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The bill would authorize $2.065 billion for FY2008, $2.313 billion for FY2009, $2.602 billion for FY2010, $2.940 billion for FY2011, and $3.337 billion FY2012 for the Community Health Centers Program within the Public Health Service and would reauthorize Rural Health Care Programs at $45 million annually from FY2008-2012.

Among other provisions, the bill would require the United States comptroller general to study the cost effectiveness and impact of establishing school-based health centers. S. 901 also would require the secretary of Health and Human Services to study health care quality in community health centers and identify strategies, technical assistance, and partnerships with federal agencies, private organizations, or networks that may help to improve health care quality in such centers.

Swedish Study

The British Medical Journal (BMJ) has highlighted a Swedish study that reported increased sexual activity among 70 year-olds:

Discussion

Abstract
Introduction
Methods
Results
Discussion
References

Self reported sexual activity among married and unmarried 70 year olds in Gothenburg, Sweden increased from 1971 to 2001. At the same time among elderly people attitudes to sexuality became more positive, and the proportion reporting a very happy relationship increased. Furthermore, the proportion reporting high satisfaction with sexual activity and that sexuality was an important factor in life increased, whereas those with sexual dysfunctions (erectile dysfunction among men, orgasmic dysfunction in women) decreased. Consistent with population studies of younger samples of later born cohorts the median age of sexual debut decreased and the proportion that had their sexual debut before age 20 increased. The one year prevalence of intercourse in the two earliest birth cohorts was similar to that among septuagenarians reported from studies in the 1950s and 1980s. The prevalence in the two younger birth cohorts is similar to a European study in 2001-2 and a US study in 2005-6.

The main reason for men to cease intercourse was self reported as personal reasons, mirroring reports by women that the reason for cessation of intercourse was due to their partner. Whether elderly couples continue to be sexually active seems to a large extent to be determined by men. This pattern, which did not change over time, was also reported in studies in the 1950s and in 2005-6.

In agreement with previous reports self reported sexual activity was more common in men, regardless of marital status. Differences between the sexes in self reported sexual behaviour, however, decreased from 1971 to 2001 among the 70 year olds in our study. Overall, men reported an earlier age of sexual debut and a higher proportion of premarital sex than women in the 1970s, but this sex difference diminished among those in later born samples. Recent studies on adolescents report that women experience first sexual intercourse at a younger age than men. Finally, whereas 70 year old men in the 1970s more often reported positive attitudes to sexuality than women, there were no sex differences in attitudes in 2000-1. Thus attitudes to sexuality cannot entirely explain observed differences between the sexes in sexual activity. Women were less likely to be married or in other intimate relationships than men, as reported by others. As in other studies, the proportion of elderly people reporting sexual activity was higher among married participants than among unmarried participants, especially in women. Sexual activity was reportedly rare among unmarried women in the 1970s.

Read the entire article at the BMJ site

Article

Ferida Wolff, Getting Goopy: I know this emotional irritability is part of the menopausal profile but it doesn’t make it pleasant. It requires too much energy. And yet …

Contagion

From Harvard University's Library Open Collection Program Contagion: Historical Views of Diseases and Epidemics is a digital library collection that brings a unique set of resources from Harvard’s libraries to Internet users everywhere. Offering valuable insights to students of the history of medicine and to researchers seeking an historical context for current epidemiology, the collection contributes to the understanding of the global, social – history, and public – policy implications of disease. Contagion is also a unique social-history resource for students of many ages and disciplines. These materials include digitized copies of books, serials, pamphlets, incunabula, and manuscripts — a total of more than 500,000 pages — many of which contain visual materials, such as plates, engravings, maps, charts, broadsides, and other illustrations. The collection also includes two unique sets of visual materials from the Center for the History of Medicine at Harvard’s Francis A. Countway Library of Medicine. Library materials and archival materials are supplemented by explanatory pages that introduce concepts related to diseases and epidemics, historical approaches to medicine, and notable men and women.Some of the epidemics covered are: Tuberculosis in Europe and North America, 1800–1922; Tropical Diseases and the Construction of the Panama Canal, 1904–1914; Spanish Influenza in North America, 1918–1919; The Boston Smallpox Epidemic, 1721 and “Pestilence” and the Printed Books of the Late 15th Century

