Lubbock ranks last in bad teeth study
Fri, 14 Mar 2008 22:08:08 GMTLUBBOCK, Texas - If you're looking for cavity-free pearly whites, search anywhere but Lubbock. A new study in next month's Men's Health magazine says this West Texas city has the worst teeth of the 100 large U.S. cities examined. El Paso , San Antonio and Dallas weren't far ahead. The magazine said the best teeth could be found in Madison, Wis.; Nashville, Tenn.; and Raleigh, N.C.
The study used data from the Centers for Disease Control and Prevention on the number of annual dentist visits, canceled appointments, regular flossers and households using flouride.
Some blame the high level of fluoride in Lubbock's well water. Dentists say too much fluoride in the water may cause the enamel on teeth to become rough, leaving brown or white stains. Others say the high cost of dental care is to blame, leaving poor people without proper checkups or education.
Some people questioned the study.
John Epperson, a longtime Lubbock dentist, said some people take excellent care of their teeth and some don't.
"My expectation is people in Lubbock are like people around the country," he said.
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Information from: Lubbock Avalanche-Journal: http://www.lubbockonline.com
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On the Web:
Men's Health: http://www.menshealth.com/metrogrades/08_apr_teeth/
Monitors dont stop patients from waking
Fri, 14 Mar 2008 22:08:56 GMTBy LINDA A. JOHNSON, Associated Press Writer
Patients say it feels like being trapped in a corpse: They wake up during surgery, unable to move or scream. Some remember hearing their surgeons talk, and a few recall feeling intense pain.
Some experts have said special brain-wave monitors were the best way to prevent anesthesia awareness. Now, in a big setback for efforts to prevent it, the first large, independent test of the monitors shows they are no better than older technology.
Researchers at Washington University School of Medicine in St. Louis compared two groups of about 1,000 patients each, all deemed at high risk of waking up during surgery because of health conditions, medication or other factors.
One group used the leading brain-monitoring system, which uses electrodes on the forehead to measure brain waves and software to calculate likelihood of consciousness. The other used an older device that analyzes exhaled anesthetic gas.
Anesthesiologists watched for movement and changes in vital signs and followed protocols to maintain patients' depth of sleep, adjusting anesthesia levels as needed. Patients were interviewed after their surgeries about what they remembered.
Two people in each group had experienced awareness — and the two monitored with the newer system reported having felt pain as well.
Lead researcher Dr. Michael Avidan said that in two of those cases — one with each system — the monitors indicated no problems with the anesthesia. In the other two cases, the monitors signaled problems.
The study analyzed groups of people who had surgery at the university's partner hospital, Barnes-Jewish in St. Louis, in 2005 and 2006. It was published in Thursday's issue of the New England Journal of Medicine.
Anesthesia awareness occurs in 1 or 2 of every 1,000 surgical patients — possibly more often in children — and is thought to happen to roughly 30,000 Americans each year.
Some just have fleeting memories of things they heard, but others describe "white-hot pain" and terror, triggering long-term emotional problems.
Carol Weihrer of Reston, Va., said that 11 years after awakening during surgery to remove a diseased eye that caused severe pain, she still has post-traumatic stress disorder, can sleep for just short periods and suffers mood swings and panic attacks.
Weihrer, who founded the group Anesthesia Awareness Campaign Inc., said she heard the doctor give instructions: "Cut deeper, pull harder." "I actually saw them cut the optic nerve when everything went black," she said.
"While you're laying there on the table," she recalled, "you are thinking, praying, cursing, plotting, pleading, trying to crawl off the gurney, trying to kick, scream, move any part of your body to let them know you're awake. In effect, you are entombed in a corpse."
Kathy LaBrie of Nashua, N.H., also suffered awareness during surgery for a deviated septum. She said she heard "the sound of pushing and grinding and the surgeon talking to the nurses about the kind of car he had. ... I tried moving my arms and legs — I couldn't do anything. I thought I was dying."
