from the U.S. Department of Health and Human Services also said that it would use its authority to send $660 million of money left over from 2002 accounts to states with funding gaps.

"No state will be left short and no child will lose coverage due to a shortfall, period," says HHS Secretary Tommy G. Thompson.

The Bush administration wants to spend this year's left over money on outreach programs to expand SCHIP enrollment, Thompson wrote in a letter to lawmakers. Approximately 5 million U.S. children eligible for SCHIP are not enrolled, according to federal figures.

Rockefeller and a bipartisan group of senators announced that they will continue attempts to force Congress to send the $1.1 billion to states before lawmakers reach a scheduled adjournment in mid-October.

Where the Money Goes

Meanwhile, new data show a growing gap in health spending between children and the elderly. One study published by economists at the University of Pennsylvania concludes that the government spent approximately $25.8 billion on Medicaid and SCHIP health programs for children in 2000 but spent more than eight times that on Medicaid and Medicare coverage for seniors.

At the same time, per capita social welfare and health spending grew 20% faster for the elderly than for children between 1980 and 2000, the researchers say.

Some analysts point to the difference as evidence that the U.S. is not spending enough to deliver health care to children. Lisa Simpson, a health policy researcher from the University of South Florida, points out that the U.S. has higher infant mortality rates than 24 other countries and lower immunization rates than 67 others.

"Overall children are in worse health in this country than in comparable other countries," she told an audience at a Capitol Hill briefing sponsored by the Alliance for Health Reform.

How much do you know about what makes up a healthy lifestyle? Here's a pop quiz.

1. How do you define working out?

a. Going to the gym.
b. Turning the jump-rope for the neighbor's kid.
c. Playing Frisbee with your dog.

2. How do you define good nutrition?

a. Eating a vegetable at every meal.
b. Eating two vegetables at every meal.
c. Drinking a fruit smoothie for breakfast.

3. Which of these is a healthy activity?

a. Push-ups, sit-ups, or running the track.
b. Walking the dog after dinner.
c. Spending Saturday afternoon snoozing on the sofa.

Believe it or not, the correct answer to every question is A, B, and C -- even that Saturday afternoon snooze! According to the growing "Stealth Health" movement, sneaking healthy habits into our daily living is easier than we think.

"You can infuse your life with the power of prevention incrementally and fairly painlessly, and yes, doing something, no matter how small, is infinitely better for you than doing nothing," says David Katz, MD, MPH, director of Yale University's Prevention Research Center and of the Yale Preventive Medicine Center. Katz is also co-author of the book Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying.

From your morning shower to the evening news, from your work commute to your household chores, Katz says, there are at least 2,400 ways to sneak healthy activities into daily living.

"If you let yourself make small changes, they will add up to meaningful changes in the quality of your diet, your physical activity pattern, your capacity to deal with stress, and in your sleep quality -- and those four things comprise an enormously powerful health promotion that can change your life," says Katz.

And yes, he says, a nap on the couch can be a health-giving opportunity -- particularly if you aren't getting enough sleep at night.

Nutritionist and diabetes educator Fran Grossman, RD, CDE, agrees. "You don't have to belong to a gym or live on wheat grass just to be healthy," says Grossman, a nutrition counselor at the Mt. Sinai School of Medicine in New York. "There are dozens of small things you can do every day that make a difference, and you don't always have to do a lot to gain a lot."

Gardening can be a great workout and boost for body and soul -- if you do it right.

Sharon Lovejoy, author of Country Living Gardener: A Blessing of Toads, tells WebMD she started gardening as an infant. Her grandmother, not her mother, was the gardener in the family. "I think it often skips a generation," she says.

The key, Lovejoy says, is to see gardening not as a punishment but a joy. "You should feel lucky to be outside in the garden," she says.

And maybe healthier, too. And not just from eating veggies you grew yourself.

Aerobic Gardening

Gardening provides all three types of exercise: endurance, flexibility, and strength.

Jeff Restuccio, author of Fitness the Dynamic Gardening Way, is a first-degree black belt but found he was getting more exercise playing in the garden with his kids. "I like gardening because it's purposeful," he tells WebMD. "With food so cheap in the stores, you may not save money growing your own, but the chances are, if you grew it, your family will eat it."

He suggests making your gardening into a structured exercise routine, alternating light activities with heavier ones, then a light one, and so on. Rake for a while, then dig holes, then prune. "Exercise 30 to 60 minutes, then quit, whether everything is planted or not," he advises.

"Stretch first!" Lovejoy begs. "You'd stretch before going to the gym, wouldn't you?"

Restuccio also recommends concentrating on deep breathing while you work -- and increasing your range of motion, exaggerating the raking motion or the digging motion. "You can use up 500 calories an hour that way," he says (official counts put gardening activities at the 100- to 200-per-hour calorie-burning level).

He also recommends raking right-handed 15 times, then left-handed 15 times.

"If you think double digging (going down a foot, turning the soil over, then down another foot, bringing that soil to the top) isn't exercise," he says, "you haven't tried it."

Gardening is something parents and kids can do together. "Never make cutting the grass or helping a punishment," she urges.

"When I go into the schools, I see so many more obese kids than I did 20 years ago," Lovejoy says. "I think parents are afraid to let them out."

You never know where those seeds, if you will pardon the expression, will fall or when they will sprout. "Many of us probably had to weed the garden," Sandra Mason, an extension educator in horticulture and environment at the University of Illinois, tells WebMD. "A lot [of people] come back to gardening later -- maybe when [they] purchase a home."

Gardening as Therapy

The American Horticulture Therapy Association concentrates on the cleansing, calming benefits of being in the natural world.

• Lovejoy says studies have shown a link between ADHD and insufficient outdoors time.
• "Hospital patients also do better when looking at a plant rather than a cinderblock wall," she says. "Maybe that is how bringing flowers to the hospital got started."
• Older people, even those with memory problems, thrive in a community gardening situation, according to the AHTA.
• Special gardens have also sprung up for the blind, the wheelchair-bound (raised beds), and people with mental disabilities.(2)

  Just walking into a fragrant, warm greenhouse can change someone's whole mood, Lovejoy points out.