NEJM Editorial

Planning for the Future — Long-Term Care and the 2008 Election

Long-term care has all the makings of a great campaign issue. It affects a large portion of the population, it is expensive (it currently accounts for about 10% of all health care costs), and it requires a unique partnership between government and citizens. Moreover, a range of constituencies perceive the current long-term care system as seriously broken. It exposes people who need services to considerable financial risk, and it too often relies on an institutional model of care that is at odds with consumer preferences.

Nonetheless, the candidates in the 2008 presidential race have been virtually silent about long-term care policy. Health care received substantial attention during the 35 Democratic and Republican debates (garnering more than 1000 mentions), but almost nothing has been said about long-term care. Not a single major debate question has focused specifically on the topic, and it has been mentioned by candidates in response to other questions only 11 times. Nor has long-term care received much attention on the campaign trail. Only one candidate, Senator Hillary Clinton, has delivered a speech on the topic and proposed a detailed agenda for the future. Candidates have backed broadly appealing goals such as improving the quality of care in nursing homes, reducing hassles with companies that offer insurance for long-term care, and more frequently providing long-term care at home or in the community. There has not, however, been a serious discussion about a reformed vision for long-term care in this country — in particular, how it will be financed.

Read the rest of the free editorial, Planning for the Future — Long-Term Care and the 2008 Election, at the New England Journal of Medicine site.

The Bathtub Collection

The National Library of Medicine introduces us to a little-known aspect of its history:

"The Bathtub Collection consists of fragments found in the old and rare bindings of the NLM rare book collection when items were rebound and conserved in the 1940s and 1950s. It is called the Bathtub Collection because then-curator Dorothy Schullian took the leftovers of conservation work home and soaked them in her bathtub to retrieve the often interesting bits and pieces of medieval manuscripts and early printed ephemera she found.

"The story of the 'Bathtub Collection' begins in the middle of the last century. In the 1940's, The Army Medical Library, as the National Library of Medicine was then known, began a serious conservation program for its rare book collection. The AML hired Dorothy Schullian as curator of rare books and Jean Eschman, a master bookbinder from Switzerland. "Eschman repaired many of the old bindings and, when he considered them beyond repair, replaced them with new leather covers. Some of the old bindings were kept but many of them were discarded as worthless. Conservation practices have changed since then, and conservators are now much more cautious about replacing original bindings and never discard them.

"Dorothy M. Schullian was a Classics scholar with a doctorate in Latin from University of Chicago. She taught at Western Reserve and Albion College in Michigan before joining the National Library of Medicine staff in 1944 as curator of the rare book collection. She was a learned and meticulous scholar, with knowledge of a wide range of subjects as well as medical history. Her chief legacies are A Catalogue of Incunabula and Manuscripts in the Army Medical Library, published in 1950 - and the Bathtub Collection. "Though she did not consider many of the intact bindings worth preserving, she was aware of the interest and value of the materials from which they were made. When the books were rebound in the bindery, instead of discarding the old covers, Dr. Schullian, took them home, soaked them in her bathtub to loosen the paste and separate the layers of paper or parchment, hung them up to dry, and placed them in envelopes, labeled with information about the volume from which they were removed. The History of Medicine Division staff came to refer to them as the 'Bathtub Collection', both a tribute to Dr. Schullian's labors and a mark of affection for this eccentric assemblage."

Browse the Little Treasures from the Bathtub as well as Other Treasures.

