Saturday, April 28, 2007

Menstrual Problems: Orthodox and Hale Approach

Menstrual Problems

Most women have experienced some symptoms or discomfort associated with their monthly periods. It may be nothing more serious than feelings of irritation or tiredness a few days before their period which they can easily shrug off. Or it may be much more severe – depression, acute anxiety, food cravings, water retention, abdominal pain, or heavy bleeding which can turn the normal menstrual cycle into a misery – for the women concerned and for their families. Most doctors nowadays recognize premenstrual syndrome (P.M.S) as a collection of symptoms usually experienced in the two weeks before a period. Sore, “lumpy” breasts, sleep problems, a lack of interest in sex, and erratic periods are other symptoms, although some women become much keener on sex just before a period.
The causes of P.M.S. and other menstrual problems are still hotly debated. During this phase of the menstrual cycle levels of the sex hormones progesterone and oestrogen fall, affecting all parts of the body including the brain, which accounts for the wide variety of symptoms reported by women. Hormonal imbalance is certainly crucial factor, although there is a lively dispute over whether P.M.S. is caused by a deficiency of oestrogen or a problem with the way the body uses progesterone. Poor diet, lack of exercise, and stress undoubtedly aggravate the situation and may in some cases turn what might be a mild inconvenience into something much more distressing. There is also evidence that “oestrogen overload” is something of a modern epidemic caused by a combination of the contraceptive pill, poor diet, and stress.
Your symptoms may also be due to something else entirely – a shortage of iron or a thyroid problem, for example – so it is sensible to have a check-up rather than assuming that the problem is related to your monthly cycle.

Vitamin B6, and evening primrose oil are both recommended by doctors: the latter is frequently prescribed for tender breasts, the former for painful periods. For more severe P.M.S. and other menstrual problems the contraceptive pill is often recommended. This suppresses the normal monthly cycle and therefore the symptoms associated with it. The pill can have side effects such as water retention, depression, and headaches, but there are many different varieties to try if the first one prescribed does not suit you.
Conventional medicine treats specific symptoms. Diuretics may be prescribed for water retention. Depression may be treated with tranquilizers and antidepressants. Progesterone therapy – natural progesterone in the form of suppositories – is used by many doctors and does not have the side-effects associated with taking its synthetic form progestogen, which can actually cause depression. In really severe cases of P.M.S. a hormone known as GnRH, which stops the menstrual cycle completely, may be prescribed, while cases of heavy painful periods might be treated with danazol.
A hysterectomy (removal of the womb and ovaries) may be the drastic solution recommended for women suffering very heavy painful periods and conditions such as endometriosis and fibroids if all else has failed to cure the problem.

Complementary medical therapies should be tried for all but the most severe menstrual problems. Orthodox treatment usually revolves around changing the natural hormonal cycle artificially and should be considered only when the alternatives have failed. Persisting or severe bleeding, not responsive within 24 hours to complementary treatment, should be brought to the attention of your physician or gynaecologist.
Once again, nutrition plays a very important part in alleviating menstrual problems. However, if the symptoms are quite pronounced, treatments such as acupuncture, Ayurveda, and aromatherapy, which address the imbalance in the hormonal function, will be necessary as well. In cases where patients find it very difficult to change their diet, these treatments are usually sufficient to address the problem. Supportive Treatments such as light therapy, reflexology, Shiatsu, and hypnotherapy will also have a beneficial effect.
N.B. Amenorrhea. This means that periods stop completely or occur infrequently and is a much more serious problem than is generally realized. It shows that the constitution is in a weakened state and not functioning correctly. Amenorrhea is often aggravated by inadequate nutrition – some vegans and vegetarians, for example, do not make sure that they include all the necessary nutrients in their diet. The Hale Clinic would recommend changes in nutrition. Acupuncture is particularly good at “jump starting” periods again.

Acupuncture treatment is particularly effective for the treatment of heavy or irregular periods. “In Chinese medicine menstrual problems are seen and treated as an imbalance of the liver function”, says one acupuncturist. “The liver controls the smooth flow of blood in the body, so energizing that pathway clears the clotting and stagnation and improves the circulation”.
One patient who suffered extremely heavy periods had been told the only solution was a hysterectomy, but after nine months of acupuncture treatment her periods returned to normal. “It can be a long process”, says the therapist, “but it has proved a real alternative to surgery for women who have not responded to conventional treatments”.
In Chinese medicine liver imbalance is also believed to be the cause of other symptoms of P.M.S. such as anger, irritability, and sugar cravings. These too can be treated successfully by acupuncture. More about

Conventional and complementary medicine alike recognize a link between menstrual problems and an inadequate diet too low in important nutrients. “Dietary factors can have a powerful effect on female hormone chemistry”, says one nutritionist; he believes that many women have found changing their diet far more helpful than hormone treatment in combating period problems and P.M.S. Shortage of Vitamin B and of essential fatty acids found in seafood, green vegetables and some dairy products, as well as a lack of minerals such as magnesium and zinc are implicated in the physical and psychological symptoms of premenstrual syndrome.
Treatment starts with nutritional assessment – many busy women do not realize how poor their diet is until they have to compile a list of what they have eaten in the past week or so. A combination of changing your diet and taking supplements can have a significant effect on menstrual problems – but it requires time and commitment. Your diet should be low in salt, caffeine, sugar and animal fats.
There is also a range of herbal remedies that can be prescribed for specific symptoms such as heavy, painful periods, depression, and water retention, and for adjusting hormone imbalance. Products containing agnus castus or raspberry leaf may be recommended for heavy periods; burdock for water retention; vervain lemon balm, St. John’s Wort, ginseng or many others for depression. More about

No one would suggest that premenstrual syndrome and other menstrual problems were “all in the mind”. But there is plenty of research to indicate that stress and other psychological factors have a profound effect on the workings of the body, even though the precise mechanisms may not yet be fully understood. Certainly stress aggravates any tendency to P.M.S., and many of the symptoms – depression, anxiety, food cravings, and bad temper – are, of course, quite similar.
One theory is that the body is particularly sensitive to adrenalin in the two weeks before a period, so that any already existing stress symptoms become more acute at this time.
Hypnotherapy treatment helps relieve stress and uncover any psychological concerns that may be exacerbating, or even causing, your problem. It involves a weekly session for some months and combines hypnosis with counselling. More about

P.M.S. and other menstrual problems are defined as an imbalance of Vata, one of three doshas or forces that control activity in the body. Among other things the Vata controls blood circulation and the system of sending messages to the brain.
Ayurvedic therapy aims to calm down the Vata dosha by detoxifying the body. This is one of the fundamental therapies of this ancient Indian system. Treatment starts with an assessment of the individual’s prakriti – their existing state of health – followed by the prescribing of panchakarma herbal treatment. Detoxification may take the form of heat therapy, treatments designed to reduce pressure on the lower part of the body, inhalation, massage with oil, or the use of enemas. Monthly sessions over three of four months usually result in significant reduction in symptoms. More about

“Reflexology provides a deeply relaxing treatment for P.M.S. sufferers”, according to one reflexologist. “The symptoms of irritation, painful periods and back ache are often stress related and reflexology is also very helpful in relieving pain”. Treatment usually involves around six weekly one-hour sessions. The speed of improvement and length of treatment will depend on the individual and how long they have had the problem. There may be a mild reaction to the first treatment. More about

Treatment involves diagnosing “the maintaining cause” of menstrual symptoms. “The fundamental problem can be psychological as well as physical”, explains one homeopath, who believes that the stresses of modern life are responsible for a lot of menstrual problems. “Some women resent having periods; others may suffer because they are in a bad relationship. Coming off the pill after many years can play havoc with the hormonal system and an unhealthy lifestyle will aggravate any problems. Often it is a process of persuading the patient to help herself by making certain changes”.
Apart from a general assessment and advice on the patient’s physical and emotional condition, there are specific homeopathic remedies that may be prescribed for menstrual problems. Sepia is one of many remedies that is effective for heavy bleeding, irritability, and depression. Pulsatilla may be recommended by P.M.S. and Folliculinum for regulating periods. More about

Period pain can be relieved by pressing in the centre of the lower abdomen, or a point on the inside of either leg above the ankle.

