Arthritis: Environmental Exposure to Hairspray, Lipstick, Pollution, Can Trigger Autoimmune Diseases

The links between autoimmune diseases, infections, genetics and the environment are complex and mysterious. Why are people who live near airports more susceptible to autoimmune diseases like rheumatoid arthritis and lupus? How do hormones in meat trigger the onset of a disease?

Our immediate environment interacts with our genetic programming and can determine if we will succumb to an autoimmune disease, says rheumatologist Prof. Michael Ehrenfeld of Tel Aviv University's Sackler School of Medicine, who is seeking to unravel those mysteries. Prof. Ehrenfeld recently published a report in Autoimmune Reviews on how "Spondylo-arthropathies," a group of common inflammatory rheumatic disorders, appear to be triggered by environmental factors. He has also done research on how the dry-eye and mouth disease "Sjögren's syndrome" can be triggered by environmental influences.

Minimizing the risks

"The onset of autoimmune diseases is a mixture of genetics, which you can't change, and environmental factors, which in some cases you can," says Prof. Ehrenfeld. While he cites pollution as a trigger in many autoimmune disorders, "there are some environmental factors harder to avoid. For example, reactive arthritis is caused by a severe gastro-intestinal, urinary or sexual infection in some people," he says.

Afflicting more than 2 million Americans, rheumatoid arthritis is a chronic inflammatory autoimmune disease, three times more prevalent in women than men. The disorder causes the body's own immune system to attack its joints, leading to pain, deformities and a substantial loss of mobility.

It is still impossible to tell which genes encode this disease and make some people more susceptible to autoimmune diseases, but there are some basic behaviors that may keep these disorders at bay. One root cause of arthritis is extreme stress, says Prof. Ehrenfeld, for which there are already therapeutic strategies. And some medications, such as the birth control pills, might be linked in some cases to the onset of lupus.

"You won't know if taking the pill or getting a certain virus will trigger arthritis, because we don't yet know the genes that encode the various autoimmune diseases," he says. "Obviously those people whose family members share a history of rheumatoid arthritis, or other autoimmune diseases including thyroid problems, should be more vigilant, because their chances are higher."

Triggers include hairspray and lipstick

Environmental pollution is also a cause for concern to those genetically predisposed to an autoimmune disease. Second-hand smoke, food chemicals or chemicals in the air, jet fuel fumes, UV exposure and other forms of environmental pollution are amongst the triggers considered to provoke the onset of autoimmune diseases.

Industrial regions, particularly in Northern Europe and North America, still exhibit the highest rates of most autoimmune diseases. But on a much more local scale, Prof. Ehrenfeld also singles out hairspray as well as lipstick as known occasional triggers.

"Most people think arthritis has to do with old age," says Prof. Ehrenfeld. "This is false. There is only one major type of arthritis in older people: osteoarthritis, which is brought on by degenerative changes in the body. What you see in older adults is usually a non-inflammatory and non-autoimmune type of arthritis.

"Most of the other kinds of arthritis we see in the clinic, the debilitating and inflammatory types, usually occur in young women between the ages of 20 and 40," Prof. Ehrenfeld says. "We hope that our research will lessen the occurrence and onset of these painful disorders."

One in five U.S. teenagers has high cholesterol

The national study covered 3,125 young people, whose blood test results were collected by the National Health and Nutrition Examination Survey from 1999 to 2006. The data included measurements of Low Density Lipoprotein (LDL or “bad” cholesterol), High Density Lipoprotein (HDL or “good” cholesterol), and triglycerides.

In adults, high cholesterol is a major risk factor for heart disease because LDL cholesterol and triglycerides can clog the arteries. It is also associated with high blood pressure, strokes and diabetes. Unhealthy levels were at first associated with the middle-aged and elderly, but are increasingly beginning to appear in late childhood and the teenage years.

The study found 20.3% of the subjects, aged 12 to 19, had at least one abnormal cholesterol or lipid level, with more boys than girls affected (24% to 16%). High levels of LDL or triglycerides, and low HDL levels were associated with weight, and the heavier the teenagers were, the more likely they were to have abnormal levels (42.9% if they were obese), but even among those with normal body weight 14.2% had unhealthy levels. About one-third of the young people were overweight or obese, and would therefore be eligible for cholesterol screening on this basis.