Sick Around the World

Frontline, PBS' investigative unit, is presenting a program hosted by reporter T.R. Reid, Sick Around the World. The following is posted with a few changes, from the site:The program reveals remarkable differences in how these countries handle health care — from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.Reid's first stop is the UK turns up remarkable differences in how these countries handle health care — from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.In the UK, the National Health Service is funded through taxes. According to Whittington Hospital CEO David Sloman, "Every single person who's born in the UK will use the NHS ... and none of them will be presented a bill at any point during that time." Reid is surprised to find the system often dismissed as "socialized medicine." The UK is now trying free-market tactics like "pay-for-performance," where some doctors are paid more if they get good results controlling chronic diseases like diabetes, and patient choice, in which hospitals compete head to head. While such initiatives have helped reduce waiting times for elective surgeries, the London Times' medical correspondent Nigel Hawkes tells Reid the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."Reid reports next from Japan, the world's second largest economy and the country boasting the best health statistics. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRIs, use more drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States. Reid finds out the secrets of the nation's success: By law, everyone must buy health insurance — either through an employer or a community plan — and unlike in the US, insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit. Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, M.D., a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy. It is ... highly accepted by the population." As they do in Japan, medical providers must charge standard prices which are negotiated with the government every year. As a consequence, physicians in Germany earn between half and two-thirds as much as their U.S. counterparts. Taiwan researched many health care systems before settling on one where the government runs the financing, but Reid finds the delivery of health care is left to the market. Taiwanese health care offers medical, dental, mental and Chinese medicine, with no waiting time and for less that half of what we pay in the United States. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But what Reid finds is that the Taiwanese spend too little to sustain their health care system. According to Princeton's Tsung-Mei Cheng, who advised the Taiwanese government, "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers."Reid's final destination is Switzerland, a country whose health care system suffered from some America's problems until, in 1994, the country attempted a major reform. Despite a huge private insurance business, a law called LAMal was passed, which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. Today, Swiss politicians from the political right and left enthusiastically support universal health care. Pascal Couchepin, the president of the Swiss Federation, argues: "Everybody has a right to health care. ... It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."Go to the Frontline site for videos, show dates and a discussion time.

Health Risks of Long-Term Combination Hormone Therapy Updated

 "The good news is that after women stop taking combination hormone therapy, their risk of heart disease appears to decrease," noted Elizabeth G. Nabel, M.D., NHLBI director. "However, these findings also indicate that women who take estrogen plus progestin continue to be at increased risk of breast cancer, even years after stopping therapy.  Today's report confirms the study's primary conclusion that combination hormone therapy should not be used to prevent disease in healthy, postmenopausal women." The FDA recommends that hormone therapy never be used to prevent heart disease, and, when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible.  The new findings are from a follow-up study of 15,730 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment, who participated in the WHI estrogen-plus-progestin clinical trial. Participants were randomly assigned to receive a combination of estrogen (0.625 milligrams of conjugated equine estrogens per day) plus progestin (2.5 mg of medroxyprogesterone acetate) or placebo (inactive pill). The main estrogen-plus-progestin study was stopped in 2002 after an average of 5.6 years of treatment due to an increase in breast cancer. Women on combination hormone therapy were also at increased risk of stroke, blood clots, and heart disease, while their risk of colorectal cancer and hip fractures was lower, compared to women who did not take hormone therapy.

Read the rest of the NIH release of the study of 15,730 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment, who participated in the WHI estrogen-plus-progestin clinical trial.

ScienceTaking it in Stride

A team of Canadian researchers have come up with almost unique device: "We have developed a biomechanical energy harvester that generates electricity during human walking with little extra effort. Unlike conventional human-powered generators that use positive muscle work, our technology assists muscles in performing negative work, analogous to regenerative braking in hybrid cars, where energy normally dissipated during braking drives a generator instead. The energy harvester mounts at the knee and selectively engages power generation at the end of the swing phase, thus assisting deceleration of the joint. Test subjects walking with one device on each leg produced an average of 5 watts of electricity, which is about 10 times that of shoe-mounted devices. The cost of harvesting-the additional metabolic power required to produce 1 watt of electricity-is less than one-eighth of that for conventional human power generation. Producing substantial electricity with little extra effort makes this method well-suited for charging powered prosthetic limbs and other portable medical devices." The above is a summary of article in the journal Science. Below is a release generated by Simon Fraser University in British Colombia:

Sport

Excerpt: Your Brain on Cubs
Inside the Heads of Players and Fans

Edited by Dan Gordon

From Chapter One: "A fan's dedication to a chronically losing baseball team involves a number of social-cognitive processes that allow him to accept his fate. ... In the case of a losing team, a fan has to be prepared to delay gratification for years, decades, and occasionally a century (the latter case involves handing down the delayed gratification to subsequent generation of family fans, entrusting them to appreciate the long road to the ultimate victory).... There is some evidence that being in the majority (everyone loves a winner) reduces reflective thinking, whereas being in the minority (rooting for a loser) increases reflection.  Perhaps that reflection is rewarding in itself and helps motivate fans to root for a losing team (in that sense it is the chase that is important rather than the ultimate victory). ... Sitting with friends at the game, hearing or discussing the game with the fans around you, or listening to it on the radio or watching it on TV allows for bonding with others.  Such bonding activates the septum and the subgenual prefrontal cortex, which then release chemicals such as oxytocin that signal the degree of pleasure of the bonding.... The prefrontal cortex is also an essential brain region for mediating our notion of self.  For example, watching a baseball team play may activate memories of playing baseball in our youth.  Neuroscientists have identified so-called mirror neurons in our brain that are activated whether we engage in playing a sport or watch others play.From Chapter Two:Your child likes to play and is happy with her teammates. But will her talent last more than a season?.... This tension between what kids are born with and what they gain from practice is at the core of understanding what it takes to become an expert.  It is also at the center of understanding how neuroscientists approach the question of defining what the brain of an expert looks like and how it might function differently compared to the merely competent .... expertise is explained in part by higher cortical efficiency.  The expert uses much less brain activity to do the practiced activity.  The implication is that many years of practice may lead to a neural network that is efficient at using the fewest numbers of synapses to get a behavior accomplished... Even though developing expertise requires lots of practice, does extensive practice guarantee that one will become an expert? Not necessarily... The consequences of smart practice compared to exercise alone are beginning to be found in the br ain.... There is emerging evidence that too much thinking during practice can actually interfere with learning motor skills that are better left to unconscious control. From Chapter Three:Here we view the batter-pitcher dual from the point of view of the neural networks involved in making the motor program that enable the batter to swing the bat.  We show that there is more to hitting a baseball than meets the eye... In fact, deciding and planning begin even before the ball leaves the pitcher's hand... What is the nature of the information that the batter uses to make decision about swinging his bat? Recent research emphasizes that athletes in fast-ball sports anticipate where the ball will be based on kinematically relevant source of information.  In baseball, this information is gathered before the ball is thrown: a batter may note the movements the pitcher makes during windup, remember his past experiences with this pitcher, and pick up clues from watching the pitcher face previous batters.  A clear relationship exists between the skill level of the batter and the type of information that is extracted in this pre-swing period.... On order to successfully hit the pitched ball, the hitter's brain must be involved in two tasks: (1) preparing the neuronal program for the movement involved in swinging the bat and (2) interpreting the movement of the pitcher in order to predict where the pitched ball will go.  Although it is quite likely that these two tasks occur simultaneously, we will describe what is know about them separately.  Modern methods of brain imaging, particularly functional magnetic resonance imaging (fMRI), have made it possible to peer inside an athlete's brain while he is preparing to swing a bat.Read all the excerpts from The Dana Foundation site

FDA's Warning about Bisphosphonates

FDA informed healthcare professionals and patients of the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates. Although severe musculoskeletal pain is included in the prescribing information for all bisphosphonates, the association between bisphosphonates and severe musculoskeletal pain may be overlooked by healthcare professionals, delaying diagnosis, prolonging pain and/or impairment, and necessitating the use of analgesics. The severe musculoskeletal pain may occur within days, months, or years after starting a bisphosphonates. Some patients have reported complete relief of symptoms after discontinuing the bisphosphonate, whereas others have reported slow or incomplete resolution. The risk factors for and incidence of severe musculoskeletal pain associated with bisphosphonates are unknown. Read the warning at the FDA site Editor's Note: These drugs are marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa

The View from the Other Side — Patients, Doctors, and the Power of a Camera

This is part of a Perspective published by the New England Journal of Medicine. The videos are revealing, disturbing and ultimately instructive. By the time Galen Buckwalter's physician knocked on the exam-room door, Buckwalter's video camera had been recording for nearly 40 minutes. He had booked the appointment because his shoulders were hurting, and the camera recorded his view of the examination table, the comments he made while waiting and, eventually, a largely transactional and superficial exchange with his physician. Two weeks later, in his home, the camera would record a strikingly different take on his shoulder pain — a growing problem that, Buckwalter worried aloud, might cost him even more of his cherished independence. As an internist, I was disturbed by the contrast between those two scenes, the second revealing the depth of Buckwalter's concerns and fears, none of which were apparent during the conversation with his doctor. In the later tape, Buckwalter's struggle is palpable. If such stark contrasts are common, how much do I really know about my own patients? Probably far less than I care to admit. Buckwalter's videotaping of his appointment was part of a project I'd begun 9 months earlier (see video at www.nejm.org). The goal was to understand the experience of being in a wheelchair, with the help of a video camera — an approach influenced by my previous career in documentary filmmaking and by research disciplines including participant-action research, narrative medicine, and ethnography. I have spent 10 years giving cameras to participants and have learned much from the projects. The recorded images were often unsteady and out of focus, but the content — representing participants' own views of their experience, not mine — consistently proved interesting. I learned that participants generally need more than a few days or weeks with a video camera to record their experiences adequately; the unfurling of one's life requires time. But the results are rich; film is a medium conducive to exploring the smallest details that make up a life. These details are often overlooked, or missed, in clinical research conducted in more traditional ways. As nuances of a patient's experience are compressed into standardized responses, statistical power is achieved, but depth is lost. What could videotape show about experiences of disability that hadn't already been said eloquently in the medical literature documenting inequities faced by the disabled or in memoirs and films about being disabled? Perhaps a first-person perspective, recorded from the wheelchair, would reveal a world rarely seen by most nondisabled persons. Buckwalter had been the first to volunteer for the project, followed by Vicki Elman and Ernie Wallengren. All lived in the Los Angeles area and had heard about the project through the UCLA medical community. Buckwalter used a wheelchair as a result of a cervical spinal cord injury, Elman because of multiple sclerosis, and Wallengren because of amyotrophic lateral sclerosis.

Screening Beyond 70

Medpage covering the San Antonio Breast Cancer Symposium Meeting:Women who are 70 or older remain in the prime of life for screening mammography, researchers reported here. A majority of breast masses and calcifications in patients 70 and older were identified by screening versus diagnostic mammography, Neely Hines, M.D., of Albert Einstein College of Medicine in New York, said at the San Antonio Breast Cancer Symposium. The American Cancer Society recommends that women continue screening mammography as long as they remain in good health. As life expectancy continues to increase, so will the number of women at risk for breast cancer. The CDC estimates that 70-year-old women of any race have 15.9 more years of life expectancy. "We believe that continuation of annual screening mammography beyond the age of 70 years will identify clinically occult and earlier-stage cancers that can be successfully treated and possibly prolong survival," said Dr. Hines. "Our results suggest that screening mammography is beneficial in diagnosing cancers in this population, which represents a growing proportion of the population and has an increased risk of developing breast cancer," said Dr. Hines. "We think older patients and their physicians should request screening mammography." Read the rest of the MedPage article.