Maya Abdominal Massage: A non-invasive massage technique that specialises in treating gynaecological and digestive conditions. It improves organ function by relieving congestion, enhancing blood supply; increasing lymphatic drainage and aiding nerve supply to the pelvic and reproductive organs.

Iridology: The diagnostic approach (right) - also known as iris analysis – can help you identify the cause of menstrual distress if there seems to be no reason for it. This should not be used as an alternative to conventional medical diagnosis, however.

Aromatherapy: Massage with essential oils helps rebalance hormones and reduce the effects of stress on them. Hormone-like essential oils such as clary sage, cypress, and geranium are particularly recommended for menstrual problems. Aromatherapy massage also eases pain and tension in the lower back and abdomen. Acupressure during the treatment helps to harmonize the internal energies of organs such as the liver, spleen, heart, and kidneys, reducing symptoms. A clinical aromatherapist will encourage changes in diet and recommend exercise/meditation for self-care.

Flower Remedies: Gentle Bach Flower remedies can help relieve P.M.S. Your therapist will pick a combination to counteract the emotions that well up just before your period. Holly may be recommended to counteract “vexation”, while Larch can help those who feel that they are incapable of achieving anything. Other helpful remedies include She Oak (Australian Bush), Japanese Magnolia (Petite Fleur), and Easter Lily (Pacific).

Shiatsu: Concentrating on the spleen, liver and kidney meridians, Shiatsu massage helps adjust hormonal imbalance.

Healing: In cases of heavy, painful, or irregular periods healing helps rebalance the hormonal system, reduce stress and control the blood flow.

Light Therapy: This works directly on the pineal gland in the brain to stimulate and balance the hormones. It can be used to treat P.M.S. and to regulate heavy, irregular or scanty periods. You can buy a full-spectrum light box and use it at home to ensure you are getting enough light.
Chi Kung: These exercises rebalance the body energy, reduce stress and tension, and help eliminate toxins from the system. Certain of the exercises support the muscles of the abdominal area, easing symptoms. Other exercises work on balancing the energy of the liver, spleen, kidneys and heart, helping to harmonize the hormones and internal energies, reducing unpleasant symptoms, and calming both mind and body.

Friday, April 27, 2007

HIV positive people: travel restrictions

US should ease its travel restrictions on HIV positive people, think tank says

Bob Roehr
Washington, DC

An independent US think tank has called for a change in the law that prohibits HIV positive visitors and immigrants coming to the United States, allowing only occasional waivers on a case by case basis.
The Center for Strategic and International Studies made its recommendations in a report that was discussed at a forum in Washington, DC, last week.
The "travel ban" was passed by Congress in 1993 when hysteria over HIV was at its peak, before the introduction of effective treatments. In protest, the International AIDS Society has refused to hold its huge biennial conference in the US until the law is changed, and the World Health Organization has called the policy a violation of human rights.
A coauthor of the report, Phillip Nieburg, said that our HIV knowledge base had grown since 1993 and that it was now clear that HIV is not an easily spread contagious disease. There was no justification for the law in terms of public health, he said.
Nor was it consistent with the international leadership role on HIV that the US has shown with its president's emergency plan for AIDS relief (PEPFAR). "It is just one more thing where we are out of line and inconsistent with what we are trying to do," said Helene Gayle, another coauthor of the report and president of the large international charity CARE.
The easiest part of the law to change may be visas for short term visitors. Individuals may be granted a waiver through a special application. But the applicant runs the risk of disclosure and discrimination, and the fee can be prohibitive for people on low incomes. Blanket waivers have been granted for people planning to attend large events, such as the Gay Games in Chicago last July.
The Bush administration is moving to address these issues, albeit slowly. On World AIDS Day (1 December) last year the president announced that he would issue an executive order addressing the visa concerns.
Speaking from the forum's audience, Tom Walsh, of the US Department of State's Office of the US Global AIDS Coordinator, said, "The process is under way, it is complex, and I wish there was more that I could say." Others have said that the delay results from trying to work within the confines of the law to protect the confidentiality of applicants.
Supporters of the current law fear that allowing HIV positive people into the US will increase the burden on the country's public health system. They gained ammunition after the international AIDS conference in Toronto last summer when more than 150 HIV positive people attending the conference chose to remain in Canada and seek asylum, claiming that they feared discrimination or worse in their own countries. The cost of drugs alone for those people would cost about $1m (£0.5m; 0.7m) a year in the US.
Dr Nieburg called that argument inherently discriminatory, given that other costly chronic health problems are not singled out for a blanket ban but are handled on a case by case basis.
Louis Sullivan, who was secretary of health and human services when the law was enacted, against his advice, said that the emotions and stigma surrounding AIDS had declined notably since then. The introduction of effective treatments and the greater availability of treatment in developing countries make this "truly a propitious time to try and end these [legal] restrictions," he said.

Moving Beyond the US Government Policy of Inadmissibility of HIV-Infected Noncitizens is at

BMJ 2007;334:820-821 (21 April)

Thursday, April 26, 2007

Alcohol screening

Smoking indicator of alcohol misuse

New Haven, Conn. — Where there is cigarette smoking there is probably misuse of alcohol too, according to a study by Yale School of Medicine researchers in the Archives of Internal Medicine.
“This means cigarette smoking status can be used as a clinical indicator for alcohol misuse, which presents an opportunity for intervention,” said the principal investigator, Sherry McKee, assistant professor of psychiatry.
She said that although brief screening and brief intervention provided in primary care settings are effective, clinicians do not frequently screen for alcohol misuse. This is a matter of concern because 26 percent of the U.S. population is drinking at hazardous levels, which puts them at increased risk for alcohol-related consequences such as injuries from motor vehicle crashes, hypertension, depression, and certain cancers.
“Only an estimated 30 percent of individuals who had a primary care visit reported being screened for an alcohol or drug use problem,” McKee said. “Physicians are much more likely to ask patients whether and how often they smoke.”
She and her collaborators arrived at their conclusions after analyzing data obtained from 42,374 adults in a national epidemiological survey on alcohol misuse and other related conditions. Following guidelines that physicians use to assess tobacco and alcohol use, they found that non-daily smokers are five times more likely to have a problem with alcohol compared to people who have never smoked. Daily smokers are three times more likely to have an alcohol problem.
“This is the first study to document that individuals who are smokers, but don’t smoke every day, have the highest rates of problem drinking,” McKee said. “Using smoking status as a ‘red flag’ for more aggressive assessment of alcohol use is a highly feasible and clinically sensible approach to screening.”
The findings, she said, highlight the importance of physicians adopting standard alcohol screening questions into their practice.

Yale University

Sunday, April 22, 2007

Depression: New therapy

Depression: New therapy gives reason for hope

Initial preliminary study a sensational success story
A study at the University Clinics of Bonn and Cologne gives people with therapy-resistant depression reason for hope. The doctors treated two men and a woman with what is known as deep brain stimulation. All three patients have been suffering from very severe depression for several years which could neither be brought under control using medication nor by other therapies. During the simulation the condition of two of the three patients improved within a few days. Initial changes were even noticeable in a matter of minutes. The research team warn against exaggerated expectations in view of the small number of patients involved. Nevertheless, the results of the preliminary study are so sensational that they have now been published in the renowned journal Neuropsychopharmacology (doi: 10.1038/ sj.npp.1301408).

In deep brain stimulation (DBS) electrodes are implanted selectively in certain areas of the brain and are stimulated using an electric pulse generator. Up to now the procedure has mainly been used in the treatment of Parkinson’s. It is currently being investigated whether it also helps with certain psychiatric diseases such as compulsive behavioural disorders. Initial tests on about two dozen patients worldwide also show that it could possibly also have an effect in the case of severe depression.

Previous tests have concentrated mainly on two areas of the brain in particular. “By contrast we stimulated a third region, the nucleus accumbens,” the Bonn Professor of Psychiatry, Thomas E. Schläpfer, explains. The nucleus accumbens is an important part of what is known as the “reward system”. It ensures that we remember good experiences and puts us in a state of pleasurable anticipation. Without the reward system we would not make plans for the future, simply because we could not enjoy the fruits of these plans. “Inactivity and inability to enjoy things are two important signs of depression,” Profesor Schläpfer emphasises. “The conclusion is therefore obvious that the nucleus accumbens plays a key role in the genesis of the disease.”