Leader of the study, Dr Ashleigh May, an epidemic intelligence service officer with CDC, described the results as “very concerning” and said that a large proportion of the young people had at least one abnormal level. May said they wanted to ensure doctors recommend lipid screening and lifestyle changes for young people, especially if they were overweight or obese. The study backs up a recommendation made by the American Academy of Pediatrics in 2008 that children and adolescents should have blood tests if they are overweight, smoke, have high blood pressure, or if there is a family history of elevated cholesterol levels. The guidelines were controversial at the time because they recommended cholesterol-lowering drug treatments for children as young as eight (two years younger than previously recommended).

May emphasized that the best ways to reduce the risk of heart disease in the future was for young people to be active and to follow a healthy eating regime.

Radiation Offers New Cures, and Ways to Do Harm

As Scott Jerome-Parks lay dying, he clung to this wish: that his fatal radiation overdose — which left him deaf, struggling to see, unable to swallow, burned, with his teeth falling out, with ulcers in his mouth and throat, nauseated, in severe pain and finally unable to breathe — be studied and talked about publicly so that others might not have to live his nightmare.
Sensing death was near, Mr. Jerome-Parks summoned his family for a final Christmas. His friends sent two buckets of sand from the beach where they had played as children so he could touch it, feel it and remember better days.

Mr. Jerome-Parks died several weeks later in 2007. He was 43.

A New York City hospital treating him for tongue cancer had failed to detect a computer error that directed a linear accelerator to blast his brain stem and neck with errant beams of radiation. Not once, but on three consecutive days.

Soon after the accident, at St. Vincent’s Hospital in Manhattan, state health officials cautioned hospitals to be extra careful with linear accelerators, machines that generate beams of high-energy radiation.

But on the day of the warning, at the State University of New York Downstate Medical Center in Brooklyn, a 32-year-old breast cancer patient named Alexandra Jn-Charles absorbed the first of 27 days of radiation overdoses, each three times the prescribed amount. A linear accelerator with a missing filter would burn a hole in her chest, leaving a gaping wound so painful that this mother of two young children considered suicide.

Ms. Jn-Charles and Mr. Jerome-Parks died a month apart. Both experienced the wonders and the brutality of radiation. It helped diagnose and treat their disease. It also inflicted unspeakable pain.

Yet while Mr. Jerome-Parks had hoped that others might learn from his misfortune, the details of his case — and Ms. Jn-Charles’s — have until now been shielded from public view by the government, doctors and the hospital.

Americans today receive far more medical radiation than ever before. The average lifetime dose of diagnostic radiation has increased sevenfold since 1980, and more than half of all cancer patients receive radiation therapy. Without a doubt, radiation saves countless lives, and serious accidents are rare.

But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry. To better understand those risks, The New York Times examined thousands of pages of public and private records and interviewed physicians, medical physicists, researchers and government regulators.

The Times found that while this new technology allows doctors to more accurately attack tumors and reduce certain mistakes, its complexity has created new avenues for error — through software flaws, faulty programming, poor safety procedures or inadequate staffing and training. When those errors occur, they can be crippling.

“Linear accelerators and treatment planning are enormously more complex than 20 years ago,” said Dr. Howard I. Amols, chief of clinical physics at Memorial Sloan-Kettering Cancer Center in New York. But hospitals, he said, are often too trusting of the new computer systems and software, relying on them as if they had been tested over time, when in fact they have not.

Regulators and researchers can only guess how often radiotherapy accidents occur. With no single agency overseeing medical radiation, there is no central clearinghouse of cases. Accidents are chronically underreported, records show, and some states do not require that they be reported at all.

In June, The Times reported that a Philadelphia hospital gave the wrong radiation dose to more than 90 patients with prostate cancer — and then kept quiet about it. In 2005, a Florida hospital disclosed that 77 brain cancer patients had received 50 percent more radiation than prescribed because one of the most powerful — and supposedly precise — linear accelerators had been programmed incorrectly for nearly a year.