Dr. Jeffrey Apfelbaum, president of the American Society of Anesthesiologists, who was not involved in the study, said there is "tremendous pressure" from industry and patient advocates to use the brain-wave technology, despite the lack of solid evidence that it works better.
The position of the anesthesiologists group has been that brain-wave monitoring should not be done routinely, but may be helpful for certain patients at high risk of awareness. But widespread use would be very costly.
The dominant maker of brain-wave systems, Aspect Medical Systems, says its monitor, called a bispectral index or BIS, is used in about 17 percent of the roughly 20 million U.S. surgeries each year in which anesthesia gas is used.
The device can cost as little as $5,000. But the researchers estimated that if it were used on all U.S. patients getting general anesthesia, the disposable electrodes alone would cost more than $360 million a year.
The device, on sale since 1998, "can prevent both too little anesthesia, which could cause awareness, and too much anesthesia, which could cause prolonged recovery and anesthetic side effects" such as grogginess and nausea, said Aspect's medical director, Boston anesthesiologist Dr. Scott Kelley.
He said the new results show the system can help anesthesiologists "achieve a very low incidence of awareness in high-risk patients."
But Avidan's fellow researcher, anesthesiology professor Dr. Alex Evers, said he thinks having doctors closely follow a protocol to maintain the patients' depth of sleep was the key to reducing anesthesia awareness in both groups.
The Food and Drug Administration has stated only that the BIS device "may be associated" with reducing awareness during surgery.
About 10 percent of U.S. surgical patients receive intravenous anesthesia, without any gas. The study findings do not apply to them.
Dr. Douglas Jackson, assistant anesthesiology professor at University of Medicine and Dentistry of New Jersey in Newark, said the study shows the BIS system "is not a magic bullet."
"We still don't have a monitor that can tell us about depth of anesthesia awareness," he said, adding that controlling that is still an art.
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On the Net: http://www.nejm.org
Anesthesia Awareness Campaign Inc.: http://www.anesthesiaawareness.com
Dementia diagnosis may relieve patients
Fri, 14 Mar 2008 22:09:09 GMTBy CHERYL WITTENAUER, Associated Press Writer
ST. LOUIS - Doctors often hesitate to tell patients they likely suffer from Alzheimer's disease or another form of dementia, fearing the news will overwhelm them. But a study by Washington University in St. Louis suggests physicians need not worry.
Not only did the diagnosis not increase anxiety or depression among patients and their caregivers, but most were relieved to have symptoms explained and a way to find help.
"It's not good news. No one is pleased to find out they have dementia," said Brian Carpenter, co-investigator and associate professor of psychology at Washington University. "But some people find comfort in getting resolution to their anxiety and concerns, and knowing that people can help them."
The study, which appears in the March issue of the Journal of the American Geriatrics Society, gauged depression and anxiety two days before and two days after an evaluation and diagnosis.
Medical practice guidelines say doctors should tell their patients about a dementia diagnosis regardless of the stage of the disease.
But a review of published studies dating from the 1970s until very recently showed half of doctors were not telling their patients what they suspected, the researchers said.
Scott Roberts, an Alzheimer's researcher at the University of Michigan who was not involved in the study, said medical ethicists debate patients' right to information and the fear that such knowledge may upset them.
"This study is interesting, because it shows a lot of the paternalistic fears are not supported by the data," he said.
Neurologist John Morris, who heads the Alzheimer's Disease Research Center at Washington University where the study subjects were evaluated, said doctors have varying comfort levels, in part because of uncertainty the diagnosis is accurate.
He said he wanted to evaluate patients' reactions because early detection has advantages, such as enabling patients to plan for their future care.
In the St. Louis study, 90 patients and their caregivers were interviewed at the center two days before the evaluation, and by telephone two days later. Their levels of anxiety and depression were gauged based on answers to standardized questionnaires.
On average, for both patient and caregiver, anxiety and depression levels were the same or had decreased.