Initial effects minutes after onset of therapy
In their study the researchers report on two men and a woman who have been suffering from very severe depression for years. The researchers implanted electrodes in the nucleus accumbens, which they were able to stimulate using an electric pulse generator in the chest. Some of the effects were observable instantly. “One of the patients expressed the desire to go to the top of Cologne Cathedral a minute after the start of the stimulation and put this into practice the next day,” Thomas Schläpfer says. “The woman treated was similar. She said she would enjoy going bowling again.” Nevertheless, the patients did not notice a direct improvement in their mood. Nor could they tell whether the pulse generator was switched on or off.

In the first few days of the DBS the symptoms of depression improved significantly in two of the three patients. Their condition remained constant for as long as they were undergoing treatment. However, as soon as the pulse generator was switched off, the depression recurred with full intensity. “The recurring symptoms were so severe that for ethical reasons we could not permit the treatment to be interrupted for as long as we had originally planned,” Professor Schläpfer emphasises.
While psychotropics generally interfere with the biochemistry of the brain, DBS acts locally in the affected areas. The doctors did not observe any side effects like those occurring after the use of antidepressants. The patients only complained about post-operative pain at the site of implantation. In the long term DBS does not seem to pose any major risks. There have been patients with Parkinson“s who have been using this kind of brain pacemaker for more than ten years without experiencing any problems.

Preliminary results
Even so, the research team caution against exaggerated expectations. ”Of course, with so few patients, these are only fairly preliminary results,“ Professor Schläpfer says. ”Our follow-up experiments are showing even now that by no means every patient will respond to this therapy.“ In the case of operations on the brain, in particular, ethical factors also need to be taken into account, not least because such operations are always risky. For that reason, there were particularly stringent conditions attached to the patients” consent. “One thing has certainly been demonstrated by our research and that of others: DBS can help some people with depression even in cases which were assumed to be resistant to therapy.”

University of Bonn

Saturday, April 21, 2007

Influenza: the risk map

Map predicting spread of avian flu

The 2003 epidemic of Highly Pathogenic Avian Influenza (HPAI) in the Netherlands is the only recent epidemic of HPAI in the developed world. Gert-Jan Boender and colleagues have examined the data from this outbreak and produced a model which can predict the probability of infection from one farm to another; the ‘transmission kernel’. They also identify high-risk areas in the Netherlands and analyze various control strategies, concluding that in these regions an epidemic can only be brought to an end by massive culling of susceptible farms.

For avian influenza, the analyses show that there are two poultry-dense areas in The Netherlands where epidemic spread is possible, one in the central region and one in the south, close to the German and Belgian border (see attached figure). The authors suggest local control measures are unlikely to be able to halt an unfolding epidemic in these areas.

The paper, published in the Open Access journal PLoS Computational Biology, arrives at these conclusions through a computational (or mathematical) modeling method, an approach which has already proved its worth in the analysis of infectious diseases such as the 2001 foot-and-mouth outbreak in the UK. The method can estimate the key parameters which determine the spread of highly transmissible animal diseases between farms. These risk maps identify geographic areas in which a given intervention strategy fails to control the spread of the disease between farms. “The risk map concept is an instrument suitable for analyses of epidemic control options both during crisis and in peacetime” says Boender.

Public Library of Science

Friday, April 20, 2007

Insomnia treatment

Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

Your insomnia is more than just occasionally being unable to get a good night's sleep. It's a serious disorder, and until now, there were few safe, effective insomnia treatments.

Your insomnia may be caused by one or more underlying problems. You may have restless legs syndrome, sleep apnea or a serious medical condition that keeps you from getting restful sleep. And like a large number of people who have insomnia — 42 million by some estimates — you may have turned to sleeping pills for insomnia treatment.

What's so good about a good night's sleep?
Sleep is essential for your physical and mental well-being. When you're sleep-deprived, recovery from stress takes longer, and you're more likely to develop infections, high blood pressure, cardiovascular disease and diabetes. You may have problems with learning and memory, may be depressed and irritable, and apt to make mistakes on the job. You also have a higher risk of being in a motor vehicle crash — people with insomnia have twice as many car accidents as does the general population.
Natural sleep is best. It's physically restorative, and it usually provides enough dreaming time (REM sleep) to improve learning, memory and mood. But most sleep experts agree that there are times when sleeping pills, especially the relatively new class of drugs that includes zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata), may be of help.

Such times include periods of pain or grief, or when sleep loss affects your job performance. But though sleeping pills are a temporary aid and shouldn't be taken for more than a few days to a few weeks, some people take these drugs far longer — often every night for months. And some users may increase their dosage as the pills become less effective.
Especially when taken for long periods or in higher than normal doses, sleeping pills can cause serious problems that far outweigh their benefits. Among other side effects, sleeping pills can:

  • Mask the real causes of poor sleep, such as depression, heart trouble, asthma and Parkinson's disease, and delay treatment of these disorders
  • Interact with other medications or alcohol, often with serious, even deadly, results
  • Cause next-day grogginess or rebound insomnia — an inability to sleep that's worse than the original problem
  • Lead to high blood pressure, dizziness, weakness, nausea, confusion, short-term amnesia and bizarre behavior that goes far beyond traditional sleepwalking to include "sleep binge eating," "sleep shoplifting" and "sleep driving" — none of which the person remembers

Cognitive behavioral therapy: A new tool for treating insomnia
For years, people who spent their nights tossing and turning didn't have many choices. But now there is an insomnia treatment that's an alternative to pills, even for people with severe or chronic sleep problems. Called cognitive behavioral therapy (CBT), this relatively simple, short-term treatment has long been used to treat a range of problems, including depression, panic attacks, eating disorders and substance abuse. Now, it has also proved effective against insomnia. So effective, in fact, that for most people it works better than sleeping pills — with no side effects.
CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, an intractable, lifelong inability to get enough rest. What's more, the effects seem to last — a year after CBT, most people still sleep soundly.

How does it work?
CBT is based on the idea that how you think affects the way you feel and behave. By changing your thought processes (cognition), the theory goes, your behavior also changes. When used as an insomnia treatment, CBT, which usually requires four to eight 30-minute sessions with a trained sleep therapist, works on two levels. First, it teaches you to recognize and change false beliefs that affect your ability to sleep — the idea that you need exactly eight hours of sleep every night, for instance, or that one restless night will make you sick. CBT also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize. In therapy, you learn how much sleep you really need and how to plan for it.

The second part of CBT insomnia treatment deals with behavior, or what sleep experts call "sleep hygiene." This helps reprogram the part of the brain that governs the sleep-wake cycle. In CBT you learn to:

1) Get up at approximately the same time every day, even on holidays and weekends.
2) Get as much natural light as possible during the day, and limit light when you want to sleep.
3) Go to bed only when you think you can fall asleep. If you haven't dozed off within 20 to 30 minutes, get out of bed and do something else until you feel drowsy. Limiting the amount of time you spend in bed when you're not actually sleeping increases your desire to sleep.
4) Avoid napping during the day.
5) Avoid caffeine, nicotine and alcohol, especially late in the day.
6) Get regular exercise. Whether exercise close to bedtime disturbs sleep remains unclear and may vary from person to person.
7) Start winding down an hour or two before bedtime. Turn down the lights. Stop watching television and using the computer. Take a warm bath.

Thursday, April 19, 2007

Herbal Teas

Herbal Teas

In a stainless steel pot, boil desired amount of water. The moment it boils turn the heat off. Add the following herbs in an infuser, muslin bag or tea ball for a single cup or add one-three teaspoons of herbs per cup for larger amounts. Allow the herbs to infuse for up to 5 minutes. Drink 3-4 cups a day. For flavor-add lemon and sweeten with Stevia or organic honey. These herbs are helpful for gently cleanses, purifying, detoxing, anti-inflammatory. This powerful formula will help remove accumulated toxins in the body. Strong antioxidant, cleanses the colon and stimulates circulation.

