Definition
Bipolar disorder is characterized by periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.
Alternative Names
Manic depression; Bipolar affective disorder
Causes, Incidence, and Risk factors
Bipolar disorder results from disturbances in the areas of the brain that regulate mood. During manic periods, a person with bipolar disorder may be overly impulsive and energetic, with an exaggerated sense of self. The depressed phase brings overwhelming feelings of anxiety, low self-worth, and suicidal thoughts.
There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. (In the past, bipolar disorder I was called manic depression.)
People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.
A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.
Bipolar disorder affects men and women equally and usually appears between the ages of 15 and 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.
Symptoms
The manic phase may last from days to months and include the following symptoms:
Elevated mood,Racing thoughts, Hyperactivity Increased energy, Lack of self-control,Inflated self-esteem (delusions of grandeur, false beliefs in special abilities),Over-involvement in activities,Reckless behavior, Spending sprees, Binge eating, drinking, and/or drug use Sexual promiscuity, Impaired judgment,Tendency to be easily distracted, Little need for sleep,Easily agitated or irritated,Poor temper control.These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.
The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:
Persistent sadness,Fatigue or listlessness,Sleep disturbances,Excessive sleepiness,Inability to sleep,Eating disturbances,Loss of appetite and weight loss,Overeating and weight gain,Loss of self-esteem,Feelings of worthlessness, hopelessness and/or guilt,Difficulty concentrating, remembering, or making decisions ,Withdrawal from friends,Withdrawal from activities that were once enjoyed,Persistent thoughts of death,There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.
Signs and tests
A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:
Observe your behavior and mood,Obtain your medical history, including any medical problems you have and any medications you take,Ask about your recent mood swings and how long you've experienced them,Ask about your family medical history, particularly whether anyone has or had bipolar disorder,Perform a thorough examination to identify or rule out physical causes for the symptoms,Request laboratory tests to check for thyroid problems or drug levels,Speak with your family members to discuss their observations about your behaviorNote: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.
Treatment
Bipolar disorder is often treated with mood-stabilizing medications such as valproic acid, lithium, and carbamazepine. These are effective for treating both the manic and depressive phases, as well as preventing future symptoms.
Antidepressant drugs may be useful during the depressive phase IF the antidepressants are used with a mood stabilizer. Mood stabilizers are very important in people with bipolar disorder. Without a mood stabilizer, antidepressants may trigger mania in people with bipolar disorder. (Keep in mind that people with bipolar disorder II may be misdiagnosed with depression only because they do not experience full-fledged mania. If these patients take antidepressants without mood stabilizers, it can trigger a manic episode.)
Anti-psychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.
Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.
Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.
Expectations (prognosis)
Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.
Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.
Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.
Complications
Stopping or improperly taking medication can lead to symptoms coming back and the following complications:
Alcohol and/or drug abuse may be used as a strategy to "self-medicate."Personal relationships, work, and finances may suffer as a result of mood swings. Suicidal thoughts and behaviors are a very real complication of bipolar disorder.This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.
Thursday, October 4, 2007
Obesity: An Expensive Disease!
Obesity is a big factor driving soaring rates of chronic disease in the United States, with many more Americans chronically ill than their European counterparts, a new study finds.
It's an expensive problem, too: According to researchers, chronic illnesses such as diabetes and heart disease account for some $100 to $150 billion in health-care spending in the United States each year.
"The United States spends twice as much as European countries on health care," noted lead researcher Kenneth Thorpe, chairman of the department of health policy and management at Emory University's Rollins School of Public Health in Atlanta. "Seventy-five percent of what we spend in this country is associated with patients that have one or more chronic conditions and most of the growth is due to obesity."
"We have got to find more effective means to reduce, and at the worst, stabilize this persistent rise in obesity among adults and kids in this country," he said.
In addition, experts must find better and less expensive ways of managing chronic health-care problems, Thorpe said.
"That's where all the money is being spent," he said. "We are not going to control costs until we get the level and growth in chronic disease prevalence down."
The report appears in the Oct. 2 online edition of Health Affairs.
In the study, Thorpe's team compared 2004 data on the prevalence and treatment of diseases among adults aged 50 and older in the United States and Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden and Switzerland.
They report that about 17 percent of European adults are obese, compared with around a third of American adults. In addition, 53 percent of adult Americans are either former or current smokers, compared with 43 percent of those in Europe. American adults were also more likely than Europeans to have heart disease, cancer, diabetes and chronic lung disease -- all associated with obesity and/or smoking.
"The United States spends more on health care than any country in Europe," Thorpe said. In the United States, in 2004 the per capita spending on health care was $6,102 -- about twice as much as in the Netherlands and Germany, and almost twice that of France.
If the prevalence of obesity could be reduced (and along with it, chronic disease), Thorpe's team estimates that health spending could be cut by $100 billion to $150 billion per year, trimming up to 18.7 percent off the nation's total health-care budget.
There are several reasons for the costs of chronic disease in the United States, Thorpe's group notes. In addition to high rates of obesity and smoking, these include more aggressive cancer screening in the United States than in Europe, and more intensive drug treatment for chronic disease than in Europe, further driving up costs.