Do Mandrakes Really Scream?
Magic and Medicine in Harry Potter

The National Library of Medicine has closely examined some of the myths, potions and herbology cited in Harry Potter and the Philosopher's Stone. "There is more to the Harry Potter series than a child hero or a fantasy adventure — many of the characters, plants, and creatures in Rowling’s stories are based in history, medicine, or magical lore. Death, evil, illness, and injury affect the characters of Harry Potter’s imaginary world. In describing their experiences, Ms. Rowling has drawn on important works of alchemy and herbology. These works and other links to Harry Potter books are examined in this exhibition.""The world of Harry Potter is filled with many magical creatures, including hippogriffs, nifflers, thestrals, phoenixes, dragons, and unicorns. Hogwarts students learn about these creatures in the Care of Magical Creatures class, helped along by their magical biting textbook.""In Harry Potter and the Philosopher's Stone, Nicholas Flamel is featured as the creator of the "Philosopher's Stone." Because this stone allows its owner to live forever, it must be protected from falling into the hands of the evil Lord Voldemort. "Although Harry Potter is fictional, Frenchman Nicolas Flamel lived during the late 14th and early 15th centuries. A scholar and scribe, Flamel devoted his life to understanding the text of a mysterious book filled with encoded alchemical symbols that some believed held the secrets of the Philosopher's Stone."Many myths surround Flamel, including the belief that he successfully created the Stone. His death in 1417 didn’t hurt that myth, and his quest for the Philosopher's Stone lives on in his writings. Although modern scholarship has cast doubt on the authenticity of alchemical texts ascribed to him, he remains an important figure in the alchemical world."

Physicians, Patients and Consulting

Biomet is a manufacturer and designer of products for hip, knee, shoulder and elbow replacements, as well as other small joint replacements. The company is one of five that reached a deferred prosecution agreement with the US Attorney in New Jersey. The others include DePuy Orthopaedics, Inc., a Johnson & Johnson company; Smith & Nephew plc; Stryker Corp; and Zimmer, Inc all of whom have posted payments to medical consultants on their websites.

Cancer and Disclosure

From the abstract of an free text article entitled Social Constraints on Disclosure and Adjustment to Cancer from Blackwell Synergy: This article introduces the concept of social constraints on disclosure, puts it in a theoretical framework, and examines how it can affect adjustment to major life stressors using the exemplar of cancer. Cancer is a leading cause of death and disability worldwide. It is often life threatening, disfiguring, and unpredictable; hence, it can undermine people's basic and often positive beliefs and expectations about themselves, their future, and social relationships. For many people with cancer, it is important to come to terms psychologically with the illness — to make sense of or somehow accept the reality of it. People often do this by thinking about different aspects of the disease and its implications for their life, but also through socially processing, or talking about, their cancer-related thoughts, feelings, and concerns with others. When people experience social constraints on their disclosure of cancer-related thoughts and feelings, it can adversely affect how they think and talk about their illness, their coping behaviors, and psychological adjustment. In addition to discussing mechanisms and consequences of social constraints on disclosure, we discuss some of its determinants and future research directions.

You seldom listen to me, and when you do you don't hear, and when you do hear you hear wrong, and even when you hear right you change it so fast that it's never the same.

— Marjorie Kellogg, 1922–2005. In one study, investigators examined social constraints in communication between recently diagnosed lung cancer patients and their spouse (Badr & Carmack Taylor, 2006). The investigators found that slightly over a third of the sample reported avoiding or having difficulties talking about the cancer in general, and two thirds of the spouses had difficulties or avoided discussing prognosis, death, or funeral arrangements, ostensibly for fear of upsetting the patient. Some patients reported that their partner's denial and avoidance was distressing, made them change how they interacted with the partner, and strained the marital relationship. The investigators also found evidence that social constraints can change over time, perhaps as the ‘reality’ of cancer sets in and denial abates. For example, one female patient reported: ‘[My husband] told me the other day he just didn't realize about what's going on with me, how hard that is, because initially, he just kind of really shut down and didn't do very much at all ... he was sorry he wasn't there for me at the beginning. And I understood’ (p. 677).The entire article, Social Constraints on Disclosure and Adjustment to Cancer, is available.