Immune Builder Tea

When taken on a regular basis, this tea helps to build and strengthen the immune system. Astrugalus, Echinacea, Hawthorne, Peppermint, Spearmint.

Calm Tea
Reduces stress and helps to relax you. Improves circulation and acts as a sedative. Reduces mucous from colds, muscle and menstrual cramps and helps with anxiety and stress. Chamomile, Rosehips, Catnip, Alfalfa, Skullcap, Fo-Ti, Hops, Vervain, Wild Lettuce, Passion Flower, Lemon Verbena.

Chamomile Tea
Age old remedy for calming and soothing the nerves. Works wonders on the digestive tract and tames stomach troubles and ulcer pain. Chamomile stems, flowers.

Sleepy Tea
Soothing blend of herbs for relaxing moments or right before bed. Helps in relieving stress and anxiety, indigestion, and insomnia. Kava Kava, Chamomile, Rosehips, Catnip, Alfalfa, Skullcap, Fo-Ti, Hops, Vervain, Wild Lettuce, Passion Flower, Lemon Verbena.

Wednesday, April 18, 2007

Herbal Remedies

Herbal Remedies

Chamomile German (Matricaria recutita), Roman (Chamaemelum nobile)
Chamomile's medicinal properties range from skin inflammations to lightening hair to treating digestive problems. As a mild sedative, anti-inflammatory, and antibacterial, it improves digestion by relaxing the muscles throughout the gastrointestinal system and it can induce an overall sense of calm and well-being.

Valerian (Valeriana officinalis)
Improves circulation and acts as a sedative. Good for relieving anxiety, fatigue, high blood pressure, insomnia, nervousness and stress. Helps ease the pain of irritable bowel syndrome, muscle and menstrual cramps, and pain, spasms and ulcers.

Rosehips (Rosa canina)
If you leave the flower on your rosebush, the petals will fall off after it finishes blooming, and a small red fruit will form -- that is the rosehip. Rosehips form on any sort of rose shrub, even a hybrid tea or floribunda, but the hips most commonly used in foods and beverages are harvested from wild roses. Fresh rosehips are a source of vitamin C, which is how they got the reputation for being healthful.

Catnip leaf (Nepeta cataria)
Catnip has always been used by people, for whom it is a mild, safe sedative. Catnip tea was a regular beverage in England before the introduction of tea from China. It is a traditional cold remedy. It also is traditionally used for upset stomach and children's ailments, such diarrhea, hysteria and nightmare. The essential oil in catnip contains a monoterpene similar to the valepotriates found in valerian, an even more widely renowned sedative. Animal studies (except those involving cats) have found it to increase sleep. The monoterpenes also help with coughs.

Hops flower (Humulus lupulus)
Hops are high in the bitter principles humulone and lupulone. These are thought to be responsible for the appetite-stimulating properties of hops. Hops also contain about 1–3% volatile oils. Hops have been shown to have mild sedative properties. Many herbal preparations for insomnia combine hops with other sedative herbs, such as valerian, passion flower and scullcap. Hops have tonic, nervine, diuretic and anodyne properties. Their volatile oil produces sedative and soporific effects, and the Lupamaric acid or bitter principle is stomachic and tonic. For this reason Hops improve the appetite and promote sleep.

Skullcap (Scutellaria laterifolia)
Skullcap relaxes states of nervous tension whilst at the same time renewing and revivifying the central nervous system. It has a specific use in the treatment of seizure and hysterical states as well as epilepsy. May be used in all exhausted or depressed conditions. Can be used with complete safety in the easing of pre-menstrual tension.

Passion flower (Passiflora incarnata)

Passionflower is a mild tranquilizer made from a climbing native flower of the southeastern United States that also produces an edible fruit called the maypop. The whole plant is used to make tinctures and extracts. These are calming without being sedating and are a useful complement to programs of stress reduction, much safer than pharmaceutical tranquilizers. Take one dropperful of the tincture in a little warm water or two capsules of extract up to four times a day as needed.

Tuesday, April 17, 2007

Sick building syndrome: symptoms and illnesses

Sick building syndrome: A-Z of symptoms and illnesses

Not everyone who works in a sick building will become sick, just as the whole population does not succumb to a bout of the flu during an epidemic. There are many factors that determine a person's physical response to their environment, although the response in sick building syndrome is rarely so severe that the person needs to take sick leave.

People who have become sensitised to a particular allergen (such as the house dust mite which provokes an attack of asthma in sensitive individuals) can be affected by very small amounts of that agent. Some substances are more likely than others to cause allergy, but any organic substance is a potential allergen.
A US company that specialises in remedying sick buildings carried out research which showed that allergenic fungi were the main pollutants in 34 per cent of mechanically ventilated buildings (Guardian 1988).
See also Asthma, Humidifier fever

Symptoms that are suggestive of work-related asthma include chest tightness, difficulty in breathing, shortness of breath and wheezing. Someone who is told by their general practitioner that they have recurrent bronchitis may in fact have occupational asthma. Breathing difficulties that improve on days away from the workplace could be due to occupational asthma.
'I teach computer studies in a room which, I feel, has made me develop asthma and which, latterly, has given me severe headaches. A colleague has suggested that I should use an ioniser in the room. If you know of any medical evidence that would substantiate my claim I would appreciate it. At the moment I am just told to keep taking the Becotide (for the asthma) and Paracodol (for the headaches).' (Ballyclare, County Antrim)
In one study, up to 10 per cent of workers in air-conditioned offices with humidification experienced chest tightness compared with about 2 per cent of those in buildings with natural ventilation (Finnegan et al 1984).
Work-related asthma may be caused by an allergic reaction to inhaled micro-organisms or their toxic products (Morris 1987).
See also Allergy, Humidifier fever

Breathing difficulties
See Asthma

Chest infections
A high frequency of airways infection is one of the features of the sick building syndrome described by the World Health Organization (1983).
See also Respiratory infections

See Respiratory infections
See Chest infections, Humidifier fever, Sick building syndrome

Eye problems
The sensitivity of the eyes to the atmosphere means that they are easily irritated, and symptoms such as soreness, itchiness, grittiness, watering and redness are common in buildings with indoor climate problems. Some of these symptoms are due to dryness, whereas others (watery eyes) may be an allergic response.
Tests for 'dry eyes' have shown that people who report building-related eye symptoms may have unstable tear-films and damaged conjunctival epithelium (Franck 1986).
Eye problems often occur together with nasal and throat problems.
See also Sick building syndrome
See Nausea

Extrinsic allergic alveolitis
The alveoli are the tiny airways at the bottom of the lungs where exchange of gases takes place. In extrinsic allergic alveolitis, these airways become inflamed as a result of an allergic response to an inhaled allergen. The illness is similar to farmers' lung, where the allergen is fungal spores. Symptoms are similar to those of humidifier fever - fever, chills, cough, malaise, chest tightness and shortness of breath - except they do not disappear because tolerance does not develop. Additional, long-term symptoms include loss of appetite, weight loss and a persistent cough with sputum which can lead to permanent lung damage due to scarring (fibrosis).
Extrinsic allergic alveolitis due to organisms from humidification systems has been reported in a few people (Robertson and Burge 1985).
The headaches associated with sick building syndrome are most often felt across the forehead, above both eyes, and also at the back of the neck. They are not usually throbbing or associated with visual symptoms, as in migraine (Robertson and Burge 1985), and were described as 'usually mild' in one study (Finnegan et al 1984).
The headache, like the lethargy which often accompanies it, usually gets worse as the day progresses and starts to improve quite quickly once the person has left the building. Headache has many possible causes, including working all day under fluorescent lighting or spending too many hours in front of a visual display unit. It may be useful to keep a diary of when headaches occur to see if they are related to time spent in the building.
See also Humidifier fever
Hypersensitivity pneumonitis
This is the American term for extrinsic allergic alveolitis.