May 24, 2004 (Orlando, Fla.) - As the number of children defined as overweight and obese continues to rise, researchers say new studies now show that obese children are more susceptible to lung damage from air pollution than lean youngsters.

"Given the epidemic of obesity in children, it might be we're developing a population more vulnerable to pollution's negative effects on the airway," says Heike Luttmann-Gibson, PhD, statistician and research associate in the Environmental Epidemiology Program at Harvard School of Public Health.

When exposed to the same amount of pollution, obese boys and girls had more trouble breathing than kids of normal weight, she reports.

Obesity's Far-Reaching Health Effects

The findings offer one more reason to put overweight and obese youngsters on a diet and exercise program. Consider the facts:

• The number of overweight and obese children has nearly tripled since the 1970s.

• There has been a tenfold increase in the number of children with type 2 diabetes over the past five years. Once called 'adult-onset' diabetes, type 2 diabetes is linked to obesity and inactivity.

• Overweight kids are more likely to become overweight adults, increasing their risk of obesity-related health conditions such as heart disease, stroke, and bone fracture.

David B. Peden, MD, MS, professor of pediatrics and center director of the Center for Environmental Medicine, Asthma and Lung Biology at the University of North Carolina in Chapel Hill, says, "Being overweight clearly causes a lot of bad things to happen. But even a modest reduction in weight can have a big effect on a child's health, including [lung problems tied to] air pollution."

Problems Expand Along With Ballooning Waistlines

In the study, 611 fourth and fifth graders, who were participating in a larger study on the long-term effects of air pollution, were tested for lung function. About one in 10 was obese. Parents of the children helped fill out questionnaires asking about general and respiratory health.

After analyzing the information, the researchers showed that the effects of air pollution on lung function were two to five times stronger for obese children than for those of normal weight, Luttmann-Gibson reports.

The researchers found that children exposed to nitrogen dioxide -- an irritant that is found in car exhaust -- had a drop in lung function. Obese kids exposed on one day had an 11% dip in lung function the following day, while lean youngsters exposed to the same levels of the pollutant had only a 2% drop in lung function.

The more obese the child, the greater the effects of air pollution on lung function, says Luttmann-Gibson. "Any decline in lung function is bad, and obesity makes it even worse."

Luttmann-Gibson says she suspects that air pollution and obesity pack a double whammy to the airways. Researchers know that chemicals relating to inflammation in the body are elevated in obese persons, she explains. "And air pollution increases inflammation in the airways. Being obese is setting you up to be more susceptible to the inflammatory effects of air pollution."

And that, researchers say, may mean that an increased risk of asthma should be added to the list of obesity-related health conditions.

Peden tells WebMD, "If obesity is resulting in more inflammation, the risk of developing asthma might be further increased, too."

Although further study is needed to prove the association, it's a link many doctors already suspect, Peden says. "It's intriguing, a new and exciting area of interest."

June 30, 2003 -- Daily injections of low-dose growth hormone may help overweight people lose body fat while maintaining muscle mass, according to early research from St. Louis University. Obese patients who got the injections lost modest amounts of weight, but researchers caution that it is too soon to know if the findings are significant.

The research was presented at the 85th annual meeting of the Endocrine Society in Philadelphia.

In the study, 59 people who averaged 40% above their ideal body weight were told to follow a calorie-restricted diet and exercise program. They also got either daily self-administered shots of low-dose growth hormone or placebo injections.

One third of the original participants dropped out during the six-month treatment phase, but only one patient left the study because of side effects. The rest did not want to follow the lifestyle guidelines or give themselves the daily injections.

In earlier studies using higher doses of growth hormone, potentially serious side effects were commonly seen. These side effects included arthritis and insulin resistance, which can lead to diabetes.

Modest Weight Loss

At the end of the study, the people who got the growth hormone had lost an average of five pounds of body fat, while those who did not receive the hormone lost nothing. The growth hormone group saw a 19% improvement in HDL, or good, cholesterol levels with no change in LDL, or bad, cholesterol levels.

Lead researcher Stewart Albert, MD, says he does not believe growth hormone was directly responsible for the weight loss but it might have made it easier for people to maintain a healthier lifestyle.

"If the growth hormone had any benefit, it was to allow people to continue with the diet and exercise," Albert tells WebMD. "It may be that growth hormone has a beneficial effect on appetite control or that because people didn't lose muscle mass they were able to exercise more. It will take much larger studies to answer these questions."

Clinical endocrinologist Lawrence Frohman, MD, tells WebMD that the high dropout rate in the study and the moderate weight reductions in the growth hormone group make him skeptical about the clinical potential of this treatment.

There are numerous over-the-counter products marketed as growth hormone for weight loss, sold over the Internet or in health stores. Frohman says the products are not growth hormone and they have not been subjected to clinical scrutiny to determine if they are safe.

"Anything that is sold over the counter cannot be growth hormone, because growth hormone is regulated by the FDA," he says. "It is hard to get the actual content of what is in these products, but they are of limited to no value."

They used to say that Chicago stockyard workers used "everything but the squeal." If you use everything but the gobble, you need to remember several important rules to make sure that table full of lukewarm, breathed-on food is safe to eat later.

William Stallings, MS, RD, clinical dietitian at Temple University Hospital in Philadelphia, says to remember the "2-2-4" formula. This means:

• 2 hours. Store all leftovers in the refrigerator or freeze no more than two hours after cooking. If food has been out more than two hours, toss it.
  
  
• 2 inches. Use shallow containers, about two inches deep, to store food. This will allow it to cool quickly and evenly, foiling pesky bacteria.
  