Thorpe believes the only way to get health-care costs under control is to find ways to reduce obesity. "There is a lack of an effective primary-care system in this country," he said. "We have to manage patients with chronic conditions more effectively, and we have got to find a way to prevent this rise in obesity."
One expert agreed with the scope of the problem, but said solutions remain elusive.
"There are two reasons why the U.S. might spend more of our total economy on health care than any other country -- treatment here costs more, and more of us need treatment," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.
That Americans are fatter than Europeans comes as no surprise, Katz said, but that more Americans smoke is surprising. "This finding does make me question the reliability of the data to some degree. But even if we know for sure that Americans have more chronic disease risk factors than populations abroad, it doesn't necessarily tell us how to fix the problem," he said.
Obesity rates in Europe are rising fast, so "we are exporting our bad example and higher health-care costs may well follow [there]," Katz said. "Without a doubt, the high costs of health care are best reduced by the propagation of health. Defining how best to get there from here is as yet a challenge inadequately met."
Another health-care cost expert agreed.
"I'm not sure obesity is a medical condition that lends itself to medical treatment," said Greg Scandlen, the founder of Consumers for Health Care Choices, a health-care lobbying group. "Certainly, it does suggest the need for more exercise and better diets, but that is a grandmother's advice. Do we need highly trained and expensive professionals telling people what grandmothers have told them for free for generations?"
"I'm just not sure this information is of much use to the health-care system, though it may be for the education system," Scandlen said. His suggestions? "Bring back P.E. classes, [use the] transportation system, use more bicycles and fewer cars, and urban design, get rid of escalators so people will walk up stairs," he said.
It's an expensive problem, too: According to researchers, chronic illnesses such as diabetes and heart disease account for some $100 to $150 billion in health-care spending in the United States each year.
"The United States spends twice as much as European countries on health care," noted lead researcher Kenneth Thorpe, chairman of the department of health policy and management at Emory University's Rollins School of Public Health in Atlanta. "Seventy-five percent of what we spend in this country is associated with patients that have one or more chronic conditions and most of the growth is due to obesity."
"We have got to find more effective means to reduce, and at the worst, stabilize this persistent rise in obesity among adults and kids in this country," he said.
In addition, experts must find better and less expensive ways of managing chronic health-care problems, Thorpe said.
"That's where all the money is being spent," he said. "We are not going to control costs until we get the level and growth in chronic disease prevalence down."
The report appears in the Oct. 2 online edition of Health Affairs.
In the study, Thorpe's team compared 2004 data on the prevalence and treatment of diseases among adults aged 50 and older in the United States and Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden and Switzerland.
They report that about 17 percent of European adults are obese, compared with around a third of American adults. In addition, 53 percent of adult Americans are either former or current smokers, compared with 43 percent of those in Europe. American adults were also more likely than Europeans to have heart disease, cancer, diabetes and chronic lung disease -- all associated with obesity and/or smoking.
"The United States spends more on health care than any country in Europe," Thorpe said. In the United States, in 2004 the per capita spending on health care was $6,102 -- about twice as much as in the Netherlands and Germany, and almost twice that of France.
If the prevalence of obesity could be reduced (and along with it, chronic disease), Thorpe's team estimates that health spending could be cut by $100 billion to $150 billion per year, trimming up to 18.7 percent off the nation's total health-care budget.
There are several reasons for the costs of chronic disease in the United States, Thorpe's group notes. In addition to high rates of obesity and smoking, these include more aggressive cancer screening in the United States than in Europe, and more intensive drug treatment for chronic disease than in Europe, further driving up costs.
Thorpe believes the only way to get health-care costs under control is to find ways to reduce obesity. "There is a lack of an effective primary-care system in this country," he said. "We have to manage patients with chronic conditions more effectively, and we have got to find a way to prevent this rise in obesity."
One expert agreed with the scope of the problem, but said solutions remain elusive.
"There are two reasons why the U.S. might spend more of our total economy on health care than any other country -- treatment here costs more, and more of us need treatment," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.
That Americans are fatter than Europeans comes as no surprise, Katz said, but that more Americans smoke is surprising. "This finding does make me question the reliability of the data to some degree. But even if we know for sure that Americans have more chronic disease risk factors than populations abroad, it doesn't necessarily tell us how to fix the problem," he said.
Obesity rates in Europe are rising fast, so "we are exporting our bad example and higher health-care costs may well follow [there]," Katz said. "Without a doubt, the high costs of health care are best reduced by the propagation of health. Defining how best to get there from here is as yet a challenge inadequately met."
Another health-care cost expert agreed.
"I'm not sure obesity is a medical condition that lends itself to medical treatment," said Greg Scandlen, the founder of Consumers for Health Care Choices, a health-care lobbying group. "Certainly, it does suggest the need for more exercise and better diets, but that is a grandmother's advice. Do we need highly trained and expensive professionals telling people what grandmothers have told them for free for generations?"
"I'm just not sure this information is of much use to the health-care system, though it may be for the education system," Scandlen said. His suggestions? "Bring back P.E. classes, [use the] transportation system, use more bicycles and fewer cars, and urban design, get rid of escalators so people will walk up stairs," he said.