Humidifier fever
Humidifier fever is caused by breathing in water droplets from humidifiers (or sometimes from other components of a ventilation system such as air filters) that have become heavily contaminated with micro-organisms. Such contaminated water can cause various illnesses, including respiratory infections and allergenic illnesses such as asthma and extrinsic allergic alveolitis. Humidifier fever is the most common and best documented of these illnesses (Sykes 1988). Sometimes a diagnosis of humidifier fever is made by testing sufferers for their reaction to extracts of the water or organic material taken from a contaminated humidifier.
Humidifier fever is a non-infective (that is, you can't 'catch' it from anyone else) building-related illness for which a specific cause can often be found, if it is looked for, unlike sick building syndrome which usually has non-specific causes. The disease has been reported more often in industrial buildings than in offices or public buildings, and is a particular problem in printing works where humidification needs are high and paper dust provides a good source of nutrients for microbes in the air-conditioning system.
The acute symptoms are very like those of flu - fever, cough, aching limbs, headache, tiredness and lethargy - although the symptoms don't usually last for quite so long. Some people who are particularly sensitive to the causative agent may also have asthmatic symptoms of tight chest and difficulty in breathing (see Table 1).
Symptoms usually develop on the first day back at work after the weekend or other break (the disease is sometimes called 'Monday fever'), and they are often worse after a longer break or after a period of air-conditioning plant shut-down. They start only after the person has been back in the guilty environment for some hours, perhaps in the late afternoon of the first day, and often become severe in the evening and night after the person has left work, lasting for 24-48 hours. Despite the fact that the person may continue working in the contaminated environment, the symptoms do improve, indicating that an allergic reaction may be involved.
Cold water humidification systems can become contaminated with a wide range of micro-organisms (algae, amoebae, bacteria and fungi) and the response may be to the organism itself or to toxins produced. humidification systems that spray tepid water into the air are most prone to cause humidifier fever. The treatment of humidification systems with biocides or other chemicals can make the situation worse, since the chemicals may also be toxic. Humidifier fever is said to occur in about 3 per cent of people working in offices where a humidifier in the air-conditioning system is in operation (Robertson and Burge 1985).
Permanent lung damage does not occur, although a few reports have been made of people who have developed the more serious condition extrinsic allergic alveolitis due to organisms from humidification systems (Robertson and Burge 1985).
See also Asthma
Problems associated with poor air quality at work are often put down by bosses as a hysterical reaction, particularly since clerical staff are more likely than managerial staff to suffer from sick building syndrome and more women than men are clerical workers (Wilson and Hedge 1987). Since sick building syndrome has been accepted as a 'definite entity' by the Health and Safety Executive and the World Health Organization, the label of 'hysteria' can be seen as evidence of ignorance.
The influenza virus, like other airborne infectious agents, can be spread around a building by the recirculation of air in a ventilation system. Symptoms of flu are similar to those of humidifier fever, although their expression is not work related and they tend to last longer.
People working in sick buildings tend to suffer more from respiratory infections.
Lethargy, described in dictionaries as 'morbid drowsiness', might also go under the headings of tiredness, lack of energy, apathy, mental fatigue and sleepiness. The feeling that it is a great effort to concentrate tends to develop in the afternoons but improves once the person goes outside the workplace - sometimes within minutes, sometimes within 2-3 hours (Robertson and Burge 1985).
For lethargy to be taken seriously as a work-related condition it may be best to keep a diary, scoring the lethargy on a scale from 0-7 every 2 hours. The lethargy experienced in sick building syndrome is often also accompanied by a headache.
Lethargy may be experienced by about 50 per cent of workers in buildings that are air conditioned, with or without humidification systems, although about 15 per cent of people working in naturally ventilated buildings also complained of this symptom in the same study (Finnegan et al 1984). Many causes have been suggested for the symptoms of headache and lethargy: lack of negative ions, lack of air movement, low humidity, ozone and carbon monoxide, formaldehyde from furniture and furnishings, too much time spent at a visual display unit, fluorescent lighting.
See also Humidifier fever, Sick building syndrome
Nasal problems
If the air is dry, the mucous membranes of the nose will also be dried and the nose will feel 'stuffy'. Or the membranes may be irritated and inflamed (as in the allergic response seen in hay fever), so that the nose is runny and perhaps itchy or blocked.
Nasal problems are more common in mechanically ventilated buildings with chiller or humidification systems than in those without such systems, which in turn have more problems than naturally ventilated buildings (Finnegan et al 1984; Robertson et al 1985; Burge et al 1987). Stuffy nose and dry throat, eyes and skin, are thought to be due to working in an atmosphere with low relative humidity or moisture content. However, one study showed that humidity levels were adequate, casting some doubt on the reasons for the 'dryness' reaction (Robertson et al 1985).
Nasal problems often go hand in hand with throat and eye problems.
See also Humidifier fever, Sick building syndrome
Nausea and dizziness are included in the World Health Organization's (1983) list of symptoms associated with sick building syndrome, but not all researchers have found these problems to be any more common than in the general population (Wilson and Hedge 1987).
Respiratory infections
A dry atmosphere leads to an increased incidence of respiratory infections since the mucous membranes are dried out too. Upper respiratory tract infections, such as colds and influenza, are more common in air-conditioned offices than in naturally ventilated ones (Ruheoann 1985). This may be partly due to the fact that recirculation of air in the system will spread viruses around the building and partly due to the debilitating effects of sick building syndrome. The inhalation of contaminated water from humidification systems may also cause respiratory infections.
'I work in a building that has a second-hand air-conditioning system and I don't think it works properly. All of us have had cold after cold and sore throats and coughs galore. We all feel very tired and lethargic at the end of the day. The boss won't allow us to have the windows open - even in the summer. I always feel headachy and my lungs are craving for fresh air at the end of the day. It feels very claustrophobic in there sometimes.' (Electrical wirer of audio equipment, Salisbury, Wiltshire)
See also Humidifier fever, Sick building syndrome, Stress

Sick building syndrome
Since the symptoms of sick building syndrome are common in the general population, it is the pattern of their expression that points to the diagnosis: in sick building syndrome, symptoms are associated with being in a particular building and are relieved by leaving or staying away from that building. Table 1 shows two types of syndrome; one is a more allergic response in sensitive individuals. In addition, the World Health Organization (1983) lists the following symptoms of malaise:

  • eye, nose and throat irritation
  • sensation of dry mucous membranes and skin
  • erythema
  • mental fatigue
  • headache
  • high frequency of airway infection and cough
  • hoarseness, wheezing, itching and unspecific hypersensitivity
  • nausea, dizziness

In a study of 4373 people working in 46 buildings (Wilson and Hedge 1987), 80 per cent had symptoms of ill-health which they associated with being in their place of work. Twenty-five per cent experienced one or two symptoms only, but 29 per cent had five or more symptoms. Lethargy was the most common complaint (57 per cent), followed by stuffy nose (47 per cent), dry throat (46 per cent), headache (43 per cent), itching eyes (28 per cent), dry eyes (27 per cent), runny nose (23 per cent), flu-like symptoms (23 per cent), difficulty in breathing (9 per cent) and chest tightness (9 per cent).
This study also showed that people with clerical/secretarial jobs have 50 per cent more symptoms than those with managerial posts, and 30 per cent more than 'professionals'. The likely reasons for this are that clerical workers most often work in open-plan offices where there is less control over environmental conditions than in cellular offices; they are more tied to their desks, so that they are exposed to the same conditions for most of the working day, unlike managers who are usually more mobile; and they often do repetitive, visually demanding jobs that stress the body physically. (Clerical/secretarial work comes high on the ladder of stressful occupations.)
Women report symptoms more frequently than men, a difference that may be due to the fact that women are employed predominantly in clerical/secretarial jobs and men in professional/managerial posts. Also, women tend to be more aware of how they are feeling than men. Another suggestion for this gender difference is that women may be more prone to sick building syndrome because a dose-response relationship exists: women need a lesser dose of a chemical or pollutant to become ill (Jones 1989).
People working in air-conditioned buildings consistently show higher rates of sickness than those working in buildings that are naturally ventilated or that have mechanical systems of ventilation supplying ducted air but not cooling or humidifying it, although it may be pre-heated (Finnegan et al 1984; Robertson et al 1985; Burge et al 1987; Wilson and Hedge 1987; Wilson et al 1987). For all ventilation categories, workers in public sector buildings have consistently higher rates of building-related sickness than those in the private sector (Wilson and Hedge 1987).

