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Positive Outlook on Life Linked to Lower Risk of Heart Attacks

People who are able to enjoy simple pleasures, have a sunny disposition and positive outlook on life are less likely to have heart attacks and strokes, it has been found.

It was known that stress and depression increase the chances of being unwell and is harmful for the heart but less was known about how positive emotions affect health.

In the first review of its kind, a team at Harvard School of Public Health, in Boston, America, examined 200 separate research studies which looked as psychological wellbeing and cardiovascular health.

The findings were published online in Psychological Bulletin.

Lead author Julia Boehm, research fellow in the Department of Society, Human Development, and Health at HSPH said: “The absence of the negative is not the same thing as the presence of the positive. We found that factors such as optimism, life satisfaction, and happiness are associated with reduced risk of cardiovascular disease regardless of such factors as a person’s age, socioeconomic status, smoking status, or body weight.

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Kinect-based Virtual Reality Training Promotes Brain Reorganization after Stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. Recently, a study team from the First Affiliated Hospital, Sun Yat-sen University in China has verified that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sensorimotor cortex. This study, reported in the Neural Regeneration Research (Vol. 8, No. 31, 2013), located the target brain region for Kinect-based virtual reality intervention and preliminarily explored the mechanism of the Kinect system for physical rehabilitation of upper limb dysfunction.

via Kinect-based virtual reality training promotes brain reorganization after stroke – Medical News Today.

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Scientists Solve Key Piece of Prostate Cancer Puzzle

Cancer Research UK scientists have revealed a completely new route by which male androgen hormones fuel the growth of prostate cancer, raising the prospect that existing drugs could be used to treat the disease.

Prostate cancers are often treated with hormone therapies that target the  (AR) – a large protein that switches on signals telling the cell to divide, and which can become overactive in prostate cancer cells.

AR relies on interactions with several other proteins, such as HSP90 and p23, which help fold it into its active form.

Previously it was thought that p23 and HSP90 work together to activate AR, but this latest research – funded by Cancer Research UK and the Association for International Cancer Research – shows that p23 also increases activity of the AR independently.

Crucially this means that drugs to block p23 could be effective at treating prostate cancers that have become resistant to HSP90 inhibitors – which are currently being trialled in breast and prostate cancers.

The findings are published in Molecular Endocrinology.

Study leader, Dr Charlotte Bevan, from the Department of Surgery and Cancer at Imperial College London, said: “Cell signals from the androgen receptor (AR) drive many prostate cancers and our team is part of an ongoing international effort to find new  targets that can potentially disable this key protein.

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CRUfAD Shortbits: Distress & Self-Harm

Posted on by Kristy

Al Griskaitis BSc (Hons), MBBS (Sydney)

Distressed people have a problem to solve, but their distress gets in everybody’s way.

When people are acutely distressed, they are not in a position to figure out what went wrong or what they can do about it. They just cry, shout, wail, self-harm and disturb everyone, not the least themselves. They are not receptive to rational advice and it’s hard to know what to do.

A magic scheme: If they’re agitated, then time to settle down is essential. “I want you to  sit in the waiting room and compose yourself, I’ll see you after the next patient and then we can talk properly”. The gesture of giving tissues when crying is validating. Some time in the waiting room or even outside where they can pace gives people time to compose themselves. Trying to help while they’re too disorganised is unhelpful… OK, some time has elapsed, they’ve calmed down enough that you can sit them down and talk, what next? Listen to them explain the trigger for their distress. Don’t be shocked and don’t judge: you’re the expert and you’ve heard it all before, right: so stay very calm. Some validation is a good step “that’s just terrible”, “I can’t imagine how that would feel” etc. Good, now they are getting engaged a few more validations while they tell their story, perfect. Time for empathy, followed by education to switch on their rational mind.