Halitosis: Causes and Reduction!
Halitosis is the term for persistent bad breath.
The condition can be caused by a a variety of factors and conditions, some of which are behaviors that can be avoided to reduce bad breath.
Here are some common causes of halitosis and ways to help reduce it, courtesy of the American Dental Association:
What you eat can cause halitosis, so avoid potent foods like garlic and onions. Not eating can also cause bad breath, so don't avoid meals.
Poor dental hygiene can lead to bad breath, so brush, floss and use mouthwash frequently to keep breath fresh.
Dry mouth can exacerbate bad breath, so stay well hydrated, and try sucking on sugar-free candies to stimulate saliva production.
Don't smoke.
Since bad breath can be caused by a medical condition, such as a respiratory infection, bronchitis, sinusitis, liver or kidney illness, and many others, talk to your doctor about a diagnosis.
The condition can be caused by a a variety of factors and conditions, some of which are behaviors that can be avoided to reduce bad breath.
Here are some common causes of halitosis and ways to help reduce it, courtesy of the American Dental Association:
What you eat can cause halitosis, so avoid potent foods like garlic and onions. Not eating can also cause bad breath, so don't avoid meals.
Poor dental hygiene can lead to bad breath, so brush, floss and use mouthwash frequently to keep breath fresh.
Dry mouth can exacerbate bad breath, so stay well hydrated, and try sucking on sugar-free candies to stimulate saliva production.
Don't smoke.
Since bad breath can be caused by a medical condition, such as a respiratory infection, bronchitis, sinusitis, liver or kidney illness, and many others, talk to your doctor about a diagnosis.
Rat Study Gets at Root of Nicotine Addiction
Research in rats has pinpointed a brain mechanism linked to nicotine dependence and to the anxiety and cravings associated with nicotine withdrawal.
Researchers at the Scripps Research Institute in La Jolla, Calif., said the findings may point to better drugs that can help smokers kick the habit.
In rats, chronic nicotine use recruits a major brain stress system -- the extrahypothalamic corticotropin releasing factor (CRF) system. This contributes to continued nicotine use by exacerbating anxiety and craving whenever nicotine is withdrawn, the researchers found.
The CRF system is located in the amygdala, a brain region that plays a major role in the processing of memory and emotional reactions. The CRF system is activated by CRF-1, an essential protein for coping with stressful events.
"These results suggest long-lasting neuroadaptations of the CRF system, possibly through gene regulation, that may help explain why many cigarette smokers relapse even after a long abstinence from smoking," Olivier George, a research associate at Scripps, said in a prepared statement.
The Scripps team also discovered that giving the rats a compound that blocked these receptors eased the rodents' withdrawal symptoms.
"We reduced the need to take nicotine by blocking CRF-1 receptors in the brain," George said.
"We were surprised by the compound's dramatic effectiveness. We don't know yet if the same mechanism is involved in humans with tobacco dependence, but it is very promising."
Researchers at the Scripps Research Institute in La Jolla, Calif., said the findings may point to better drugs that can help smokers kick the habit.
In rats, chronic nicotine use recruits a major brain stress system -- the extrahypothalamic corticotropin releasing factor (CRF) system. This contributes to continued nicotine use by exacerbating anxiety and craving whenever nicotine is withdrawn, the researchers found.
The CRF system is located in the amygdala, a brain region that plays a major role in the processing of memory and emotional reactions. The CRF system is activated by CRF-1, an essential protein for coping with stressful events.
"These results suggest long-lasting neuroadaptations of the CRF system, possibly through gene regulation, that may help explain why many cigarette smokers relapse even after a long abstinence from smoking," Olivier George, a research associate at Scripps, said in a prepared statement.
The Scripps team also discovered that giving the rats a compound that blocked these receptors eased the rodents' withdrawal symptoms.
"We reduced the need to take nicotine by blocking CRF-1 receptors in the brain," George said.
"We were surprised by the compound's dramatic effectiveness. We don't know yet if the same mechanism is involved in humans with tobacco dependence, but it is very promising."
Will Alzheimer's Drug Ease Patients' Agitation?
By Amanda Gardner
Aricept, a drug commonly used to treat the cognitive symptoms of Alzheimer's disease, is no better than a placebo when it comes to treating the agitation associated with the illness, a new study finds.
When combined with other research, the trial suggests that doctors and patients shouldn't rule out using the medication, but they shouldn't count on it either, experts said.
"This is part of a greater dialogue about how you deal with these behavioral symptoms of Alzheimer's and I think the findings are relatively consistent with what's been seen before," said William Thies, vice president of medical and scientific relations at the Alzheimer's Association.
Previous trials have shown some variation in the effectiveness of cholinesterase inhibitors -- the class of medicines to which Aricept (donepezil) belongs -- in easing agitation. However, any positive effect from the drug has typically been small.
Although memory loss and cognitive dysfunction are hallmarks of Alzheimer's disease, behavioral disturbances such as agitation can cloud other changes, experts say. The group of symptoms known as "agitation" can lead patients to pace, wander, shout and become aggressive.