Skin problems
Dryness of the skin affects exposed areas such as the face, lips, arms and hands. In one study it was found to be commoner in women, who found they had to use more moisturising cream after moving from a naturally ventilated to an air-conditioned building (Finnegan et al 1984). Other reported problems include rashes, blotches (erythema) and itchy skin.
See also Sick building syndrome
The acute problems associated with stress include headaches, digestive disorders, fatigue and lethargy, sleeping problems, skin disorders and a reduced immunological response (i.e. a decreased resistance to infection). Many of these symptoms are similar to those seen in sick building syndrome, so stress due to environmental and other factors should also be considered as a cause of sick building syndrome.
Throat problems
Dry throat and hoarseness are symptoms that indicate drying of the mucous membranes and are often found together with a stuffy nose and sore eyes. Throat and chest infections are more common in buildings with air quality problems.
See also Eye problems, Nasal problems, Sick building syndrome
See Asthma

Sick Building Syndrome: causes, effects and control - Chapter 2

© 1990 London Hazards Centre, Interchange Studios, Hampstead Town Hall Centre, 213 Haverstock Hill, London NW3 4QP, UK

Monday, April 16, 2007

Sick building syndrome: psychosocial and physical factors

Is health in office buildings related only to psychosocial factors?

M J Mendell and W J Fisk
Indoor Environment Department, Lawrence Berkeley National Laboratory, California, USA

It has been clear for years, on the basis of much published research, that symptoms in office workers are associated with several environmental factors in office buildings and also, independently, with psychosocial stressors at work. So, we were surprised to see a recent article by Marmot et al reporting that, in offices in the Whitehall II Study, "raised symptom levels appear to be largely due to a working environment characterized by poor psychosocial conditions". The article concluded that the physical environment in the offices had a small and unimportant influence on these symptoms. The analyses, however, had substantial limitations that were not mentioned. Further, the conclusions were inconsistent with much of the current scientific literature, but the discussion cited only other studies that agreed with the findings and none of the substantial literature that disagreed.

We expand on these points.
1. Key environmental measurements and interpretations used by Marmot et al in the 1991–3 data collection are no longer considered relevant by most indoor environmental scientists. Single metrics of total volatile organic compounds that lump all compounds together have long been considered inappropriate for predicting human response, because irritancy and odour vary by orders of magnitude among specific volatile organic compounds. Metrics based on counts of culturable airborne fungi and bacteria do not detect most indoor microbial matter and "provide little information about the microbial status of an indoor environment". Also, many of the thresholds for acceptability used by Marmot et al are not considered relevant for studying building-related symptoms—for example, dry bulb temperature between 19 and 24°C, carbon dioxide (CO2) 500 parts per million, or any particular number for total airborne fungi, bacteria or volatile organic compounds. In addition, the lumping together of extreme high and low levels for many of the parameters (eg, combining very hot and very cold temperatures in one category and comparing with a broad middle range of temperatures) is inappropriate—high and low temperature (or high and low humidity) may have quite different, even opposite, effects. Researchers using more current or precise metrics have reported consistent associations of building-related symptoms in office workers with both lower ventilation rates and higher temperatures. There is also a substantial amount of literature showing that visible dampness and mould, but not traditional airborne mould counts, are consistently associated with asthma exacerbation and respiratory symptoms in building occupants.

2. The authors do not report the association of passive tobacco smoke exposure at work with symptoms, although it is included in their models as a confounding factor. It was strongly correlated with increased symptoms (p = 0.004) in prior analyses of their data. The current article, without explanation, does not consider passive tobacco smoke exposure to be an indoor environmental risk factor, although it reports risk estimates for other indoor air pollutants.

3. The paper cites prior studies that agreed with its findings, but is inexplicably silent about the many prior studies that have disagreed. Ventilation rate and temperature, both objectively assessed indoor environmental risk factors, have been significantly and independently associated with symptoms in multiple prior office studies.

A 1999 review of studies reported between 1986 and 1999 found that (1) in six studies using measured ventilation rates, 20 of 27 comparisons of different ventilation rates found increased symptoms associated with lower measured office ventilation rates, and (2) 9 of 18 studies using CO2 measurements as simpler but less accurate indicators of ventilation rate also found such associations. Nine articles on associations between temperature and symptoms in offices, published between 1989 and 2004, show overall that symptom prevalence increased systematically as temperatures increased between about 21 and 24.5°C, almost entirely within the "acceptable" reference level used by Marmot et al.

We suggest further analyses of the Whitehall II data by Marmot et al to refine their findings and help resolve discordant results: (1) the use of environmental metrics based on current knowledge that symptoms in office workers generally increase as temperatures increase >21–22°C, as indoor CO2 increases above about 600–800 ppm, with the presence of passive tobacco smoke, and in buildings with air-conditioning or humidification; (2) statistical adjustment for season of study; (3) the inclusion of the additional psychosocial variables available in the Whitehall II study; and (4) separate analyses for outcomes of biologically related symptom subgroups—rather than continuing to use the non-specific "sick building syndrome" metric (for instance, lumps, rash/itch, together with cold/flu), which may be sensitive to stress-related over-reporting but insensitive to specific biological effects.

In conclusion, substantial evidence suggests that psychosocial and physical factors in indoor environments, as well as biological and chemical factors, influence the symptoms experienced by office workers, through multiple mechanisms that we still do not understand. Dismissing the importance of any of these indoor environmental risk factors is not useful or, based on all that we know, justified.

Ultimately, researchers in many disciplines will need to help us understand causation and prevention of this problem.

Friday, April 13, 2007

Late-Life Insomnia: Brief Behavioral Treatment

Effects of a Brief Behavioral Treatment for Late-Life Insomnia: Preliminary Findings

Anne Germain, Ph.D.; Douglas E. Moul, M.D., M.P.H.; Peter L. Franzen, Ph.D.; Jean M. Miewald, B.A.; Charles F. Reynolds, III, M.D.; Timothy H. Monk, Ph.D., D.Sc.; Daniel J. Buysse, M.D.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

Study Objectives: Insomnia is a chronic and prevalent sleep disorder in adults older than 65 years. Hypnotics raise safety concerns in this group, and standard behavioral treatments are time consuming. This preliminary report addresses the effects of a brief behavioral treatment for insomnia in older adults who present with the typical psychiatric and medical comorbidities of aging.

Methods: Thirty-five older adults (10 men, 25 women, mean age = 70.2 ± 6.4 years old) were randomly assigned to a brief behavioral treatment for insomnia (BBTI; n = 17) or to an information-only control (IC; n = 18) condition. All subjects completed clinician-administered and self-report measures of sleep quality, as well as a sleep diary, at baseline. Interventions were delivered in a single individual session with a booster session administered 2 weeks later. Postintervention assessments were completed after 4 weeks.

Results: Significant improvements in self-report and sleep diary measures and mild-to-moderate improvement in anxiety and depression were observed after treatment in participants randomly assigned to BBTI, as compared with participants randomly assigned to IC. At posttreatment assessment, 12 BBTI participants (71%) and 7 IC participants (39%) met criteria for response. Nine BBTI participants (53%) met criteria for remission, whereas, in the IC group, 3 participants (17%) met the criteria.

Conclusion: BBTI was associated with significant improvements in sleep measures and in daytime symptoms of anxiety and depression. BBTI appears to be a promising intervention for older adults with insomnia.

Journal of Clinical Sleep Medicine VOL. 2, №4, OCTOBER 15, 2006, p. 407-408
American Academy of Sleep Medicine

Thursday, April 12, 2007

Sick Building Syndrome

Sick Building Syndrome

People who work in office buildings, from cleaning staff to CEOs are not immune to occupational lung diseases. When a substantial number of building occupants experience symptoms that do not fit the pattern of any particular illness and are difficult to trace to any specific source, the problem may be “sick building syndrome.” Sick building problems may arise because of poorly designed or maintained heating, ventilating and air conditioning (HVAC) systems, office equipment, furniture and supplies and operations in the building.