  
• 4 days. Eat leftovers within four days. Holiday food kept longer than that should be thrown out. Freeze anything that is not going to be used within four days.

It also is important to keep the fridge at 34 to 40 degrees at all times. Don't forget, while preparing the feast, you probably opened it a lot. The setting may need to be lowered a little at least temporarily.

It is also important during prep time, Stallings tells WebMD, to wash your hands frequently and avoid preparing raw meat on a porous surface, such as a wooden cutting board, that might soak up contaminated juices and transfer them to other foods.

Some Foods Keep Better Than Others

Constance Garrett, RD, MS, MA, nutrition and family consumer science adviser at the University of California Cooperative in San Bernardino, tells WebMD that stuffing doesn't keep well. At the very least, it should be removed from the turkey cavity if some of it was placed there. While inside, the dressing may flavor the turkey -- and be flavored by it -- but it might not get hot enough to thoroughly scourge harmful bacteria.

These days, many people put an onion and herbs inside the turkey and prepare the dressing in a separate pan as a side dish.

Stallings says it's OK to cook the stuffing inside, though, if you use a meat thermometer and make sure the stuffing reaches 165 degrees Fahrenheit.

"People also put a lot of delicate stuff in mashed potatoes at Thanksgiving," Garrett says. "They can be risky to keep unrefrigerated."

Sweet potatoes, however, contain sugar and are also prepared using sugary ingredients (such as those excellent little marshmallows). "Sugar," Garrett notes, "acts as something of a preservative."

What about that creamy greenbean/onion ring casserole? "It only contains three-fourths of a cup of milk," Garrett says, "so it keeps fairly well."

She also recommends that some dishes be prepared ahead, frozen or refrigerated, and then microwaved, giving you another shot at zapping harmful bugs. "This keeps the food safe a little longer."

Aug. 25, 2004 -- The FDA is warning doctors that people using the drug Remicade may face an increased risk of potentially fatal blood or nervous system disorders.

Remicade was approved for the treatment of Crohn's disease in 1998 and for rheumatoid arthritis in 2000. Since then, the manufacturer, Centocor, says it has learned of several reports of blood and nervous system disorders, including some fatal cases, in people taking the drug.

In a warning letter sent to health care providers earlier this month, the company said some Remicade users suffered from a loss of infection-fighting white blood cells, oxygen-carrying red blood cells, and blood-clotting platelets that left them vulnerable to infection or abnormal bleeding, and some of them died. Centocor says, however, that the association between taking the drug and these disorders remains unclear.

The company also warned of rare cases of central nervous system disorders, such as inflammation of the blood vessels, that have been reported in Remicade users.

In response, Centocor and the FDA have revised the warnings and adverse reactions sections of the labeling for Remicade to include information on these possible risks.

What to Do

Officials say people using Remicade should seek immediate medical attention if they develop symptoms of blood disorders or infection while using the drug, such as:

• Persistent fever
• Bruising
• Bleeding
• Paleness

Remicade users are also advised to tell their doctor if they have a disease that affects the nervous system, or if they develop any of the following symptoms:

• Numbness
• Weakness
• Tingling
• Visual disturbances

April 5, 2002 -- Marijuana has been called a "gateway" drug because it's suspected that smoking pot is often the first step toward using stronger, potentially more dangerous substances. And now there's some proof to back up that suspicion.

The research appears in the most recent issue of Drug and Alcohol Dependence.

A Johns Hopkins University team looked at data from the 40,000 people age 21 and younger who took part in the National Household Survey on Drug Abuse. They found that 47% of those who used marijuana had been offered hallucinogenic drugs such as LSD, while only 6% of those who did not smoke pot had been offered hallucinogens. Overall, the pot smokers were at least 16 times more likely than were the nonsmokers to have had an opportunity to try hallucinogenic drugs.

Not only were the pot smokers more likely to get the chance to try the stronger drugs, but "marijuana use is associated with greater likelihood of actual hallucinogen use once an initial hallucinogen exposure opportunity has occurred," the researchers write.

They offer two possible explanations for the findings. First, kids using one drug are more likely to be hanging out with kids using other drugs. And second, once offered, kids who are already experimenting with drugs are more willing than non-users to try another.

The next step, the researchers write, is to clarify why some marijuana users are exposed to hallucinogens while others are not, and "to understand why some marijuana users do not progress [to other drugs] even when they have a chance to do so."

Aug. 6, 2001 -- Justin Washington could literally fit in the palms of his mother's cupped hands when he was born six years ago in a Nashville hospital. Dorenda Washington was one month past the halfway point in her pregnancy when she learned there was nothing more that could be done to stop her baby from coming.

Born at 24 weeks, weighing just 1 pound, 8 ounces, Justin remained in neonatal intensive care for more than four months and had countless surgeries before finally going home with his parents. Today he is a healthy, happy little boy who likes to swim and ride his bike and who wants to be president some day, his mom says. The March of Dimes chose Justin as their 2001 national ambassador to highlight the issue of premature birth, and the Washingtons now travel all over the country to bring attention to the issue.

"We are incredibly lucky," Dorenda Washington tells WebMD. "When they give you the news that your child is going to be born halfway through your pregnancy, and you don't know if he is going to survive, all you can do is pray and rely on the people who are trained to deal with this. They become family."

Aug. 19, 2005 -- New research from India links higher birth weight to leaner adults.

The study was done in India, in a culture quite different from the mainstream U.S. But if the findings check out, it could mean that being born big or becoming big in early childhood predicts adult leanness.

The study appears in The American Journal of Clinical Nutrition. It was led by researchers including Harshpal Sachdev, MD, of the pediatrics department at Maulana Azad Medical College in New Delhi.

Long-Term Study

The study spanned more than 20 years. In the late 1960s and early 1970s, measurements were recorded for more than 2,500 newborns in Delhi, India.

Follow-up was done at six months, one year, and every six months after that until age 14-21 years. More than 1,500 participants got one last check when they were 26-32 years old.