"These kinds of symptoms are very difficult to deal with and, both from a care and a medical perspective, they are the most likely causes of people moving into some sort of care facility as opposed to being cared for at home," Thies noted. "Memory issues often can be dealt with but when people get aggressive and agitated, that is frequently going to go beyond what a single caregiver can manage."
"Agitation is difficult to address in the first place," added Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City.
Antipsychotics and tranquilizers are commonly used to treat these behavioral disturbances but the effect -- if any -- is usually small and the side effects can be severe.
Cholinesterase inhibitors like Aricept have been shown to improve cognitive outcomes but the benefits in terms of behavioral disturbances have been unclear.
This British trial was originally designed to compare the efficacy of Risperdal (risperidone), a tranquilizer, against Aricept and a placebo. During the course of the trial, however, British regulatory authorities issued guidance saying that drugs such as Risperdal should not be given to Alzheimer's patients because of an increased incidence of stroke.
The trial therefore continued as a comparison of Aricept against placebo. Researchers randomly assigned 272 patients with Alzheimer's who also had agitation to receive 10 milligrams of donepezil per day or a placebo for 12 weeks. The patients had tried, but not responded to, a brief psychosocial treatment before being given medication. Most of the participants resided in nursing homes and had severe dementia with difficult-to-manage behaviors.
At the end of the study period, there was no significant difference in agitation between patients in the Aricept group and those in the placebo group, the research team report in the Oct. 4 issue of the New England Journal of Medicine.
There was a modest improvement in cognitive function among participants taking Aricept, however.
"It is becoming increasingly clear that tranquilisers are not an adequate treatment for managing behavioural symptoms in Alzheimer's patients and their use is associated with serious potential side effects," lead researcher Dr. Robert J. Howard, a professor of old age psychiatry at the Institute of Psychiatry, King's College London, said in a statement. "Sadly, but importantly, our results show that while donepezil may improve memory and attention in some patients, it is not effective in the management of these distressing behaviours."
According to Kennedy, there may be some question of whether this study can be extrapolated to practice in the United States. "In the U.K., few people are treated with cholinesterase inhibitors," he said. In the U.S., many people are on Aricept and related drugs to deal with cognitive problems and this may have a delaying effect on agitation. Prevention is a completely separate issue from treatment, the subject of this study.
"Just because donepezil, once they're agitated, doesn't seem to have much impact doesn't mean we don't have other agents to use," Kennedy said. "The danger is people will misread this study saying donepezil has no benefit for agitation when, in reality, the family of cholinesterase inhibitors may delay the emergence of agitation. It's an important study but it lends itself to misinterpretation."
The question, now and before, is how to best manage these patients.
"One of the things we can be pretty much guaranteed of is whatever effect there is is going to be small and highly individual," Thies said. "Every one of these people is different but having an orderly approach to them would be useful, looking at non-pharmacological interventions first. If you are going to treat for cognitive symptoms, certainly using a cholinesterase inhibitor is one of the first things you're going to try. If you benefit, that's good and an individual success but don't expect it to happen all the time."
There is some hope in the form of a recent study that found that Celexa (citalopram), an antidepressant, may help control agitation and psychotic symptoms associated with Alzheimer's. That study appeared in the Sept. 10 online issue of the American Journal of Geriatric Psychiatry.
Aricept, a drug commonly used to treat the cognitive symptoms of Alzheimer's disease, is no better than a placebo when it comes to treating the agitation associated with the illness, a new study finds.
When combined with other research, the trial suggests that doctors and patients shouldn't rule out using the medication, but they shouldn't count on it either, experts said.
"This is part of a greater dialogue about how you deal with these behavioral symptoms of Alzheimer's and I think the findings are relatively consistent with what's been seen before," said William Thies, vice president of medical and scientific relations at the Alzheimer's Association.
Previous trials have shown some variation in the effectiveness of cholinesterase inhibitors -- the class of medicines to which Aricept (donepezil) belongs -- in easing agitation. However, any positive effect from the drug has typically been small.
Although memory loss and cognitive dysfunction are hallmarks of Alzheimer's disease, behavioral disturbances such as agitation can cloud other changes, experts say. The group of symptoms known as "agitation" can lead patients to pace, wander, shout and become aggressive.
"These kinds of symptoms are very difficult to deal with and, both from a care and a medical perspective, they are the most likely causes of people moving into some sort of care facility as opposed to being cared for at home," Thies noted. "Memory issues often can be dealt with but when people get aggressive and agitated, that is frequently going to go beyond what a single caregiver can manage."
"Agitation is difficult to address in the first place," added Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City.
Antipsychotics and tranquilizers are commonly used to treat these behavioral disturbances but the effect -- if any -- is usually small and the side effects can be severe.
Cholinesterase inhibitors like Aricept have been shown to improve cognitive outcomes but the benefits in terms of behavioral disturbances have been unclear.
This British trial was originally designed to compare the efficacy of Risperdal (risperidone), a tranquilizer, against Aricept and a placebo. During the course of the trial, however, British regulatory authorities issued guidance saying that drugs such as Risperdal should not be given to Alzheimer's patients because of an increased incidence of stroke.