To save rising energy costs, new buildings are tightly sealed and modern ventilation systems recycle a large portion of inside air. If the system is not carefully designed or maintained, fresh air may not reach the worker. For example, use of flexible office partitions in large open spaces can interferewith air distribution. Energy costs in older buildings are reduced by adding insulation, caulking and weather-stripping. Windows are made air-tight and outside air dampers are closed.

Whether a building is old or new, the same recirculated air is breathed again and again by the people working in these buildings. The problem is made worse by increasing numbers and varieties of pollutants from furnishings, HVAC systems, modern office equipment and supplies, humidifiers and dehumidifiers, and secondhand tobacco smoke. In fact, according to the National Institute of Allergy and Infectious Disease poorly ventilated office spaces aid in the transmission of pneumonia to three million people annually.

According to the U.S. Department of Energy (DOE), improving buildings and indoor environments could reduce healthcare costs and sick leave and increase worker performance, resulting in an estimated productivity gain of $30 billion to $150 billion annually. The DOE further estimated the potential decrease in adverse health effects from improvements in indoor environments to be 10 percent to 30 percent for infectious lung disease, allergies and asthma; and 20 percent to 50 percent for Sick Building Syndrome symptoms.

For the United States, the corresponding annual healthcare savings plus productivity gains are:
- $6 billion to $19 billion from reduced lung disease,
- $1 billion to $4 billion from reduced allergies and asthma,
- $10 billion to $20 billion from reduced Sick Building Syndrome symptoms,
- $12 billion to $125 billion from direct improvements in worker performance unrelated to health

American Lung Association

Wednesday, April 11, 2007

Management of cluster headache

Management of cluster headache

Beck E, Sieber WJ, Trejo R.
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.

Cluster headache, an excruciating, unilateral headache usually accompanied by conjunctival injection and lacrimation, can occur episodically or chronically, and can be difficult to treat. Existing effective treatments may be underused because of underdiagnosis of the syndrome.

Oxygen and sumatriptan have been demonstrated to be effective in the acute treatment of cluster headaches. Verapamil has been shown to be effective for prophylaxis. For cluster headache completely refractory to all treatments, surgical modalities and newer interventions such as the implantation of stereotactic electrodes may be useful. Patients should be encouraged to avoid possible triggers such as smoking or alcohol consumption, especially during the duster period.

The intensity of duster headache pain leads to ethical concerns among researchers over the use of placebo, making randomized controlled trials difficult. As new technology and genetic studies clarify the etiology of duster headache, it is possible that more specific therapies will emerge.

Am Fam Physician. 2005 Feb 15;71(4):717-24.

Monday, April 09, 2007

Effects of prenatal cocaine exposure

Developmental Outcomes of Prenatal Cocaine Exposure in Infants and Young Children

Assessments in language, cognition, and motor and behavioral development is currently under study in this population. The research, therefore, is not conclusive as investigators begin to isolate confounding factors and determine the solitary effects of prenatal cocaine exposure and adverse long-term developmental outcomes.

Research indicates prenatal exposure to cocaine may affect the young child's language development, although the findings are inconsistent. Hurt, Malmud, Betancourt, Brodsky, and Giannetta (1997) investigated the early language development of 76 2 1/2-year-old children prenatally exposed to cocaine to a matched control group of 81 children. After administering the Preschool Language Scale-3 (PLS-3), the authors found no documented cocaine-related differences in terms of language function (receptive, expressive, or total language). The authors did not state whether poly-drug use was a control variable. Similarly, Kilbride, Castor, Hoffman, and Fuger (2000) reported no statistically significant difference in language development of term or near term infants prenatally exposed to cocaine, up to 3 years of age, by the Receptive-Expressive Emergent Language Scale and the Sequenced Inventory for Communicative Intent. In fact, the authors noted infants exposed to cocaine who received special early case management had a higher verbal score at 3 years of age.
In contrast, several investigators have found significant language delays among infants prenatally cocaine-exposed. Koren et al. (1998) examined the language functioning of 2 1/2-year-old children prenatally cocaine-exposed (n = 23) and adopted at birth into middle to upper class families to non cocaine-exposed control group (n = 23). After administering the Reynell language test, the authors found the children exposed to cocaine prenatally had statistically significant language delays. The authors identified that their design provides exclusion of postnatal environment influences on language functioning of infants prenatally exposed to cocaine. Similarly, Morrow et al. (2003) evaluated the association between prenatal cocaine exposure and language development of 253 African American full-term infants prenatally exposed to cocaine from the Miami Prenatal Cocaine Study. Kent Scoring Adaptation for language test was administered at 4, 8, 12, 18, and 24 months and the Clinical Evaluation of Language Fundaments-Preschool (CEL-P) at 3 years of age. After controlling for confounding factors, the authors reported the young children cocaine exposed prenatally had a lower overall language scores.
Singer et al. (2001) and a recent study by Morrow et al. (2004) both found language delay in infants/young children exposed to cocaine prenatally to be associated with increasing exposure. Singer et al. (2001) performed a longitudinal investigation of speech-language skills of 1-year-old infants (134 infants prenatally exposed to cocaine, 66 heavily exposed, and 68 lightly exposed) to a matched control group of 131 infants by administering the PLS-3. The authors reported infants heavily prenatally exposed to cocaine performed poorer on total language and auditory comprehension (receptive language) than infants with light or no exposure to cocaine prenatally. Morrow et al. (2004) looked at 424 African American full-term young children at 3 years of age (226 prenatally exposed to cocaine and 196 not) and measured their language function using the CEL-P to assess the expressive and receptive language skills. They found a significant difference in expressive and receptive language function with increasing prenatal cocaine exposure.

The results of studies to determine an association between a cognitive delay and prenatal cocaine exposure are conflicting. Several studies documented no statistically significant differences on cognitive development assessed by the Bayley Scale of Infant Development's Mental Development Index (BSID-MDI) among infants/young children exposed to cocaine prenatally when tested at 6-24 months (Frank et al., 2002; Jacobson et al., 1996; Kilbride et al., 2000; Messinger et al., 2004).

Similarly, Koren et al. (1998) investigated the intelligence quotient (IQ) of 2 1/2-year-old children prenatally cocaine-exposed (n = 23) and adopted at birth into middle to upper class families to a control group (n = 23). The authors identified that their design provides exclusion of postnatal environment influences on the cognitive functioning of infants prenatally exposed to cocaine. After administering the Bayley and McCarthy IQ tests, they found no differences in global IQ between the two groups; however, they reported a trend towards lower IQ of the children in the cocaine-exposed group.

In contrast, Singer and colleagues (2002) reported infants prenatally exposed to cocaine are twice as likely to have significant cognitive delays throughout their first 2 years of life than non-exposed infants. Alessandri, Bendersky, and Lewis (1998) and Lewis, Misra, Johnson, and Rosen (2004) reported lower MDI scores among infants/young children heavily prenatally cocaine-exposed. Alessandri and colleagues (1998) examined the cognitive functioning of infants prenatally cocaine-exposed (heavily exposed [n = 30) and lightly exposed [n = 30] to a matched control group [n = 169] at 8 and 18 months of age) using the BSID-II's MDI. They documented a decrease in MDI scores only at 18 months of age among infants prenatally cocaine-exposed overall, but the infants heavily exposed had the poorest scores. Lewis and associates (2004) examined the effects of prenatal cocaine exposure and cognitive development at 12, 18, 24, and 36 months of 147 young children who were exposed and 89 who were not. After controlling for confounding factors and using the BSID-MDI, the authors found the young children with higher meconium concentrations of cocaine metabolites had lower test scores with a decline at 18 months on mental development.