Besides stepping on a scale, their height, hips, waists, and arms were measured. They also got skin-fold tests of their arms and shoulder blade area to measure body fat.

Body mass index (BMI) is a measure used to define overweight and obesity, which uses height and weight measures. Obesity has many health consequences -- including increasing the risk of heart disease and diabetes. However BMI does not distinguish between lean and fat components of body weight, and body composition can vary at any given BMI, the researchers write.

South Asians have a low average BMI but a higher percentage of body fat; they also have more fat located at the belly (central obesity -- a risk for heart disease). The researchers say this may partly explain why this group has a higher risk of developing type 2 diabetes and heart disease -- despite the low average BMI.

They say that weight gain at different periods of early life may have different effects on the acquisition of fat and lean mass. "There is good evidence, for example, that higher birth weight is associated more strongly with adult lean body mass than with adult adiposity (fat tissue)."

A few facts stood out for the 1,500 participants who finished the long-term study:

• Average birth weight was about 6.3 pounds
• More than half were underweight as 2-year-olds
• As adults, 47% were overweight, 11% were obese, and 51% were obese around their midsection

Study's Results

Overall, bigger birth weights were tied to adult leanness. Rising BMI in infancy and early childhood followed the same pattern.

But, BMI gains in late childhood and adolescence forecast adult fatness, the study shows.

In women only, birth weight was linked to adult fat tissue -- but not fat waists, the researchers write.

Window on a Different World

Participants grew up in circumstances unfamiliar to many Americans.

At the study's start, six out of 10 families had a monthly income of more than 50 rupees, compared to the national average of 28 rupees per month. In addition, only 15% of participants' parents were illiterate, compared with India's national average of 66%, at the time.

Still, more than four out of 10 participants grew up in families that lived in only one room. Since the U.S. dollar is (and was) stronger than the Indian rupee, many families lived on a fraction of typical U.S. incomes.

The researchers noted physical activity, smoking, alcohol use, and participants' possessions. Their list of 17 items included electricity, fan, bike, radio, TV antenna, car, computer, air conditioning, and washing machine.

Leaner adult participants had fewer belongings. Those with less than six items had a BMI of 20.5 (low, yet normal weight), compared with a BMI of nearly 27 (indicating overweight) in those owning 15 or 16 possessions.

Jan. 4, 2005 -- Overweight kids have a tough time. Their self-esteem suffers and they can't keep up with the other kids. Yet very often, the pain of childhood obesity goes unnoticed.

A new study adds to growing awareness of this issue. With the ever-increasing childhood obesity problem, more and more kids are suffering emotionally, writes researcher Joanne Williams, PhD, with the Centre for Community Child Health at the Royal Children's Hospital and Murdoch Children's Research Institute in Australia.

A large number of children and adolescents could be experiencing major problems with quality of life due to their weight, Williams adds. Her report appears in the current issue of The Journal of the American Medical Association (JAMA).

Only a few studies have looked at this aspect of childhood obesity. One study published in 2003 showed that overweight kids have similar physical, emotional, and social problems as kids with cancer. However, for overweight kids the problems were often worse. Kids get sympathy when they have cancer -- but not when they're overweight.

In her study, Williams and her colleagues set out to determine just how much childhood obesity and its impact was recognized -- by the kids and their parents.

Childhood Obesity and Self-Esteem

Researchers focused on nearly 1,600 Australian children, 8 to 13 years old. All were growing up in similar homes and neighborhoods, so none was more disadvantaged or well off than anyone else.

The kids each completed detailed surveys. Among the quality-of-life issues covered: Were they happy in school? Did they have friends? Were they involved in games and activities that involved running and jumping? How did they feel about that?

In similar surveys, parents provided their own perspective on their kids' happiness.

Three years later, researchers again checked in on the kids to identify childhood obesity and its impact. At that point, 76% of the kids were normal weight, 20% overweight, and 4% obese.

Overall, overweight kids' perception of their quality of life was much lower than that of normal-weight kids. Obese kids felt their quality of life was even lower. Physical and social functioning were the most severely affected. Emotional and school-related issues were less affected.

July 7, 2004 -- Kids still watch violent TV shows, even when parents try to curb it, new research suggests. It's unsettling news, since aggression has been linked to TV violence.

"According to many studies ... children who are exposed to violent television programming are more likely to be aggressive and to become involved in the juvenile justice system," writes lead researcher Tina L. Cheng, MD, MPH, a pediatrician and adolescent medicine specialist at Children's National Medical Center in Washington, D.C. Her report appears in this month's issue of Pediatrics.

The American Academy of Pediatrics states that the link between media violence and real-life violence is "undeniable and uncontestable," writes Cheng.

To better understand this pattern, Cheng surveyed 677 adults who accompanied children to their pediatrician visits.

She found that 53% of parents always limited their children's viewing of TV violence. However, 73% believed their children -- including their youngest child -- saw "fighting, guns, and other violence on television" at least once a week.

On average, children were watching from two to three hours of TV every day -- although that may be a low estimate, Cheng notes. Studies have shown that parents often underreport the amount of children's TV viewing. Regardless, these studies have all confirmed that children and adolescents have significant exposure to TV.

Media violence is thought to foster antisocial behavior, desensitize viewers to violence, and increase the perception that the world is mean and dangerous, she explains. Few other studies have asked parents about TV monitoring of violent and sexual content. But one large study showed that 61% of families have no rules at all -- and this was for children as young as 8 years old. When children are asked about TV rules at home, the numbers are even lower, studies have shown.

"It's interesting that the majority of parents limit violent television viewing but acknowledge that their children still view television violence," writes Cheng. The kids may be watching at a friend's house, in their own bedrooms. Or it may be that parents have given up on imposing rules -- not seeing TV violence as a negative influence.

More parents should watch TV with their kids, to help enforce rules, she suggests. Also, taking TVs out of children's bedrooms would help. Both dads and moms should be involved in setting rules to reinforce the message against TV violence.