The trial therefore continued as a comparison of Aricept against placebo. Researchers randomly assigned 272 patients with Alzheimer's who also had agitation to receive 10 milligrams of donepezil per day or a placebo for 12 weeks. The patients had tried, but not responded to, a brief psychosocial treatment before being given medication. Most of the participants resided in nursing homes and had severe dementia with difficult-to-manage behaviors.
At the end of the study period, there was no significant difference in agitation between patients in the Aricept group and those in the placebo group, the research team report in the Oct. 4 issue of the New England Journal of Medicine.
There was a modest improvement in cognitive function among participants taking Aricept, however.
"It is becoming increasingly clear that tranquilisers are not an adequate treatment for managing behavioural symptoms in Alzheimer's patients and their use is associated with serious potential side effects," lead researcher Dr. Robert J. Howard, a professor of old age psychiatry at the Institute of Psychiatry, King's College London, said in a statement. "Sadly, but importantly, our results show that while donepezil may improve memory and attention in some patients, it is not effective in the management of these distressing behaviours."
According to Kennedy, there may be some question of whether this study can be extrapolated to practice in the United States. "In the U.K., few people are treated with cholinesterase inhibitors," he said. In the U.S., many people are on Aricept and related drugs to deal with cognitive problems and this may have a delaying effect on agitation. Prevention is a completely separate issue from treatment, the subject of this study.
"Just because donepezil, once they're agitated, doesn't seem to have much impact doesn't mean we don't have other agents to use," Kennedy said. "The danger is people will misread this study saying donepezil has no benefit for agitation when, in reality, the family of cholinesterase inhibitors may delay the emergence of agitation. It's an important study but it lends itself to misinterpretation."
The question, now and before, is how to best manage these patients.
"One of the things we can be pretty much guaranteed of is whatever effect there is is going to be small and highly individual," Thies said. "Every one of these people is different but having an orderly approach to them would be useful, looking at non-pharmacological interventions first. If you are going to treat for cognitive symptoms, certainly using a cholinesterase inhibitor is one of the first things you're going to try. If you benefit, that's good and an individual success but don't expect it to happen all the time."
There is some hope in the form of a recent study that found that Celexa (citalopram), an antidepressant, may help control agitation and psychotic symptoms associated with Alzheimer's. That study appeared in the Sept. 10 online issue of the American Journal of Geriatric Psychiatry.
"Medical, Behavioral Woes Can Drive Dogs to Bite Children"
Underlying anxiety, pain and other behavioral or medical problems can help prompt dogs to bite children, a new study suggests.
Researchers at the University of Pennsylvania looked at 111 cases involving 103 dogs that bit children and were referred to a veterinary behavior clinic over four years.
"Guarding of resources and territory" were the most common triggers for aggression by these dogs, according to the study in the journal Injury Prevention.
One in five of the dogs had never bitten a person before, and two-thirds of them had never bitten a child before.
The study found that young children were much more likely to be bitten when a dog felt their food or other items, such as a toy, were under threat. In cases involving older children, the bite was more likely the result of a dog's territorial behavior.
Food guarding was the most common cause of bites involving children familiar to the dog, while territorial guarding was the most likely cause in cases involving unfamiliar children.
The study also found that three-quarters of the dogs exhibited anxiety when left by their owners or when exposed to loud noises such as fireworks or thunderstorms. The authors said demonstrable fear in dogs may signal a tendency to bite when the dogs are confronted with a perceived threat.
The researchers noted that young children can be noisy and unpredictable in their movements, both of which may frighten an already anxious dog.
Half of the dogs in the study had medical conditions, mostly affecting their skin or bones. Other health issues included growths, eye problems, liver and kidney disease, hormonal problems and infections. Pain may have been a factor in some of the dog bite cases, the authors said.
Researchers at the University of Pennsylvania looked at 111 cases involving 103 dogs that bit children and were referred to a veterinary behavior clinic over four years.
"Guarding of resources and territory" were the most common triggers for aggression by these dogs, according to the study in the journal Injury Prevention.
One in five of the dogs had never bitten a person before, and two-thirds of them had never bitten a child before.
The study found that young children were much more likely to be bitten when a dog felt their food or other items, such as a toy, were under threat. In cases involving older children, the bite was more likely the result of a dog's territorial behavior.
Food guarding was the most common cause of bites involving children familiar to the dog, while territorial guarding was the most likely cause in cases involving unfamiliar children.
The study also found that three-quarters of the dogs exhibited anxiety when left by their owners or when exposed to loud noises such as fireworks or thunderstorms. The authors said demonstrable fear in dogs may signal a tendency to bite when the dogs are confronted with a perceived threat.
The researchers noted that young children can be noisy and unpredictable in their movements, both of which may frighten an already anxious dog.
Half of the dogs in the study had medical conditions, mostly affecting their skin or bones. Other health issues included growths, eye problems, liver and kidney disease, hormonal problems and infections. Pain may have been a factor in some of the dog bite cases, the authors said.