A Reminder: FDA's MedWatch

The FDA has a program that contains safety information and an email adverse event reporting program that can be subscribed to. For instance, we received this notice:FDA informed healthcare professionals and consumers of the seizure of 12,682 applicator tubes of Age Intervention Eyelash, sold and distributed by Jan Marini Skin Research, Inc. of San Jose, California. The product was seized because it may lead to decreased vision in some users. The eyelash product is an unapproved and misbranded drug because it is promoted to increase eyelash growth. Before a new drug product may legally be marketed, it must be shown to be safe and effective, and approved by FDA. FDA considers the product to be an adulterated cosmetic because it contains bimatoprost, an active ingredient in an FDA-approved drug to treat elevated intraocular pressure (elevated pressure inside the eye). Use of the prescription drug in addition to the eyelash product containing the drug, may increase the risk of optic nerve damage because the extra dose of bimatoprost may decrease the prescription drug's effectiveness. Damage to the optic nerve may lead to deceased vision and possibly blindness. Other possible adverse events may include macular edema (swelling of the retina) and uveitis (inflammation in the eye) which may lead to decreased vision.

Dermatologists, estheticians, and consumers who may still have Age Intervention Eyelash should discontinue use and discard any remaining product. Consumers should also consult their healthcare professional if they have experienced any adverse events that they suspect are related to use of the product.

Read the complete 2007 MedWatch safety summary including a link to the FDA News Release regarding this issue at: 

http://www.fda.gov/medwatch/safety/2007/safety07.htm#Eyelash

Describing Dizziness

A Mayo Clinic Proceeding covers an always involving subject:

Dizziness: How Do Patients Describe Dizziness and How Do Emergency Physicians Use These Descriptions for Diagnosis?

“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean — neither more nor less.” “The question is,” said Alice, “whether you can make words mean so many different things.”

Lewis Carroll, Through the Looking Glass

Physicians are taught repeatedly throughout their training that the clinical history is the single most important source of information on which to build a diagnosis. However, few studies systematically analyze the utility of aspects of history taking and of the reliability of patient descriptions. The importance of this issue cannot be overemphasized because symptoms are why patients visit physicians. New or serious symptoms often drive patients to overcrowded emergency departments (EDs).

Feelings of dizziness, vertigo, and imbalance can be extremely unpleasant and frightening, especially if they occur suddenly. We all derive security from the feeling that terra firma is firmly placed beneath us, and when we think it is not we often panic. Dizziness and vertigo are among the most common symptoms of patients who come to EDs and physicians offices. In this edition of Mayo Clinic Proceedings, 2 systematic studies (1) how well patients describe dizziness in the ED and (2) how physicians use these descriptions to formulate diagnoses.

Read the free article at the Mayo Clinic Proceedings site

70-Year-Old Women & Breast Cancer Screening

MedPage Today has published this article on an Australian study:

Given Risk-Benefit Data, Women Age 70 Opt for Routine Mammography

Seventy-year-old women resoundingly endorsed yearly mammography, rejecting the minuses that were pointed out of them, found investigators here.

New Link

StarDate.org: Every weekend on NPR, we listen to another segment from StarDate, a public education and outreach arm of the University of Texas McDonald Observatory. Radio programs are presented in both English and Spanish. The resources page includes links to all things starry, solar, spacey and universal as well as to astronomers and observatories. Another resource page offers lists of books and software. Sky Almanac and Weekly Tips are for up-to-date stargazing information. We also noted a page containing information on the radio voice of StarDate, Sandy Wood.

Eyes, Bones, The Brain and Beyond

From the Nutrition Action Health Letter's The Greens Party:

As you age, your eyes age. The older lens no longer adjusts as well to see accurately at different distances, and the older pupil no longer dilates as much to let light reach the retina. An 80-year-old retina receives one-sixth the light of a 20-year-old retina in a well-lit room and one-sixteenth as much light in a darker room. Worse yet, the older eye is more vulnerable to cataracts (clouded lens) and macular degeneration (deterioration of the center of the retina, or macula). Macular degeneration is the leading cause of blindness in people over the age of 60.