Antioxidants aren't always good for you and can impair muscle function, study shows

Antioxidants increasingly have been praised for their benefits against disease and aging, but recent studies at Kansas State University show that they also can cause harm.

Researchers in K-State's Cardiorespiratory Exercise Laboratory have been studying how to improve oxygen delivery to the skeletal muscle during physical activity by using antioxidants, which are nutrients in foods that can prevent or slow the oxidative damage to the body. Their findings show that sometimes antioxidants can impair muscle function.

"Antioxidant is one of those buzz words right now," said Steven Copp, a doctoral student in anatomy and physiology from Manhattan and a researcher in the lab. "Walking around grocery stores you see things advertised that are loaded with antioxidants. I think what a lot of people don't realize is that the antioxidant and pro-oxidant balance is really delicate. One of the things we've seen in our research is that you can't just give a larger dose of antioxidants and presume that there will be some sort of beneficial effect. In fact, you can actually make a problem worse."

David C. Poole and Timothy I. Musch, K-State professors from both the departments of kinesiology and anatomy and physiology, direct the Cardiorespiratory Exercise Laboratory, located in the College of Veterinary Medicine complex. Researchers in the lab study the physiology of physical activity in health and disease through animal models. Copp and Daniel Hirai, an anatomy and physiology doctoral student from Manhattan working in the lab, have conducted various studies associated with how muscles control blood flow and the effects of different doses and types of antioxidants.

Abnormalities in the circulatory system, such as those that result from aging or a disease like chronic heart failure, can impair oxygen delivery to the skeletal muscle and increase fatigability during physical activity, Copp said. The researchers are studying the effects antioxidants could have in the process.

"If you have a person trying to recover from a heart attack and you put them in cardiac rehab, when they walk on a treadmill they might say it's difficult," Poole said. "Their muscles get sore and stiff. We try to understand why the blood cells aren't flowing properly and why they can't get oxygen to the muscles, as happens in healthy individuals."

Copp said there is a potential for antioxidants to reverse or partially reverse some of those changes that result from aging or disease. However, K-State's studies have shown that some of the oxidants in our body, such as hydrogen peroxide, are helpful to increase blood flow.

"We're now learning that if antioxidant therapy takes away hydrogen peroxide – or other naturally occurring vasodilators, which are compounds that help open blood vessels – you impair the body's ability to deliver oxygen to the muscle so that it doesn't work properly," Poole said.

Poole said antioxidants are largely thought to produce better health, but their studies have shown that antioxidants can actually suppress key signaling mechanisms that are necessary for muscle to function effectively.

"It's really a cautionary note that before we start recommending people get more antioxidants, we need to understand more about how they function in physiological systems and circumstances like exercise," Poole said.

Hirai said the researchers will continue to explore antioxidants and the effects of exercise training. Their studies are looking at how these can help individuals combat the decreased mobility and muscle function that comes with advancing age and diseases like heart failure.

"The research we do here is very mechanistic in nature, and down the road our aim is to take our findings and make recommendations for diseased and aging populations," Copp said.

Low-carb diet best for lowering blood pressure

NEW YORK (Reuters Health) - People with high blood pressure who want to drop some pounds may want to choose a low-carb diet, a new study shows.

Health

In the study, overweight or obese individuals who went on a low-carb diet lost about the same amount of weight as those who cut down on their fat intake and took the weight-loss aid orlistat (sold as Xenical or Alli). However, the low-carb diet produced more favorable effects on blood pressure.

Most studies of weight loss methods have enrolled overweight or obese volunteers who were healthy, aside from weighing too much. The current study, in contrast, enrolled "real patients" with common conditions like diabetes and heart disease, William S. Yancy Jr. of the VA Medical Center in Durham, North Carolina, told Reuters Health. People with these health issues are often excluded from weight loss studies, Yancy said.