"Congressional hearings on FDA's Control of Tobacco"
By Steven Reinberg
WEDNESDAY, Oct. 3 (HealthDay News) -- As Congressional hearings on the issue got underway Wednesday, the chief of the U.S. Food and Drug Administration reiterated his opposition to a proposed bill granting the agency oversight over tobacco products.
The Family Smoking Prevention and Tobacco Act may be well-intentioned, said Dr. Andrew C. von Eschenbach in a statement released to meeting attendees, but "the bill could undermine the public health role of FDA."
The agency is charged with regulating goods that promote the public health, he noted, but the new bill "would ask us to apply this framework to tobacco products that, when used as intended, produce disease rather than promote health," von Eschenbach said. "FDA cannot 'approve' a tobacco product in this context, because there is no scientific context to determine benefit to outweigh the numerous risks."
In fact, "we are concerned that the public will believe that products 'approved' by the Agency are safe and that this will actually encourage individuals to smoke more rather than less," the former oncologist said.
Von Eschenbach also voiced concerns that the agency simply does not have the resources, either in money or skilled workers, to take on a new "tobacco center."
Wednesday's hearings on Capitol Hill on whether the U.S. Food and Drug Administration should regulate tobacco have certainly relit a long-smoldering debate.
Those on both sides of the issue remain divided on whether the bill will impact tobacco use, blamed for killing some 436,000 Americans a year, or almost one in every five deaths.
Overall, 200 sponsors have lined up to support legislation pending in the House, including Rep. John Dingell, (D-Mich.), chairman of the House Energy & Commerce Committee's Subcommittee on Health, which is hosting this week's hearing.
The bill also has the support of 55 senators and more than 500 public advocacy groups, according to Mathew L. Myers, president of the nonprofit Campaign for Tobacco Free-Kids.
"The hearings are the next step for a bill that is gaining momentum and bipartisan support," said Myers.
One of the bill's more surprising backers: Philip Morris USA, the nation's largest tobacco producer, which controls about half of the U.S. cigarette market, including Marlboro, the nation's bestselling brand.
The company has said it supports legislation as a way of meeting the goal of FDA regulation that was called for in a recent U.S. Institute of Medicine (IOM) report.
"These bills provide the framework for comprehensive FDA regulation of tobacco products and provide important policy solutions to many of the complex issues involving tobacco products," Howard Willard, Philip Morris USA's executive vice president of corporate responsibility, said in a prepared statement. "FDA regulation, as introduced in Congress, would be the most effective way to address the Institute of Medicine's concerns."
Philip Morris's support is the prime reason longtime antismoking crusader Stanton A. Glantz -- the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco -- said he is not supporting the new bill.
"I remain skeptical of the bill, because it's basically going to benefit Philip Morris," Glantz said. "I think that the FDA should have control over tobacco, but not on terms that Philip Morris wrote. I think that the people who are supporting this bill will live to regret it."
Other tobacco companies have lined up against the bill.
John W. Singleton Jr., director of communications at Reynolds American, Inc., whose brands include Camel cigarettes, said that the bill would protect Phillip Morris's market share, in part, by limiting advertising.
"If you make it more difficult to communicate with smokers, and you have half the market, it results in the market share getting locked in," Singleton said. "If you get locked in at 50 percent [like Philip Morris], that's pretty good. The bill gives Phillip Morris a competitive advantage."
Singleton is also concerned about how the FDA would actually regulate tobacco products and the chemicals they contain should the bill become law. "These details aren't clear, and they would need to be worked out," he said.
Identical bills in the House of Representatives and the Senate would grant the FDA the same authority over tobacco that it has over drugs, medical devices and many foods. The bill would allow the agency, which has come under fire in recent years for its monitoring of the drug industry, to regulate the levels of tar, nicotine and other harmful ingredients in cigarettes and smoke. That smoke contains some 4,000 chemicals, more than 40 of which are known to cause cancer.
The bills would also strengthen bans against tobacco advertising and bar tobacco manufacturers from making false claims or use terms such as "light" and "low tar" to describe products. They would also ban cigarette sales to minors and strengthen package warning labels.
The Senate version of the bill would also require that cigarette packs carry graphic warnings illustrating the health risks of smoking.
However, the bills would not require FDA approval of tobacco products already on the market -- only new products would need FDA approval before they could be sold to consumers. In addition, the FDA would have no authority to increase the legal age for buying cigarettes or restrict where cigarettes might be sold.
Still, the hearings themselves are good news, said M. Cass Wheeler, CEO of the American Heart Association.
"We cannot continue to allow the tobacco industry to oversee its own products. That makes as much sense as the three little pigs giving the big bad wolf the keys to their homes," Wheeler said in a statement released Wednesday. "With more than 400 Americans dying each day from cardiovascular diseases caused by smoking, we cannot waste another minute in giving the Food and Drug Administration the authority to regulate the tobacco industry."
WEDNESDAY, Oct. 3 (HealthDay News) -- As Congressional hearings on the issue got underway Wednesday, the chief of the U.S. Food and Drug Administration reiterated his opposition to a proposed bill granting the agency oversight over tobacco products.
The Family Smoking Prevention and Tobacco Act may be well-intentioned, said Dr. Andrew C. von Eschenbach in a statement released to meeting attendees, but "the bill could undermine the public health role of FDA."