On the bright side, two carotenoid pigments in leafy greens — lutein and zeaxanthin — may help protect both the lens and the retina.“Leafy greens are incredibly high in lutein and zeaxanthin, so just one or two servings a week places people in the highest intakes,” says Julie Mares of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. Researchers got interested in the two carotenoids in part because both concentrate in the eye. “The macular pigment is composed of lutein and zeaxanthin,” says Mares. “The concentration in the macula is 100-fold higher than in the blood.”

What’s more, she adds, “they’re the only carotenoids that accumulate in the lens, though the level in the lens is much lower than in the macula.” How might lutein and zeaxanthin protect the eye? "In both the lens and the retina, we suspect that they act as antioxidants that scavenge marauding oxygen molecules called free radicals,” says Mares.“In the retina, we think that they also act as a filter that absorbs short wavelength — or blue — light, which is toxic to the retina.”

Read the rest of the article, The Greens Party, by Bonnie Liebman, which also covers Bones and The Brain and Beyond at the Nutrition Action Newsletter site

The Bees and Colony Collapse Disorder

Although we've been caught up with global warming for the last decade, we admit that hearing about the disappearance of bee colonies was of more immediate concern. Even though we haven't sighted a melting iceberg in recent memory, we do notice a honey bee in this northern California gentle climate quite frequently and we would notice its decline almost immediately. For more information, consult the Colony Collapse Disorder Working Group But first, consult A Buzz About Bees, 400 Years of Beekeeping at Cornell's Mann Library:

The Life of the Bee, by Maurice Maeterlinck, 1911, London No other book on bees has enjoyed the popularity of Maeterlinck's The Life of the Bee. Originally published in 1901, it was the work of Maurice Maeterlinck, a distinguished Belgian playwright and poet awarded the Nobel Prize for Literature in 1911. In this philosophical work, Maeterlinck, a beekeeper since his youth, adorned his knowledge of bees to draw analogies between their activities and human behavior. The addition of the vivid illustrations by the famed English book illustrator, Edward J. Detmold, in 1911, undoubtedly contributed to the book's great popularity.

Articles

Read Betty Soldz's Outsmarting Forgetfulness — Strategies helpful to keep your memory sharp and Mental Illness, Undiagnosed and Untreated in Many Older AmericansRead the guidelines for nursing homes testing at the Centers for Medicare & Medicaid Services site. Our Resident Observer and caregiver, Julia Sneden has written a series on caregiving:The Slippery Slope, Part One
The Slippery Slope, Part Two
The Slippery Slope, Part Three Liz Flaherty—Smoke Free: Eight Days and Five Minutes But Who's Counting' - Easy, providing the comparison has to do with bamboo under fingernails & breech birth without drugs

Fitness Articles

"Men like to have shoulders that are big and thickly layered with muscle, and men have much more shoulder strength than women. For both genders, the shoulders perform some of the work of lifting, but a woman's strength rapidly begins to diminish as soon as her arms are lifting at shoulder height or above. She relies more on her chest for lifting and doing heavy work, and once her arms are out of the ideal position for the chest muscles to do the work, her power drops very sharply. Weightlifting will improve her power, of course, but the shoulders are never a woman's strong point." Shoulders: Strength and Grace"Every hero has a great chest, and when people want to boost their own appearance or behave with confidence, they lift the chin and thrust out the chest, a sign of confidence. We associate the chest with courage, high spiritedness, and even self-sacrifice. The chest, after all, guards the heart. Behind that wall of muscular strength, the repository of our love and tenderness lies quietly beating, protected and hidden." Of Heroes, Grandmothers, and Good Chest MusclesA Suggestion: Print Jeri's articles and pin them up by your exercise area.

Additional articles: The Mouse and the Martial Artist & Stepping Up With Jeanne