SOURCE: Cheng, T. Pediatrics: July 2004; vol 114: pp 94-99.

Nov. 14, 2003 -- Arsenic in pressure-treated wood -- used in playsets, decks, and picnic tables across the country -- poses an increased risk of cancer to children who play and eat on wood surfaces, a new EPA study shows.

Chromium copper arsenate (CCA) is an arsenic-based preservative used in pressure-treated wood sold at home improvement stores across the country. More than 90% of all outdoors wooden structures in the U.S. is made from arsenic-based treated wood.

The EPA and the wood industry agreed last year to phase out production of this arsenic-based compound and wood treated with it. However, existing structures are still a health concern, the report indicates.

"This study confirms that we need to protect children from arsenic-treated wood at playgrounds and in their backyards across the country," says researcher Jane Houlihan, in a news release. Houlihan is with the nonprofit Environmental Working Group based in Washington, D.C., which prepared the study for the EPA.

The Consumer Product Safety Commission (CPSC), voiced similar concerns.

"We don't want to be alarmist, but we do believe that precautions are in order ... there is reason for concern," says Eric Criss, a spokesman.

The wood industry voluntarily took the action in response to consumer pressure, says Jim Hale, with the Wood Preservative Science Council. "We've never thought that CCA-treated wood posed any health risk to the public or the environment and we maintain that," he tells WebMD.

However, arsenic is a known human carcinogen, and children come into contact with it when they touch the wood. Experts say that children who repeatedly come in contact with the preservative face an increase risk of developing cancer of the lungs, bladder, or skin later in life.

The EPA study shows:

• 90% of all children face a greater than one in one million cancer risk from their exposure to arsenic-treated wood. Historically, that is the EPA's "level of concern."
• In southern states, 10% of all children face a cancer risk that is 100 times higher because they spend more time outdoors playing.

"Parents should watch their children and have them avoid hand-to-mouth contact as much as possible while playing on playgrounds with CCA-pressure treated wood," Criss tells WebMD.

Children should not eat on wood surfaces and should wash their hands after touching the wood, he says.

Whether to breastfeed or formula feed is one of a new mother's earliest and most important decisions. The final choice is always a personal one and not necessarily easy to make.

What should help make your decision easier, however, is knowing that evidence continues to mount suggesting that breast milk as the exclusive source of nutrition for the first six months of life (with continued breastfeeding through the first year of life after the introduction of solid foods) provides substantial benefits to both baby and mother. In fact, the American Academy of Pediatrics (AAP) revised its policy statement regarding breastfeeding in 1997, recommending breast milk as the "preferred feeding for all infants, including premature and sick newborns." If you're still undecided, here's some "food for thought":

Breastfeeding Enhances the Emotional Bond

Breastfeeding right after delivery establishes a powerful emotional bond between mother and baby. The stronger the emotional bond between baby and mother, the more likely the mother will be sensitive and responsive to her baby's behavior. Hundreds of studies show that such a bond helps babies to develop a trusting relationship with mother and to adapt to life outside the womb.

Breastfeeding May Aid Brain Development

Breastmilk is thought to provide the optimal fat source for the development of nerve cells in the brain. Although the differences are small and reasons have not been clearly established, several studies have consistently shown that breastfed babies as a group perform better on standardized tests compared to babies who were not breastfed.

Breastfed Babies Are Healthier

Breastmilk helps build up a baby's immune system. Breastfed babies are far less likely to have ear infections and other respiratory infections. They are also less likely to have a number of other serious conditions throughout life, including:

• blood infections
• meningitis (a potentially life-threatening infection of the brain)
• urinary-tract infections
• intestinal disorders such as diarrhea
• chronic diseases, including diabetes
• allergic conditions such as eczema, asthma and some food allergies

Premature babies, whose immune systems are relatively undeveloped, may especially benefit from breastfeeding.

Moms Benefit, Too

Research has shown that mothers who nurse their infants as recommended by the AAP are less likely to develop premenopausal breast cancer and ovarian cancer, as well as osteoporosis, compared to women who do not breastfeed. Breastfeeding helps with weight loss after pregnancy, when mothers breastfeed exclusively for six months or longer. Mothers who breastfeed longer than six months report greater happiness and emotional security. Because their babies are healthier, working mothers are absent less often from work, are more productive, have reduced health care expenses and report that they experience less stress.

Coping with Obstacles

Anticipating possible problems will help get you and your baby off to a better beginning. For starters, know your hospital's policy regarding breastfeeding and the availability of resources for breastfeeding. Here are some important questions to ask:

• Can your baby room with you or does she have to stay in a group nursery? Research has shown that infants who room with their mothers have less incidence of jaundice and breastfeed more often and for a longer duration.
• Does the hospital assume that it is okay to offer formula to all babies regardless of the mother's wishes? Make sure your hospital knows whether or not you want to breastfeed exclusively.
• What resources can your ob-gyn's office or pediatrician's office provide? Will a lactation consultant be on hand? Will someone be available to answer questions by telephone?

Jan. 13, 2006 -- Dextrose, a type of sugar, could kick athletes' sports performance up a notch, new research shows.

The sweetener was the underdog winner in a recent study of sugar supplements given to college athletes.

The researchers compared dextrose to ribose, another form of sugar. They expected ribose to win. But they were wrong.

The report by Laura Dunne, MD, of Ohio State University's Sports Medicine Center appears in the Clinical Journal of Sport Medicine.

Sugars Square Off

Dunne's eight-week study included 31 women on Ohio State's rowing team.

First, the researchers timed each woman as she rowed about 1.2 miles (2,000 meters).

Next, the women drank beverages made by the researchers before and after every practice for eight weeks. The drinks either contained supplements of dextrose or ribose. The rowers weren't told which drink they got.

Lastly, the researchers timed the rowers again at the end of the study.