First the empathy: “I can see you’ve had a really hard time of it, and it happens to you a lot, you poor thing” (sincerity here otherwise they’ll be invalidated and distressed again). Next the education: begin to draw my diagram of the distress cycle, explain it step by step:

The Distress Cycle

“It starts with a problem, today [insert problem] happened. It’s natural that you had an emotional reaction to this (nice validation!), but what seemed to happen was that the emotions took off. You probably had powerful physical feelings, like when adrenaline hits you. Often when that happens, we feel out of control” Pause now and wait for them to tell you how right you are. Great, everyone’s feeling better. Then continue “The natural reaction to all this is that we have a powerful urge to rid ourselves of the emotions. When that urge leads to a urgent action like [insert what they did eg, cut up, screaming at boyfriend etc] it makes things even worse, because now we have a new problem and the cycle goes round again, (pause to digest) is that what it’s like for you?”

Now that they are in a more rational frame of mind, you are in a better position to help them problem solve. Remember, validate, and don’t judge. If they are getting distressed again, then let them cool off (in the waiting room if required but validate!) until they are ready to try to problem solve again. If necessary, remind them that some problems can’t be solved, so you may need to tell them to “change the bits you can change and get on with the next thing”. Easy. If you want you can refer them to a psychologist or to dialectical behavioural therapy (DBT) to learn skills which can help them break this cycle, so that they won’t get so distressed next time. Next patient!

crufad distress2

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Optimal Management of Low Back Pain

Posted on by Kristy

It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month. While 90% of subjects consulting general practice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability.
In fact, only 25% of the patients who consulted about low back pain had fully recovered 12 months later. Consequently, effective early treatment could reduce the burden of these symptoms and their social, economic, and medical impact.
The consultation needs to include the following elements:

  • a detailed pain history and assessment of impact of pain (with validation of the patient’s pain experience)
  • an assessment of co-existing diseases and conditions (including a red flag review)
  • a review of previous diagnostic investigations (this is an opportunity to normalise – not trivialise – findings)
  • a psychosocial assessment (show empathy and run through a checklist of yellow flags)
  • a review of outcomes of previous interventions and strategies, including patient self-management (don’t forget to applaud any individual achievements)
  • • a directed physical examination (involving the ritual laying on of hands).

Patients should feel respected, not threatened, after their visit.
However, you do not need to routinely obtain imaging or other diagnostic tests. This is a strong recommendation, with moderate-quality evidence to support it.If there are no red flags for conditions such as radiculopathy or spinal stenosis, you can move on to providing patients with evidence-based information on low back pain:

  • covering their expected course,
  • advising them to remain active, and
  • providing information about effective self-care options.

For most patients, first-line medication options are paracetamol or nonsteroidal anti-inflammatory drugs.
For patients who do not improve with self-care options, you can consider adding non-pharmacologic therapy with proven benefits. For acute low back pain, this is spinal manipulation; for chronic or subacute low back pain, this can include intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive behavioural therapy, or progressive relaxation. Note, however, that this is a weak recommendation, with moderate-quality evidence.
Source: Dr Neil Hearnden, The General Practice Education Day, Brisbane 2013

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Depression in Pregnancy: New study shows preferences for therapy over medication

Women with depression in the perinatal period experience a high degree of conflict in deciding whether and how to treat their depression, but strongly prefer treatments other than antidepressant medications, reports a study in the November Journal of Psychiatric Practice.

The preliminary study, led by Cynthia L. Battle, PHD, of the Warren Alpert Medical School of Brown University, Butler Hospital, and Women & Infants’ Hospital of Rhode Island, helps to fill the gap in knowledge about women’s preferences and decision-making patterns regarding treatment for depression during and after pregnancy.

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Biomarkers ID Teen-Onset Depression

A group of genetic biomarkers has been identified that are associated with early-onset major depression, suggesting the possibility of an objective blood test in the future, researchers reported.

A group of 11 RNA transcripts in the blood of teens who fulfill the criteria for major depression differentiated affected patients from controls with no history of depression, according to Eva E. Redei, PhD, of Northwestern University in Chicago, and colleagues.

In addition, 18 markers — some overlapping with the major depression transcripts — could distinguish individuals with depression with comorbid anxiety from those with depression alone, the researchers reported online in Translational Psychiatry.