He and his colleagues assigned 146 patients to either receive instruction on eating a low-carbohydrate diet, and to start out by eating fewer than 20 grams of carbohydrate daily, or to take 120 mg of orlistat three times a day and receive instructions on eating a lower calorie, lower-fat diet. All of the study participants received diet instructions at group meetings, which were every two weeks for the first six months of the study, and monthly thereafter.

After 48 weeks, the low-carb group had lost about 9.5 percent of their body weight, compared to 8.5 percent for the orlistat group, which wasn't a significant difference. There also were similar improvements in cholesterol levels between the two groups. But the low carb diet did offer an advantage in terms of blood pressure reduction.

The low-carb group showed about a 6 percent drop in their systolic blood pressure (the top number in a blood pressure reading) and a 4.5 point drop in their diastolic pressure (the lower number). In contrast, the orlistat group did not see a drop in blood pressure; the corresponding changes for the orlistat group were 1.5 (systolic) and 0.4 (diastolic).

The two "fairly powerful weight loss treatments were equally effective, and one of them was more effective for lowering high blood pressure," Yancy said.

Orlistat works by blocking the body's absorption of fat from food so people who use the drug need to cut down on their fat intake or risk unpleasant side effects like gas and even incontinence.

Patients using orlistat in the current study were more likely to report gas, bowel incontinence, and diarrhea than those in the low-carb group. However, only one person stopped taking the drug due to these side effects. "Orlistat can work quite well if it's used correctly," Yancy said.

The group meetings for diet advice were a key element of success, Yancy added, with those who came to 80 percent or more of these visits losing an average of 14 percent to 15 percent of their body weight.

"I don't think that too many insurance (policies) would cover this," he said, "but I think it's something that needs to happen."

Don’t forget to eat your greens

The age old reminder to always eat your greens isn’t just for kids anymore.

Not only are the vitamins and minerals good for you, but eating greens could also save your life, according to a recent study invoving scientists from Lawrence Livermore National Laboratory (LLNL).

LLNL researchers Graham Bench and Ken Turteltaub found that giving someone a small dose of chlorophyll (Chla) or chlorophyllin (CHL) — found in green leafy vegetables such as spinach, broccoli and kale — could reverse the effects of aflatoxin poisoning.

Aflatoxin is a potent, naturally occurring carcinogenic mycotoxin that is associated with the growth of two types of mold: Aspergillus flavus and Aspergillus parasiticus. Food and food crops most prone to aflatoxin contamination include corn and corn products, cottonseed, peanuts and peanut products, tree nuts and milk.

Bench and Turteltaub, working with colleagues from Oregon State University and an industry partner, Cephalon Inc., found that greens have chemopreventive potential.

Aflatoxins can invade the food supply at anytime during production, processing, transport and storage. Evidence of acute aflatoxicosis in humans has been reported primarily in developing countries lacking the resources to effectively screen aflatoxin contamination from the food supply. Because aflatoxins, particularly aflatoxin B1 (AFB1), are potent carcinogens in some animals, there is interest in the effects of long-term exposure to low levels of these important mycotoxins on humans.

The study used AMS to provide aflatoxin pharmacokinetic parameters previously unavailable for humans, and suggest that chlorophyll and chlorophyllin co-consumption may limit the bioavailability of ingested aflatoxin in humans, as they do in animal models, according to Bench.

Exposure to environmental carcinogens has been estimated to contribute to a majority of human cancers, especially through lifestyle factors related to tobacco use and diet. Notable examples are the tobacco-related carcinogens; heterocyclic amines produced from sustained, high-temperature cooking of meats; and the fungal food contaminants aflatoxins.

The team initially gave each of three volunteers a small dose of carbon 14 labeled aflatoxin (less than the amount that would be found in a peanut butter sandwich.) In subsequent experiments the patients were given a small amount of Chla or CHL concomitantly with the same dose of carbon 14 labeled aflatoxin.

By using LLNL’s Center for Accelerator Mass Spectrometry, the team was able to measure the amount of aflatoxin in each volunteer after each dosing regimen and determine whether the Chla or CHL reduced the amount of aflatoxin absorbed into the volunteers.

“The Chla and CHL treatment each significantly reduced aflatoxin absorption and bioavailability,” Bench said.