Rowers in the dextrose group improved their times by an average of 15.2 seconds. That's 10 seconds faster than the improvement in the ribose group.

Surprising Results

Dunne's team didn't expect to see dextrose in the winner's circle. They quote an article from another sports medicine journal that called ribose a "rising star on the supplement scene."

Michael Mackin, MD, who worked with Dunne on the new dextrose study, commented in a news release.

"After studying previous research, we initially hypothesized that the use of ribose would result in improved rowing times," says Mackin. In fact, dextrose was just used for comparison as a placebo, adds Mackin. He is the chairman of general pediatrics for the Children's Hospital at The Cleveland Clinic.

A mix of varsity and junior rowers took part. Not all finished the study or attended every practice session.

Rowers in both groups were equally exhausted after the time trials and recovered in the same amount of time. Mild stomach discomfort was more common in the dextrose group, the study states.

Athletes' Advantage?

Mackin says the unexpected findings "could impact how people prepare for races in the future."

He adds that the results "could springboard research into the exact amount of sugar required to optimize performance and what amounts can most effectively enhance the performance of athletes competing in different types of events."

When the researchers interviewed some of the rowers after the study, they realized that several had correctly guessed which drink they'd gotten.

That shouldn't have changed the results, write Dunne and colleagues. They argue that those rowers likely viewed ribose as more helpful than dextrose, but dextrose still won at the finish line.

We all know that aerobic exercise, strength training, and nutrition are three components of a balanced fitness regime. But there's another, just as important, component that's often overlooked: stretching.

"It's the one area that is completely being neglected," says Michael Anthony George, a personal trainer to celebrities including Reese Witherspoon and Christian Slater.

Why is flexibility -- the ability to move joints and muscles through their full range of motion - so important?

First off, staying flexible means avoiding injury and pain. Without stretching, tendons, ligaments and muscles will shorten, causing damage over time, says George, owner of Integrated Motivational Fitness.

"If a certain muscle group is weak, stiff, or tight, the body will actually hijack peripheral muscles to aid in that movement," he says. "Over time, these muscles can become injured."

For example, if someone is reaching into the car to pick up groceries and is not strong enough in the abdominals, arms, and legs, "they are going to use their back. If the motion can't come from where it needs to come from, it'll come from somewhere else," says exercise physiologist Robyn Stuhr, administrative director with the Women's Sports Medicine Center at Hospital for Special Surgery in New York.

Aliesa George (no relation to Michael Anthony George), owner of Centerworks Pilates in Wichita, Kan., sees the benefits of improved flexibility in her clients on a daily basis. Staying flexible, she says:

• Counters the shortening that occurs when muscles are repeatedly used -- as in exercise or a repetitive daily activity -- and keeps muscles elastic
• Increases the range of motion in joints
• Decreases joint pain and stress
• Improves balance, stability, and circulation
• Aids athletic performance, relaxation, and posture

In fact, Michael George says poor posture is the No. 1 problem he sees. He uses the term "collapsed thoracic syndrome" to describe the rounded and raised shoulders and tight necks often caused by slumping over a computer monitor for hours at a time,

"It happens gradually and we don't even notice," he says. "One day we look in the mirror and find our shoulders are a little rounded."

Good posture, he says, "prevents injury, speeds recovery, and improves physical appearance." But of all its benefits, a better appearance is the one he stresses to his clients. "People are concerned about body image," he says. "They don't care about injuries until they have them. Out of sight, out of mind."

In a sense, stretching can also help you stay young. "As most people get older, they experience gradual losses in flexibility, partially due to aging and partially due to lack of activity and exercise," Stuhr says.

This not only affects your workouts, but it can also affect the ability to perform daily tasks, like reaching to put away groceries or turning your head to look behind you while driving. The good news is that no matter what your age, you can improve your flexibility and with it, your quality of life.

"It's never too late to increase flexibility," says Aliesa George. "It just takes regular practice."

July 31, 2006 -- Raiding the refrigerator in the wee hours? Your body clock -- which affects patterns of eating and sleeping -- may play a role.

A new study shows that mice learned to expect food at odd hours after snacking when they would normally be sleeping.

And the mice had a hard time breaking the habit.

"Somewhere in the body, they clearly remembered this time of day," says Masashi Yanagisawa, MD, PhD, in a news release from the University of Texas Southwestern Medical Center at Dallas.

Certain body-clock genes in the mice's brains may be part of the reason, the researchers note.

Their study is due to appear in Proceedings of the National Academy of Sciences' Aug. 8 early online edition.

Chow Time

Yanagisawa and colleagues studied two groups of mice.

One group got a restricted amount of food every four hours. The other group got unlimited food around the clock.

All of the mice lived on a 12-hour light-dark cycle. That is, they spent 12 hours in darkness, followed by 12 hours of light, day after day.

Mice normally eat in the dark; they're more comfortable scurrying around under cover of darkness.

But the restricted-food group got some of their chow at an unusual time, in the middle of the light cycle.

That's like eating in the middle of the night for people, the researchers note.

Tinkering With the Body Clock

The mice in the restricted-food group came to expect their unusually timed snack, and it was hard to change their ways.

Those mice became more active during the two hours before their midday snack. Certain body-clock genes in their brains also switched on in sync with the feeding schedule, the study shows.

The pattern was tough to stop. After two days without any food at all, the body-clock genes still turned on in sync with the unusual feeding schedule.

If the findings apply to people, eating late at night might train body-clock genes to expect food at those times.

But because the study was on mice, that's not certain yet.

July 19, 2005 -- A desk job may be good for your wallet, but it could be bad for your waistline, according to new research.

An Australian study shows that men who sit at their desks more than six hours a day are nearly twice as likely to be overweight than those who sit for less than 45 minutes a day on the job. But women may not face the same risks thanks to more time spent on their feet at the office.

Researchers found men sat at their desks an average of 20 minutes longer a day than women, which ended up making a big difference in their risk of being overweight.