The biomarkers they identified have various functions and gene products, but many are involved in neurodevelopment as well as degeneration, neural protection, and oxidative stress…

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Meditation, Mindfulness and Mind-Emptiness

Ever been unable to sleep because you can’t switch off that stream of thoughts that seems to flow incessantly, mercilessly through your head?

When your mental noise distracts you from the task at hand, makes you forget why you walked into a room, or keeps you awake at night, you’re a victim of what is known in the East as “the monkey mind”. It is this thought stream that, according to Eastern tradition, is the source of much of our modern day stress and mental dysfunction.

So, what can you do about it?

In the West, meditation has become a woolly term under which many different methods have found a home. Mindfulness is the latest, and certainly the most popular, addition.

Scientifically speaking, all approaches to meditation – be they relaxation, mindfulness, visualisation, mantras or otherwise – are associated with measurable but non-specific beneficial effects. So too are all stress management-style interventions even if they are not labelled as “meditation”.

So, does meditation have a specific effect or is it just another way to relax and de-stress? These are the questions that the scientific community continues to struggle with. Importantly, we can only answer this question if we have a clear understanding of what meditation is (or isn’t).

Our research shows that by defining meditation as “mental silence”, which is an evolution of the mindfulness concept, we can effectively answer the key scientific questions about meditation.

Mindfulness essentially involves the passive observation of internal and external stimuli without mental reaction. It is most explicitly, but not exclusively, laid out in Buddhist meditation texts…

…read more>>

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Medications for Premature Ejaculation

Posted on by Kristy

It is commonly claimed that 20 to 30% men complain of premature ejaculation (PE), making it the most common male sexual dysfunction.

However, the reliability of this figure is in question, as it comes from older studies using older definitions. In fact, many men have subjective PE or are confused by normal variations in ejaculatory latency: as a result, post-hoc analysis of the research suggests that only 1–3% have real PE.

There are a range of treatment options for PE.

Antidepressant SSRIs can be used daily, although this is a off-label prescription: paroxetine, sertraline, fluoxetine, citalopram, and the serotonergic TCA clomipramine.

They are usually well tolerated but adverse effects include fatigue, yawning, mild nausea, loose stools, or perspiration that begin in the first week but wane within two to three weeks. Occasionally they cause hypoactive sexual desire and mild erectile dysfunction and occasionally they trigger agitation, so they should be avoided in adolescents and men with a history of bipolar depression.

If an SSRI is to be stopped, the patient should be weaned gradually over three to four weeks to avoid withdrawal symptoms. Dapoxetine, a fast-acting, short half-life selective SSRI, is the first compound developed for the treatment of PE and is approved for this use by the TGA. The dose is 30 mg with a full glass of water one-to-three hours before planned intercourse. It cannot be used more than once every 24 hours. Ten per cent of men experience mild nausea and 5% experience some lightheadedness but fainting is rare. There are no links to withdrawal syndromes, risk of suicide, or other neurocognitive effects. A suitable trial would be four to six weeks.

An alternative to an SSRI is an “on-demand” topical anaesthetic such as lidocaine (STUD-100®, Promescent ® sprays) or lidocaine/prilocaine cream (EMLA®). There are few controlled studies but these agents appear to be moderately effective in delaying ejaculation.

There is a potential risk of penile hypo-anaesthesia and of transvaginal absorption, resulting in vaginal numbness and female anorgasmia. A daily selective α-1 blocker, such as alfuzosin or terazosin, has been trialled.

Unfortunately, the current data is confusing and conflicting because of poor study design, so this is not recommended.

Likewise, on-demand tramadol has been investigated but is not currently recommended as a treatment for PE.

Finally, intracavernous pharmacotherapy is advocated by entrepreneurial clinics but there is no evidence-based supportive data.