The agency is charged with regulating goods that promote the public health, he noted, but the new bill "would ask us to apply this framework to tobacco products that, when used as intended, produce disease rather than promote health," von Eschenbach said. "FDA cannot 'approve' a tobacco product in this context, because there is no scientific context to determine benefit to outweigh the numerous risks."
In fact, "we are concerned that the public will believe that products 'approved' by the Agency are safe and that this will actually encourage individuals to smoke more rather than less," the former oncologist said.
Von Eschenbach also voiced concerns that the agency simply does not have the resources, either in money or skilled workers, to take on a new "tobacco center."
Wednesday's hearings on Capitol Hill on whether the U.S. Food and Drug Administration should regulate tobacco have certainly relit a long-smoldering debate.
Those on both sides of the issue remain divided on whether the bill will impact tobacco use, blamed for killing some 436,000 Americans a year, or almost one in every five deaths.
Overall, 200 sponsors have lined up to support legislation pending in the House, including Rep. John Dingell, (D-Mich.), chairman of the House Energy & Commerce Committee's Subcommittee on Health, which is hosting this week's hearing.
The bill also has the support of 55 senators and more than 500 public advocacy groups, according to Mathew L. Myers, president of the nonprofit Campaign for Tobacco Free-Kids.
"The hearings are the next step for a bill that is gaining momentum and bipartisan support," said Myers.
One of the bill's more surprising backers: Philip Morris USA, the nation's largest tobacco producer, which controls about half of the U.S. cigarette market, including Marlboro, the nation's bestselling brand.
The company has said it supports legislation as a way of meeting the goal of FDA regulation that was called for in a recent U.S. Institute of Medicine (IOM) report.
"These bills provide the framework for comprehensive FDA regulation of tobacco products and provide important policy solutions to many of the complex issues involving tobacco products," Howard Willard, Philip Morris USA's executive vice president of corporate responsibility, said in a prepared statement. "FDA regulation, as introduced in Congress, would be the most effective way to address the Institute of Medicine's concerns."
Philip Morris's support is the prime reason longtime antismoking crusader Stanton A. Glantz -- the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco -- said he is not supporting the new bill.
"I remain skeptical of the bill, because it's basically going to benefit Philip Morris," Glantz said. "I think that the FDA should have control over tobacco, but not on terms that Philip Morris wrote. I think that the people who are supporting this bill will live to regret it."
Other tobacco companies have lined up against the bill.
John W. Singleton Jr., director of communications at Reynolds American, Inc., whose brands include Camel cigarettes, said that the bill would protect Phillip Morris's market share, in part, by limiting advertising.
"If you make it more difficult to communicate with smokers, and you have half the market, it results in the market share getting locked in," Singleton said. "If you get locked in at 50 percent [like Philip Morris], that's pretty good. The bill gives Phillip Morris a competitive advantage."
Singleton is also concerned about how the FDA would actually regulate tobacco products and the chemicals they contain should the bill become law. "These details aren't clear, and they would need to be worked out," he said.
Identical bills in the House of Representatives and the Senate would grant the FDA the same authority over tobacco that it has over drugs, medical devices and many foods. The bill would allow the agency, which has come under fire in recent years for its monitoring of the drug industry, to regulate the levels of tar, nicotine and other harmful ingredients in cigarettes and smoke. That smoke contains some 4,000 chemicals, more than 40 of which are known to cause cancer.
The bills would also strengthen bans against tobacco advertising and bar tobacco manufacturers from making false claims or use terms such as "light" and "low tar" to describe products. They would also ban cigarette sales to minors and strengthen package warning labels.
The Senate version of the bill would also require that cigarette packs carry graphic warnings illustrating the health risks of smoking.
However, the bills would not require FDA approval of tobacco products already on the market -- only new products would need FDA approval before they could be sold to consumers. In addition, the FDA would have no authority to increase the legal age for buying cigarettes or restrict where cigarettes might be sold.
Still, the hearings themselves are good news, said M. Cass Wheeler, CEO of the American Heart Association.
"We cannot continue to allow the tobacco industry to oversee its own products. That makes as much sense as the three little pigs giving the big bad wolf the keys to their homes," Wheeler said in a statement released Wednesday. "With more than 400 Americans dying each day from cardiovascular diseases caused by smoking, we cannot waste another minute in giving the Food and Drug Administration the authority to regulate the tobacco industry."
Wednesday, October 3, 2007
"Quarantine Protocol Led To The Outbreak Of Equine Influenza''
Kate McClymont
QUARANTINE procedures were not followed at Sydney Airport and Eastern Creek quarantine station, the opening day of the Federal Government's inquiry into the outbreak of the equine influenza has heard.
Tony Meagher, SC, counsel assisting the retired High Court judge Ian Callinan, told the inquiry
that before August, Australia and Iceland were among the few countries to be free of the equine
virus. Now more than 33,000 horses in NSW and Queensland were infected.
The inquiry heard that in preparation for the breeding season, 43 stallions arrived at Eastern
Creek, on Sydney's outskirts, between August 3 and 8. The horses were to spend a fortnight there before the majority went to Coolmore and Darley studs in the Hunter Valley.