Motor performances in infants/young children prenatally exposed to cocaine assessed by motor developmental scales are also not consistent. Various researchers have reported no statistically significant findings of motor developmental delays among infants/young children exposed to cocaine prenatally (Jacobson et al., 1996; Kilbride et al., 2000; Messinger et al. 2004; Singer et al., 2002) assessed by the BSID-Psychomotor Developmental Index (PDI). Jacobson et al. (1996) examined 464 young children exposed to cocaine prenatally at 13 months of age. Kilbride et al. (2000) investigated term or near term infants prenatally exposed to cocaine (those who received early case management [n = 70] or routine follow-up [n = 48]) and infants who were not exposed (n = 41) up to 3 years. Singer and colleagues (2002) looked at 218 infants prenatally cocaine-exposed and 197 infants non-exposed at 6.5, 12, and 24 months. The authors noted only an increase in lower motor scores from 6.5 months to 2 years, and boys were more affected than girls in the infants/young children exposed to cocaine prenatally. Messinger and associates (2004) examined infants/young children exposed to cocaine (n = 474), opiates (n = 50), cocaine and opiates (n = 48), and neither substances (n = 655) at 1, 2, or 3 years of age.

Again, in contrast, Arendt, Angelopoulos, Salvator, and Singer (1999) assessed the motor development of an inner city population of primarily African American 2-year-old children, 98 prenatally cocaine exposed, to a matched group of 101 non-exposed children using the Peabody Developmental Motor Scales (PDMS). They found a statistically significant poorer performance among the young children exposed to cocaine prenatally on both gross (balance and the receipt and propulsion subscales) and fine (the hand use and the eye-hand coordination subscales) motor while controlling for covariates. Similarly, Lewis et al. (2004) investigated the effects of prenatal cocaine exposure on motor development at 12, 18, 24, and 36 months of 147 young children who were exposed and 89 who were not. After controlling for confounding factors and using the BSID-PDI, the authors found the young children with higher meconium concentrations of cocaine metabolites and males had lower performance scores with a decline at 18 months on motor sequelae.

Currently, there are only a few studies investigating behavioral development up to the age of 3 in children prenatally exposed to cocaine. Researchers are now looking at these children in their school age years.
Beeghly, Frank, Rose-Jacobs, Cabral, and Tronick (2003) examined the infant-caregiver attachment behavior of 154 full-term 12-month-old infants (heavily prenatally cocaine-exposed [n = 29], lightly prenatally cocaine-exposed [n = 61], and not exposed [n = 64]) using Ainsworth's Strange Situation. They found no statistically significant effects between secure/insecure or disorganized attachment status and the infant's level of prenatal cocaine exposure. However, the mother-infant dyads of the infants heavily prenatally exposed to cocaine and whose mother did not receive public financial assistance were shown to exhibit a higher level of behavioral disorganization with their caregivers during the Strange Situation. Similarly, Messinger et al. (2004) documented no association between prenatal cocaine exposure and behavior development deficit in the young child at 1, 2, or 3 years of age after accounting for confounding factors. This study examined these young children exposed to cocaine (n = 474), opiates (n = 50), cocaine and opiates (n = 48), and neither substances (n=655) on the BSID-II, Behavioral Record Scales.

Pediatr Nurs. 2005;31(5):427-436.

Thursday, April 05, 2007

Alternative Health - Music Therapy

Music Therapy

The idea of using music as a healing influence dates back to the time of Platon and Aristotle. In the modern world, music for therapy came to the fore when musicians played for war veterans to cure them of physical and emotional trauma. Since many of the patients responded well, nurses and doctors began requesting the services of musicians for therapy.

Soon, music therapy became recognized as an effective and scientifically-backed mode of treatment. The first music therapy degree program ever was established in 1944 in the State of Michigan, U.S.

A trained music therapist gauges the emotional well-being, physical health, social functioning and cognitive skills through the patient's responses to music. Once the assessment is complete, the practitioner designs music session for individuals or groups. The therapeutic music is prepared based on client needs and uses music improvisation, song writing, lyric discussion, imagery and musical performances.

Using music for therapy can be a very powerful way to reach children and adolescents. Elderly people and people with developmental and learning disabilities, people suffering from Alzheimer's disease and age related problems and people in acute pain also benefit from music therapy. Music therapy is a powerful way to help people express their feelings. Professional music therapists are usually found in rehabilitative facilities, psychiatric hospitals, medical hospitals, drug and alcohol programs, nursing homes, correctional facilities, schools and private practice.

Some people mistakenly believe that a patient needs to have some particular musical ability to benefit from therapy. There is no one particular style of music that is more therapeutic than the rest. Any style of music can be equally effective. Any person can be a patient. The patient's background, needs and history help determine the type of music used.

Even healthy people can make use of the healing powers of music. Listening to or making music, playing or drumming can greatly reduce stress and improve productivity. Research shows that music is a vital support for physical exercise. Music therapy is even said to assist labor and delivery.

In hospitals, music therapy is used to alleviate pain and is often used in conjunction with anesthesia or pain medication. A question that is often raised is why use music if anesthesia does the same thing? Music helps because it dissolves emotional barriers and elevates the patient's mood. Music also counteracts depression, calms and even sedates patients. In a nutshell, music helps reduce muscle tension and brings on a deep and satisfying relaxation.

Since 1994 music therapy has been identified as a reimbursable service in the U.S. Music therapy is considered 'active treatment' when it meets the following criteria:
- Is prescribed by a physician
- Is reasonably necessary for the treatment of the injury or condition
- Is based on a documented treatment plan
- Is showing some sort of result in the patient

The future of music therapy is indeed very promising as more and more research supports the effectiveness of music against diseases like Alzheimer's and chronic pain.

Cocaine-Exposed Children


Trained research assistants, unaware of a child's history, cannot tell the difference between a 4-year-old who was exposed to cocaine before birth and one who was not, according to new research.
"Adults may interpret normal infant or child behavior as abnormal if adults have preconceived negative beliefs about the consequences of prenatal drug exposure," says lead author Ruth Rose-Jacobs, Sc.D., of Boston University School of Medicine.
Recent research suggests that most maladaptive behavior and developmental delay in children from urban and impoverished areas is not uniquely due to prenatal cocaine exposure, and, conversely, that such exposure does not necessarily lead to developmental delay or behavioral problems.
Using a battery of standardized cognitive and behavioral assessments, assessors tested 163 children who were relatively healthy at birth. When the children were compared on a computer by their actual cocaine exposure, there were no statistically significant differences on the developmental and behavioral tests. Other biologic and social factors that could influence the development of impoverished children were not evaluated in these analyses, the researchers note.
Assessors in this study were purposely not told of the children's actual cocaine exposure and developmental history. The study, published in the October issue of the Journal of Developmental and Behavioral Pediatrics, refers to these assessors as "masked" to exposure status.
The masked assessors labeled 111 of the 163 children as having been exposed to cocaine prenatally, although only 87 had actually been exposed. The assessors did not report reasons why they classified certain children as cocaine exposed. The children who had significantly lower scores on all of the administered assessments were assumed to be cocaine-exposed by the assessors regardless of actual exposure status.
"In other words, the assessors were not only unable to correctly identify which children had been exposed in-utero to cocaine, they were also more likely to presume exposure if a child displayed cognitive and behavioral problems during testing," says the study's lead author Rose-Jacobs. "These results suggest that clinicians and educators should distrust the perception that at the preschool age, there are subtle cues that allow them to 'just know' who is cocaine exposed."
"Stigma itself is a social and developmental risk to children who were cocaine-exposed prenatally, regardless of the pharmacological effects of the drug or the reasons for assuming cocaine exposure," the researchers warn.
Previous research has shown that the same videotapes of healthy infants were rated very differently when given the label of "born without any known problems" versus "born without any known problems other than the infant's mother had used cocaine during pregnancy." When videotaped infants were labeled cocaine-exposed, they were rated as less smart, affectionate, well behaved, outgoing, cheerful, alert and coordinated than when they were not so labeled.
Labeling children as cocaine-exposed may lead to the imposition of negative expectations, which in turn undermines the children's cognitive and behavioral development, they said.
"Rather than merely creating a stigmatizing label, early identification of cocaine exposure should provide these children with the same treatment and nurturing needed by all children who are at developmental risk," says Rose-Jacobs.
The study was funded by grants from the Foundation for Physical Therapy Inc., the National Institute of Drug Abuse and the National Center for Research Resources.

Journal of Developmental and Behavioral Pediatrics: Contact Mary Sharkey at (212) 595-7717.