Take-home messages

  • PE is a common sexual disorder and imposes a substantial psychological burden upon both sufferers and partners.
  • Dapoxetine is an effective, safe, and well tolerated treatment for PE and is likely to fulfill the treatment goals of many patients.
  • Off-label anti-depressant SSRIs are effective treatments for PE.
  • Integrated pharmacotherapy and CBT may achieve superior treatment outcomes in some patients.
  • PDE-5 inhibitors alone or in combination with SSRIs or topical anaesthetics should be limited to men with acquired PE secondary to comorbid erectile dysfunction.
  • Tramadol, α1-adrenoceptor antagonists, and penile injection therapy are not recommended for the treatment of PE.

Source: Dr Chris G McMahon, The General Practice Education Day, Brisbane, 2013

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Should and Will the Drinking Age Ever Be Raised to 21?

Posted on by Kristy

Paul Dillon
Drug and Alcohol Research and Training Australia (DARTA)

With the discussion around alcohol-related violence reaching a fever-pitch over the Christmas/New Year period it was not surprising to once again see the issue of raising the legal drinking age brought up once again. Over the years that I have been working in the alcohol and other drug field calls for the drinking age to be raised to 21, as it is in the US, ring out fairly regularly.

Maybe I’m being a little cynical here but you often need to look closely at who made the call and when they made it to see how serious the person was … e.g., often it’s a politician attempting to distract attention away from other issues (Kevin Rudd spoke about it a number of times while he was PM) as discussing raising the drinking age nearly always pushes other things off the front page! Other times it’s not so much a ‘call for action’ but an ‘off the cuff’ comment made by someone in the public eye (e.g., Ita Buttrose found herself in the middle of the debate recently when reporters discovered she was going to say something about the issue in an upcoming speech). Certainly those of us in the public health sector often raise the issue when we can and certainly while the community is concerned about alcohol-related violence and our binge drinking culture it’s the perfect time!

Whenever the possibility of raising the drinking age is discussed it is absolutely fascinating to sit back and watch the different reactions. Talkback radio (and now TV) goes crazy and the response from Mr and Mrs Normal from the suburbs is varied – some horrified by the thought and others keen for governments to make the change. These polarised views are what the tabloid media love … but when it really comes down to it, is a change to the legal drinking age ever going to happen?

My answer is always the same – absolutely not! So if it’s never going to happen, why do public health advocates waste their time?

Let’s make something perfectly clear here, if we actually looked at the evidence there is no way that we would allow anyone to drink until at least 21, and for young men it would most probably be 25 years of age before we considered drinking alcohol to be low risk. This is due to the increasing evidence we now have around alcohol and the developing brain. The interesting thing is that at a time when we know more about the harms and that we should definitely delay drinking for as long as possible, many parents are actually introducing their children to alcohol at a younger and younger age. If they’re not providing the alcohol to their teens, growing numbers appear to be turning a blind eye to, or tolerating their child’s drinking.

This is why the drinking age argument keeps popping up and why we keep talking about it – it is a great way of keeping the issue in the public consciousness and highlighting the risks associated with adolescent drinking

Why then do I think we’ll never see the legal drinking age rise?

Well, firstly and most importantly, I believe that most people simply don’t support the idea. They may be outraged at seeing young teens drinking but for many of them, when it comes to their own children, they don’t necessarily want them to drink but they often see it as ‘just something all teens do’. The old – “I did it, there’s nothing wrong with me!” mentality. Many Australian parents had their first drink before they were ‘legal’ and most do not believe that drinking at that time caused them great harm. If you can’t get parental support for a legal drinking age of 18, how in heavens do you hope to get community support for 21?

Secondly, we have to remember why the drinking age was lowered to 18 in the first place. Although some Australian jurisdictions already had 18 years as the legal drinking age prior to the Vietnam War, other states that had different laws around alcohol. This meant that some young Australians who died for their country during that war were actually unable to drink alcohol, a fact that many found unacceptable (a situation that the US is now attempting to deal with) and the law was subsequently changed.

Certainly we need to keep talking about the risks associated with adolescent drinking but we also need to be careful that we tread carefully … Claims of ‘wowserism’ are getting louder and louder – I believe we have the bulk of the community on our side at the moment, push too hard and we’ll lose them, particularly on this issue!

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