“What makes this study unique among prevention trials is, that we were able to administer a microdose of radio-labeled aflatoxin to assess the actions of the carcinogen directly in people. There was no extrapolation from animal models which often are wrong,” Turteltaub said.

The research, which is co-funded by the National Institutes of Health’s National Resource for Biomedical Accelerator Mass Spectrometry, appeared in the December issue of the journal, Cancer Prevention Research.

Founded in 1952, Lawrence Livermore National Laboratory is a national security laboratory, with a mission to ensure national security and apply science and technology to the important issues of our time. Lawrence Livermore National Laboratory is managed by Lawrence Livermore National Security, LLC for the U.S. Department of Energy's National Nuclear Security Administration.

Stain repellent chemical linked to thyroid disease in adults

A study by the University of Exeter and the Peninsula Medical School for the first time links thyroid disease with human exposure to perfluorooctanoic acid (PFOA). PFOA is a persistent organic chemical used in industrial and consumer goods including nonstick cookware and stain- and water-resistant coatings for carpets and fabrics.

Published in the journal Environmental Health Perspectives, The study revealed that people with higher concentrations of PFOA in their blood have higher rates of thyroid disease. The researchers analysed samples from the US Centers for Disease Control and Prevention's nationally representative National Health and Nutrition Examination Survey (NHANES).

Tamara Galloway, a professor Ecotoxicology at the University of Exeter and the study's senior author, says: "Our results highlight a real need for further research into the human health effects of low-level exposures to environmental chemicals like PFOA that are ubiquitous in the environment and in people's homes. We need to know what they are doing."

"There have long been suspicions that PFOA concentrations might be linked to changes in thyroid hormone levels," adds study author, David Melzer, a professor of Epidemiology and Public Health at the Peninsula Medical School. "Our analysis shows that in the 'ordinary' adult population there is a solid statistical link between higher concentrations of PFOA in blood and thyroid disease."

PFOA is a very stable man-made chemical that excels at repelling heat, water, grease, and stains. It is used during the process of making common household and industrial items including nonstick pots and pans, flame-resistant and waterproof clothing, wire coatings, and chemical-resistant tubing. PFOA can also be formed by the break-down of certain other highly fluorinated chemicals used in oil and grease-resistant coatings on fast-food containers and wrappers and in stain-resistant carpets, fabrics, and paints.

The study included 3966 adults aged 20 and older whose blood serum was sampled between 1999 and 2006 for PFOA and other perfluoroalkyl acid (PFAA) compounds, including perfluoroctane sulphonate (PFOS). The researchers found that the individuals with the highest 25% of PFOA concentrations (above 5.7ng/ml) were more than twice as likely to report current thyroid disease than individuals with the lowest 50% of PFOA concentrations (below 4.0ng/ml). The most specific analysis included 163 women and 46 men who reported having current thyroid disease and who were taking thyroid medication at the time the blood samples were taken. The models used in the analysis were adjusted for potential confounding factors, such as age, gender, ethnicity, smoking, and body mass index.

Previous animal studies carried out by other scientists have shown that the compounds can affect the function of the mammalian thyroid hormone system. This is essential for maintaining heart rate, regulating body temperature and supporting many other body functions, including metabolism, reproduction, digestion and mental health.

The findings are important because research has shown that PFAAs are found in water, air and soil throughout the world, even in remote polar regions. PFOA and PFOS have also been detected in the blood of people from across the globe, as well as in wildlife including birds, fish, and polar bears.

The main source of human exposure to PFOA and PFOS remains uncertain but is believed to be through diet. However, people may also be exposed through the PFAAs used in consumer goods such as textiles, footwear, furniture, and carpets, which can contaminate indoor air and dust.

Although more research is needed to understand the mechanism by which PFOA and PFOS may affect human thyroid functioning, it is plausible that the compounds could disrupt binding of thyroid hormones in the blood or alter their metabolism in the liver. However, this new evidence does not rule out the possibility that having thyroid disease changes the way the body handles PFOA and/or PFOS. The presence of the compounds might also prove to be simply a marker for some other factor associated with thyroid disease.