Even after adjusting for age, occupation, and time spent physically active outside the office in leisure activities, the study showed that the more time men spent sitting on the job, the more likely they were to be overweight. No such association was found in women.

Researchers say the findings suggest that the workplace may be playing an underappreciated role in fostering the growing problem of overweight and obesity.

Desk Jobs Breed Obesity?

In the study, which appears in the August issue of the American Journal of Preventive Medicine, researchers collected information on more than 1,500 men and women employed in full-time jobs in Australia.

They compared data on body mass index (BMI, a measure of weight in relation to height used to indicate overweight and obesity), sex, occupation, leisure time physical activity, and time spent sitting at work.

The results showed that the workers sat for an average of more than three hours a day at work, with men logging an average of 209 minutes and women logging an average of 189 minutes per day at their desks.

One in four workers spent more than six hours a day chained to their desks, and researchers found several factors were linked to spending more time sitting at the office:

• Men aged 30 or under spent significantly less time sitting at work than older men.
• Male professionals sat more than men employed in white-collar or blue-collar occupations.
• Women who worked in blue collar jobs spent less time sitting on the job than both female professionals and white-collar workers.

Slightly more than 60% of the men and 45% of the women studied were classified as overweight (BMI of 25 to 29.9) or obese (BMI of 30 or higher).

Researchers found a significant relationship between the amount of time spent sitting at work and the risk of being overweight or obese in men, but not in women.

For example, men who spent more than six hours sitting at their desks were nearly twice as likely to be overweight or obese as those who spent less than 45 minutes sitting on the job.

In addition, a higher total daily sitting time was associated with a 68% increase in the odds of being overweight (BMI over 25).

"The current findings present the sedentary workplace as a potentially hostile environment in terms of overweight and obesity," write researcher W. Kerry Mummery, PhD, of Queensland University, and colleagues.

The immediate association between occupational sitting time and overweight and obesity presented here may be a precursor to an association between occupational sitting and chronic disease in the workplace population, they write.

Feb. 15, 2006 -- Risk takers may be less likely to develop Parkinson's disease, according to a new study.

The report, published in the Journal of Neurology, Neurosurgery, and Psychiatry, doesn't encourage anyone to get reckless to prevent the brain disease. It also doesn't blame play-it-safe personalities for Parkinson's.

Instead, the study compares 106 people with Parkinson's with 106 without Parkinson's. There were fewer risk takers among those with Parkinson's disease, the study shows.

The researchers included Andrew Lees, MD, FRCP. Lees works in London at the University College London's Reta Lila Weston Institute of Neurological Studies and the National Hospital for Neurology and Neurosurgery.

Risk Takers, Risk Avoiders

Participants took several psychological tests. The tests gauged anxiety, depression, and impulsiveness in seeking sensations.

People scoring high for impulsive sensation seeking were less likely to have Parkinson's or depression. They were also more likely to be smokers and users of caffeine and alcohol.

Depression has been associated with Parkinson's disease, the researchers note. They add that people who smoke, drink, and use caffeine may be less likely to develop Parkinson's.

Smoking, drinking, and using caffeine didn't explain the results, write Lees and colleagues, who aren't recommending those habits. They caution that their study doesn't prove that risk avoidance causes Parkinson's or that risk tolerance prevents the disease.

In Parkinson's disease, certain brain cells falter in their ability to make dopamine, a brain chemical that helps coordinate the body's movements. As a result, dopamine levels drop.

Low dopamine levels may make people with Parkinson's disease less likely to seek sensations, the researchers write. If so, they're not sure which comes first -- risk avoidance or Parkinson's disease.

July 31, 2003 -- A good support network keeps women healthy and living longer. But a stable marriage seems most important in adding years to her life.

Aging women cope better with life's stresses, have better blood pressure readings, have better immune systems -- better overall health -- when they have a longtime life partner and many friends.

A new study, published in this month's Psychosomatic Medicine, looks at a variety of health and lifestyle factors in 7,524 women, average age 74. Researchers tracked the women for an average of six years, factoring in data from hospital records and death certificates.

They found that women with strong social networks -- and especially married women -- were more likely to still be living and to have less evidence of heart disease. Of the 7,524 women in the study, 1,451 had died -- 215 from heart disease.

Women's health deteriorated when they had fewer social contacts. In fact, isolated women were most likely to die during the study period, reports lead researcher Thomas Rutledge, PhD, a psychologist with the San Diego Healthcare System Medical Center.

This was true even after researchers took into account other risk factors for women's health and longevity, such as chronic illnesses, obesity, smoking habits, and depression, Rutledge points out.

SOURCE: Psychosomatic Medicine, August 2003.

Biofeedback: Sounds like science fiction? It's actually good medicine. Biofeedback is helping many gain control over common health problems like migraines, attention deficit hyperactivity disorder, epilepsy, diabetes, high blood pressure, and incontinence.

In fact, biofeedback is barely considered alternative medicine today, says Steven Baskin, PhD, director of the New England Institute for Behavioral Medicine in Stamford, Conn. Baskin is also president of the Association of Applied Psychophysiology and Biofeedback.

Biofeedback has won approval from a top watchdog group -- the American Health Care Policy Review board, Baskin says. The board conducted an exhaustive review of all reports on biofeedback as treatment for common and difficult-to-treat disorders like epilepsy and migraines.

"That group gave biofeedback a Grade A effectiveness rating, the highest level," Baskin tells WebMD.

What Exactly is Biofeedback?

Biofeedback is a self-training, mind-over-body technique developed in the 1940s. Doing biofeedback has a slightly science fiction feel to it. But it's entirely legitimate, and it works. For example, a migraine sufferer may be able to train her body not to have migraines or to lessen the headaches' severity. Amazing, but true. It's a method in which you consciously control a body function that normally is regulated automatically by the body like skin temperature, heart rate, or blood pressure.