The researchers acknowledged that their study has limitations, and they plan additional research to expand their inquiry.
The study gauged the subjects' emotional state at only two points in time. A future study will gauge their reactions over a year.
And the very setting for the study — an Alzheimer's research center — may have influenced patients' and caregivers' expectations, researchers said.
Study subjects likely received more information and support at the center than the average patient does in a primary care doctor's office. Future studies will look at primary care and neurology and geriatrics clinics.
"It's a significant study for as far as it goes," said Dr. Greg Sachs, a research scientist at Indiana University's Center for Aging Research.
How the diagnosis is delivered, and what kind of support is offered, may have a lot to do with reaction, he said.
Sachs cautioned that study results should not be used to argue for wider screening of dementia at health fairs and doctors' offices. Available treatments are expensive and only modestly helpful, he added, and many doctors are ill-equipped to meet the challenges posed by such patients and their families.
No new flu strain found in Hong Kong
Fri, 14 Mar 2008 22:03:24 GMTBy MIN LEE, Associated Press Writer
HONG KONG - Scientists have confirmed that no new flu strain has emerged in Hong Kong's recent flu outbreak, the government said Friday.
Scientists have completed gene sequencing on the flu viruses from two children who died amid the recent outbreak and found that their genetic makeup matches that of flu strains that are already circulating, a government statement said.
"These results confirm that the two children did not die from a new virus that is more virulent than the circulating strains in the region," the statement said.
The results eased fears that a new, deadlier strain of flu might have emerged and bolstered claims by the World Health Organization and the Hong Kong government that the recent outbreak here is not cause for alarm.
The WHO has called the situation a seasonal flu outbreak. It noted the two children, a 7-year-old boy and a 3-year-old girl, also suffered from encephalitis and a metabolic disease. Officials have not yet determined what caused their deaths.
Still, as a precaution to stem the spread of flu, the Hong Kong government ordered primary schools and kindergartens closed since Thursday, keeping more than half a million students at home. It was the first such public health measure since the outbreak of SARS.
SARS, which stands for severe acute respiratory syndrome, surfaced in southern China in November 2002 before spreading to Hong Kong, where it killed 299 people and sparked a public panic.
Some secondary schools in Hong Kong have also reported suspected flu outbreaks, and four have closed voluntarily as of Friday.
Health Secretary York Chow said in a radio interview Friday the total number of flu cases in February and March was higher than the same period last year. He did not give figures.
Hong Kong is also on guard for bird flu, which killed six people here in 1997.
Scientists also fear the virus that causes it could eventually mutate into a form that spreads easily among humans that some say could kill millions.
Hong Kong occasionally finds wild birds with avian influenza, the latest a peregrine falcon. After several tests, scientists confirmed it contracted the deadly H5N1 strain, the government said in a statement Friday.
The flu cases in Hong Kong have also prompted close monitoring in southern China's Guangdong province, but officials haven't detected more flu cases than usual, Chinese health minister Chen Zhu told reporters in Beijing Friday.
Guangdong's health department said in a statement on its Web site Friday it recorded five flu outbreaks this year across the province, with each outbreak involving at least 15 cases a week.
That figure was "a bit" higher than the same period last year, but the flu virus behind the outbreaks was less virulent, the health department said.
The provincial capital Guangzhou had two outbreaks, while Shenzhen, across the Chinese border from Hong Kong, had one.
Guangdong health officials have also sent experts to Hong Kong to learn more about the situation there, the department said.
Former British colony Hong Kong is now Chinese territory, but it maintains separate political and economic systems from the mainland.
In statistics released late Thursday, Hong Kong officials announced nine new confirmed flu outbreaks and 41 suspected ones, affecting 305 people.
That brings the total since March 6 to 18 confirmed outbreaks, 106 suspected outbreaks and 837 affected people in a city of nearly 7 million. Most of the cases have been confined to schools.
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Associated Press writer Audra Ang contributed to this report from Beijing.