Thyroid diseases, particularly hypothyroidism, are much more common in women than men. However, in terms of the link between PFOA and thyroid disease, the researchers found no evidence of a statistically different effect between the sexes. The researchers also found a link between thyroid disease and higher concentrations of PFOS in men, but not in women.

Although previous studies of people living in communities near where PFOA and PFOS are manufactured did not find an association between exposure to these chemicals and thyroid hormone functioning, the largest study of such exposed communities is currently underway. (The 'C8' study of communities near DuPont's Washington Works plant, including Marietta, OH, and Parkersburg, WV, both in the US).

Physical exercise helps brains grow, mouse study finds

Fresh research may help explain why regular exercise can improve brain power, say Cambridge scientists.

The report, which was published in the Proceedings of the National Academy of Sciences, found mice which exercised performed better on memory tests.

These mice also grew more new cells in a part of the brain linked to memory than those which did not exercise.

The authors believe the new brain cells were behind the improvement in cognitive performance.

The aim of the study, which was carried out by scientists from the Department of Experimental Psychology at the University of Cambridge and researchers at the National Institute on Aging in Baltimore, was to find out why exercise might improve brain function.

Previous research had suggested that exercise helps mental performance in both people and animals. Studies had also shown that exercise increases the number of new brain cells in rodents.

Unlimited action

The new finding in this study is that mice which exercise are better able to distinguish between memories of similar things. The authors believe this is explained by the additional brain cells generated by exercise.

The study was conducted on two groups of mice over a period of 105 days. The mice were trained to touch a box on a computer screen to get food pellets.

One group were then allowed unlimited access to an exercise wheel. They ran over 20km (12 miles) a day on average. The control group were not able to exercise.

Both groups were then repeatedly shown two boxes on a screen, one of which provided a treat when it was touched.

The mice learned which box released the treat, and then the boxes were moved around. First the boxes were moved close together, which made it harder for the mice to remember which one to touch to get the food.

The exercising mice did better on this task than the non-exercising mice.

Similar memories

The task was then made easier by placing the boxes further apart so that they seemed more distinct. This time there was no difference in the performance of the exercising and non-exercising mice.


a valuable contribution in understanding the effects of exercise on brain health and function.

Stan Colcombe, Bangor University
"Keeping similar memories distinct is an important part of having a good memory" says the senior author of the study, Timothy Bussey from Cambridge University.

"It is this aspect of memory that is improved by exercise, our study shows.

"The human equivalent might be remembering which car parking space you have used on two different days in the previous week. It becomes difficult to distinguish memories when events are similar."

By the end of the experiment, the animals which exercised had more than twice as many new brain cells as those that did not.

These cells were in the hippocampus, an area of the brain which is important in memory and learning.

The Cambridge team believes the results of their study may well extrapolate to humans, a view shared by another researcher who studies the impact of exercise on memory.

Stan Colcombe, from Bangor University, said: "Their data strongly suggest that new neurons created after exercise can play a role in improving cognitive function, which likely has direct implications for human research into the effects of exercise on neurocognition."

He described the research as "a very elegant experiment" which "made a valuable contribution in understanding the effects of exercise on brain health and function".

Weak evidence of benefit for scoliosis bracing

NEW YORK (Reuters Health) - The use of braces to correct excessive curvature of the spine (scoliosis) in adolescents is a subject of ongoing debate and a new review of the medical literature does little to resolve the matter.

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Although there is some evidence that adolescents with scoliosis may benefit from wearing hard or elastic braces to correct spinal curvature, research thus far has failed to prove definitively that bracing works, the investigators conclude.

The evidence for bracing is weak, as is the evidence of any long-term benefits of bracing, Dr. Stefano Negrini of the Italian Scientific Spine Institute of Milan, Italy, and colleagues report in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
Negrini and his team searched the medical literature for studies comparing braces with no treatment, other treatment, surgery, and different types of braces. From a pool of 1,285 titles, the researchers read 128 full texts, and found only 2 that fit their criteria.