On August 17, a Coolmore stallion Encosta de Lago showed symptoms of equine influenza. Three days later, in the adjoining stable, Danehill Dancer showed symptoms. By August 23 all five Coolmore stallions that had been in row E stables at Eastern Creek returned positive swabs for the virus.
These horses had arrived from the Coolmore stud in Ireland on August 7.
Questions were raised about the adequacy of Irish quarantine procedures. Mr Meagher noted several stallions spent their pre-entry quarantine period at farms associated with Coolmore stud in Ireland under the supervision of the Irish Department of Agriculture. "That supervision appears to be ad hoc," he said.
Mr Meagher said the horses may not have been effectively vaccinated against horse flu, despite
certification to the contrary.
Meanwhile, only one day after Encosta de Lago first exhibited symptoms, 215 horses attended a weekend equestrian event at Carroll's Ranch near Maitland on August 18 and 19. The following week various outbreaks of the virus around NSW and Queensland were traced to horses which attended the event.
How did the virus get from Eastern Creek into the general horse population? One possibility
raised was that it could have been spread before the animals arrived at Eastern Creek by people or equipment at Sydney Airport. The inquiry heard there was a throng of people at the airport - grooms, vets, owners, truck drivers, ground staff and even a film crew documenting stallions on their way to Darley Stud.
The film, which will be screened at the hearing, reveals that most people at the airport when the horses arrived were not wearing protective clothing.
The situation at Eastern Creek was just as bad. While a vet from the Australian Quarantine
Inspection Service (AQIS) attended to horses within a day or so of their arrival, for the rest of
their time in quarantine the horses were attended to by their own grooms, private vets and
farriers. Private caterers arrived with food daily.
Most of those tending the horses "did so without wearing any protective clothing and without
carrying out any decontamination procedures before leaving the quarantine station," Mr Meagher said. It was suggested that people or equipment from Eastern Creek may have spread the virus to horses which then took part in the Carroll's Ranch event. To have passed the virus on, a horse would have had to be exposed to the virus between three and six days earlier.
Mr Meagher urged people to come forward if they had witnessed a horse coughing before the
Carroll's Ranch event.
The first day of public hearings will be on November 8.
QUARANTINE procedures were not followed at Sydney Airport and Eastern Creek quarantine station, the opening day of the Federal Government's inquiry into the outbreak of the equine influenza has heard.
Tony Meagher, SC, counsel assisting the retired High Court judge Ian Callinan, told the inquiry
that before August, Australia and Iceland were among the few countries to be free of the equine
virus. Now more than 33,000 horses in NSW and Queensland were infected.
The inquiry heard that in preparation for the breeding season, 43 stallions arrived at Eastern
Creek, on Sydney's outskirts, between August 3 and 8. The horses were to spend a fortnight there before the majority went to Coolmore and Darley studs in the Hunter Valley.
On August 17, a Coolmore stallion Encosta de Lago showed symptoms of equine influenza. Three days later, in the adjoining stable, Danehill Dancer showed symptoms. By August 23 all five Coolmore stallions that had been in row E stables at Eastern Creek returned positive swabs for the virus.
These horses had arrived from the Coolmore stud in Ireland on August 7.
Questions were raised about the adequacy of Irish quarantine procedures. Mr Meagher noted several stallions spent their pre-entry quarantine period at farms associated with Coolmore stud in Ireland under the supervision of the Irish Department of Agriculture. "That supervision appears to be ad hoc," he said.
Mr Meagher said the horses may not have been effectively vaccinated against horse flu, despite
certification to the contrary.
Meanwhile, only one day after Encosta de Lago first exhibited symptoms, 215 horses attended a weekend equestrian event at Carroll's Ranch near Maitland on August 18 and 19. The following week various outbreaks of the virus around NSW and Queensland were traced to horses which attended the event.
How did the virus get from Eastern Creek into the general horse population? One possibility
raised was that it could have been spread before the animals arrived at Eastern Creek by people or equipment at Sydney Airport. The inquiry heard there was a throng of people at the airport - grooms, vets, owners, truck drivers, ground staff and even a film crew documenting stallions on their way to Darley Stud.
The film, which will be screened at the hearing, reveals that most people at the airport when the horses arrived were not wearing protective clothing.
The situation at Eastern Creek was just as bad. While a vet from the Australian Quarantine
Inspection Service (AQIS) attended to horses within a day or so of their arrival, for the rest of
their time in quarantine the horses were attended to by their own grooms, private vets and
farriers. Private caterers arrived with food daily.
Most of those tending the horses "did so without wearing any protective clothing and without
carrying out any decontamination procedures before leaving the quarantine station," Mr Meagher said. It was suggested that people or equipment from Eastern Creek may have spread the virus to horses which then took part in the Carroll's Ranch event. To have passed the virus on, a horse would have had to be exposed to the virus between three and six days earlier.
Mr Meagher urged people to come forward if they had witnessed a horse coughing before the
Carroll's Ranch event.
The first day of public hearings will be on November 8.
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