Here's what happens: You wear sensors on your head and elsewhere to let you "hear" or "see" certain bodily functions like pulse, digestion, body temperature, and muscle tension. The squiggly lines and/or beeps on monitors reflect what's going on inside your body. It's similar to watching a heart monitor in action.

Then you learn to control those beeps and squiggles. After a few sessions, there's no need for sensors or monitors. "Your mind trains your biological system to learn the skills," Baskin says.

Biofeedback is not hard to learn, Baskin tells WebMD. People have learned to control blood pressure, brain activity, bowel and bladder problems, digestion, muscle tension, nausea, heart rate, even sweat glands. Among the uses today:

Migraines and other headaches:

Biofeedback has gained widespread acceptance as a treatment for migraines. By learning biofeedback, migraine sufferers can short-circuit migraines and other headaches, or at least reduce the pain, Baskin tells WebMD. The trick may be by increasing blood flow to the hands. That diverts the excess blood flow from the head, which may contribute to the headaches.

Tension headaches, caused by tightened head muscles, also quiet down when biofeedback is used to relax those muscles, he adds.

"In times of high stress, or when they have a feeling of a headache coming on, hand warming and relaxation will decrease the eventuality of having a headache -- or at least one that's not as severe," says Baskin.

Studies show that a combination of medication and biofeedback has greater effect than either treatment alone, he says. Also, recent data have shown that long-term relief for migraine sufferers is better with biofeedback. In that study, a group trained in biofeedback had much lower recurrences of migraines, fewer hospitalizations, and lower cost of treatment since they could cut back on medications.

ADHD:

Neurofeedback is a form of biofeedback that is being used to treat children with ADHD. "In the last five to 10 years, data is beginning to emerge showing this to be a very promising new treatment," Baskin tells WebMD. "I think it's going to gradually become the standard of care for ADD and ADHD. Training sessions are getting shorter, equipment is getting better, and combined with very good therapy, the data [on effectiveness] is looking very good."

One study found an improvement in impulsiveness, inattention and functioning in school after 40 neurofeedback sessions combined with teaching strategies.

"Biofeedback can not only help a child use brainwaves they don't usually employ, but it may also help increase blood flow to specific parts of the brain involved with ADHD," said Joel Lubar, PhD, a psychologist at the University of Tennessee, Knoxville, in a previous interview. Lubar developed the ADHD treatment in the 1970s.

"Used with behavior therapies that incorporate classroom and homework skills, neurofeedback can help these children become less dependent on stimulants like Ritalin," Lubar told WebMD.

Mental Illness:

Biofeedback is also being used to help treat depression, addiction, bipolar disorder, and schizophrenia.

July 19, 2006 -- Taking certain migraine drugs with some types of antidepressants may create a life-threatening condition, the FDA warns.

The FDA's warning, issued today, focuses on migraine medications called triptans when taken together with selective serotonin reuptake inhibitors (SSRIs), or with serotonin and norepinephrine reuptake inhibitors (SNRIs).

SSRIs and SNRIs are used to treat depressiondepression and mood disorders. SSRIs include Zoloft, Paxil, Celexa, and Prozac. SNRIs include Cymbalta and Effexor.

"A life-threatening condition called serotonin syndrome may occur when triptans are used together with an SSRI or a SNRI," states an FDA news release.

Serotonin syndrome occurs when the body has too much serotonin, a chemical found in the nervous system. Triptans, SSRIs, and SNRIs all raise serotonin levels.

Symptoms

Symptoms of serotonin syndrome may include restlessness, hallucinations, loss of coordination, fast heartbeat, rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrheadiarrhea.

Patients taking a triptan along with an SSRI or SNRI should talk to a doctor before stopping their medication, and immediately seek medical attention if they experience any possible symptoms of serotonin syndrome, says the FDA.

The FDA also urges doctors who prescribe triptans, SSRIs, or SNRIs to remember that patients may have prescriptions from other doctors and talk to their patients about the possibility of serotonin syndrome if triptans are taken with SSRIs or SNRIs.

Doctors should work with patients to weigh the risks of taking triptans with SSRIs or SNRIs and closely follow patients taking those drug combinations, says the FDA.

The FDA has also asked all makers of triptans, SSRIs, and SNRIs to update their prescribing information to warn of the possibility of serotonin syndrome when these medications are taken together.

Important
It is possible that the main title of the report Waldenstrom's Macroglobulinemia is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

• Hyperglobulinemic Purpura
• Macroglobulinemia
• Waldenstroem's Macroglobulinemia
• Waldenstrom's Purpura
• Waldenstrom's Syndrome

Disorder Subdivisions

• None

General Discussion

Waldenstrom's macroglobulinemia (WMG) is a malignant disorder of the blood, closely related to lymphoma and characterized by the presence of abnormally large numbers of a particular kind of white blood cell known as B lymphocytes. As these cells accumulate in the body, excessive quantities of an antibody known as IgM are produced. This causes the blood to become thick (hyperviscosity) and affects the flow of blood through the smaller blood vessels, leading to the symptoms of the disorder. The organs fed by these small blood vessels do not receive sufficient blood and oxygen, potentially resulting in partial or complete failure of the organ.

Resources

American Cancer Society, Inc.
1599 Clifton Road NE
Atlanta, GA 30329
USA
Tel: 4043203333
Tel: 8002272345
Internet: http://www.cancer.org

NIH/National Heart, Lung and Blood Institute
31 Center Drive MSC 2480
Building 31A Rm 4A16
Bethesda, MD 20892-2480
Tel: (301)592-8573
Fax: (240)629-3246
Email: nhlbiinfo@rover.nhlbi.nih.gov
Internet: http://www.nhlbi.nih.gov/

International Waldenstrom's Macroglobulinemia Foundation
3932D Swift Road
Sarasota, FL 34231
USA
Tel: 9419274963
Fax: 9419274467
Email: info@iwmf.com
Internet: http://www.iwmf.com