One study involved 286 girls; some wore a brace, some received electrical stimulation, and some received no treatment at all, for up to 4 years.

This study found evidence that bracing was more effective than observation (wait-and-see) or electrical stimulation. At three years, the success rates were 80 percent for bracing, 46 percent for observation and 39 percent for electrical stimulation. At four years, the success rates were 74 percent, 34 percent and 33 percent, respectively. However, over the long term, formerly braced patients reverted back to their pre-treatment curvatures.

The other study compared the efficacy of rigid versus elastic braces in 43 girls over 45 months. This study found evidence that rigid braces were more effective than elastic braces.

However, both studies, the researchers emphasize, constituted very "low quality evidence" in favor of using braces.

Despite the lack of strong evidence, Negrini told the Health Behavior News Service, that his clinic often prescribes braces in conjunction with exercises for patients with scoliosis.

"We are aware of the very good results it is possible to obtain with high-quality bracing and making sure there is good patient compliance with wearing the brace," Negrini said.

Dr. John Dormans, chief of orthopedic surgery at the Children's Hospital of Philadelphia and president of the Pediatric Orthopedic Society of North America, also favors bracing.

"If you polled the orthopedists who treat the vast majority of patients with adolescent idiopathic scoliosis, the overwhelming opinion would be that bracing is effective, that it does alter the natural history of the disease," Dormans said.

But getting teenagers to wear the brace for an adequate number of hours each day is a big issue. "The efficacy of bracing depends on two main factors: efficacy of the brace itself and compliance," Negrini wrote in an email to Reuters Health.

Questions about the effectiveness of bracing for adolescent scoliosis might soon be answered by more definitive research: a five-year, multimillion-dollar study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases is currently under way.

SOURCE: The Cochrane Library, 2010.

Dangers Of Spinal Surgery

'The drill slipped and my life changed completely'
GEORGINA ROBINSON
January 25, 2010

HELEN KERNER trusted her "nice, clean-cut" neurosurgeon when he said he had performed the delicate spinal operation she required 1500 times before.

The 60-year-old was confused when she woke up incontinent, still in pain, with no feeling in her legs or pelvis, and upset when he tried to discharge her from hospital two days into recovery.

But when Suresh Surendranath Nair confessed that his "drill slipped" during the procedure, severing several nerves in her spine, Ms Kerner said she felt sorry for the doctor, who was then 38.


"I felt like 'my goodness me, he must be feeling awful for what he's done'," Ms Kerner said. "But not now, not now, I'm pretty angry now."

The Health Care Complaints Commission is reportedly reviewing all surgery performed at Nepean Public Hospital under the direction of Dr Nair, 41, who faces drugs charges following the death in November of a 22-year-old student in his $1.7 million apartment.

Sydney West Area Health Service has admitted a breach of duty of care in Ms Kerner's case.

Another neurosurgeon described the procedure, performed in 2006, as a standard operation and said Dr Nair's mistake was ''usually so rare as to be virtually unheard of''.

The Malaysian-born, Australian-trained surgeon's registration had been suspended in 2004, after an appearance before the NSW Medical Board's Impaired Registrants Panel.

He was suspended again in 2008 and on November 26 last year, following his arrest.

Ms Kerner, a former relief manager at Anglicare second-hand shops, said she did not know Dr Nair had been suspended when she was referred to him in 2006. "I had very bad back pain, sciatic pain, and all the doctor had to do was remove a bone spur away from the nerve, just grind it away from the nerve," Ms Kerner said. "The drill slipped … and my life changed, completely changed.''

Sydney West Area Health Service would not comment.

Dr Nair's solicitor, Mitchell Cavanagh, said he was not aware of the case and had not yet been able to discuss it with his client.

Ms Kerner, formerly a keen dancer and gardener, now uses walking sticks because she cannot feel her left leg and her foot is deformed. She is bowel and bladder incontinent, has lost all sexual function and lives with constant, severe pain in her legs and feet, according to a statement of claim filed in the NSW Supreme Court.

"I'm very depressed. I wake up in the morning crying sometimes … I'm very embarrassed to go out because of things that happen,'' she said. "That's my life now. I don't have one."

Ms Kerner said she knew something was wrong as soon as she woke up. "I spoke to Dr Nair the next morning and he didn't tell me he slipped with the drill … He told me [he] stretched one of the nerves and it had to be repaired," she said.

"He said within three months it should heal itself and I believed him because he's my doctor."

Her confusion was compounded when Dr Nair tried to have her discharged from hospital two days after the procedure, before she had been seen by an continence adviser or physiotherapist.

It was not until Ms Kerner noticed the word "severed" written on her observation chart that she pressed for answers.

At a meeting Ms Kerner said she attended with her then partner, the hospital's nursing manager and a clinical liaison officer, Dr Nair confessed his mistake.

"I said, 'But you didn't tell me that before' and he said, 'Yes I did' … " she said.

At a second meeting attended, according to Ms Kerner, by her continence adviser and a friend, two hospital administrators told her she could sue for negligence.

Legal proceedings began in November 2008 and Sydney West Area Health Services wrote to Ms Kerner's solicitor on November 3 last year, admitting a breach of duty of care.

"As far as I'm concerned the hospital should have got rid of him at the start, in 2004," Ms Kerner said. "If he was gone I wouldn't be like this."

Dr Nair has been in police custody since January 9 after he breached his bail conditions, which prohibited him from hiring prostitutes or taking illicit drugs. He is due in court on March 1.

The State Coroner is also investigating the death of an escort, Victoria McIntyre, whose body was found in Dr Nair's apartment last February.

A NSW Supreme Court hearing in July will determine what compensation and damages NSW Health must pay Ms Kerner.

7 Steps for a Healthy Heart

Jan. 20, 2010 -- The American Heart Association has identified seven "simple" steps you can take for a healthy heart. But the road to better cardiovascular health will take some work.

“Life’s Simple 7” categorizes cardiovascular health as Poor, Intermediate, or Ideal in each of seven areas.

Published in Circulation: Journal of the American Heart Association, the AHA says ideal cardiovascular health for adults is defined by these health measures:

Never smoked or quit more than a year ago.
A healthy body mass index (BMI), an estimate of body fat determined by a formula using weight and height.
Physical activity, and the more the better. The new measure says at least 150 minutes per week of moderate-intensity exercise is necessary for ideal health, or 75 minutes weekly of vigorous physical activity.
Blood pressure below 120/80.
Fasting blood glucose less than 100 milligrams/deciliter, a fasting measure of blood sugar level.
Total cholesterol of less than 200 milligrams/deciliter.
Eating a healthy diet. Four to five of the key components of a healthy diet are followed. For a 2,000-calorie diet, these include:
At least 4.5 cups of fruits and vegetables per day
At least two 3.5 oz. servings of fish per week, preferably oily fish
At least three 1-ounce servings of fiber-rich whole grains per day
Limiting sodium to less than 1,500 milligrams a day
Drinking no more than 36 ounces weekly of sugar-sweetened beverages

The AHA hopes the seven factors could improve the cardiovascular health of Americans by 20% by the year 2020, and also reduce deaths from cardiovascular-related diseases and strokes by 20%.

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New Resource for Heart Health
The AHA says its goals represent the first time it has adopted better health as a principal goal and that it has developed a new online resource, “My Life Check,” at www.heart.org/MyLifeCheck. By completing the assessment, people can determine what they need to do to achieve better cardiovascular health.

“To date, there has been great success in reducing disability and death from heart disease and stroke, in part through aggressive improvements in the diagnosis and treatment of these diseases and in limited uptake of measures to prevent heart disease and stroke,” Clyde W. Yancy, MD, president of the American Heart Association, says in the news release. “We achieved our 2010 goal of reducing death by heart disease and stroke by 25%, earlier and by a wider margin than we had targeted.”

Still, he says, too many people “continue to have unrelenting exposure to known important risk factors for heart disease and stroke to the point that we are likely to begin seeing an increase in these diseases, and at an earlier age.”

That, he says, is cause for alarm and a trend that needs to be stopped.