Saturday, May 8, 2010

TV Watching at Age 2 Spells Trouble Later


TV Watching at Age 2 Spells Trouble Later



By Kathleen Doheny
WebMD Health News

Reviewed By Laura J. Martin, MD

May 3, 2010 -- Television watching at age 2 1/2 boosts a child's risk of having multiple school and health problems later in life, according to a new study.

The effects of too much TV too early was far-reaching and long-lasting, says study author Linda Pagani, PhD, professor of psycho-education at the Universite de Montreal and a researcher at the Sainte-Justine University Hospital Research Center in Montreal, Canada.

"You get a child who's more sedentary, has a higher BMI, is not eating properly, and not doing well in school socially and academically in the fourth grade," Pagani tells WebMD.

Numerous other studies have focused on the effects of television viewing on children, linking too much screen time to poorer school work and excess weight later. But Pagani says her new research is more comprehensive -- it looked at a variety of potential effects, not a single one. And she followed up on the children longer -- until age 10, or fourth grade.

Evaluating the effects of early TV viewing is important, she says. "From birth to age 5, you have enormous brain expansion. We're talking exponential."

And, according to her research, early television viewing is not doing the toddler brain any favors.
Television and Kids: Study Details

For the study, Pagani and her colleagues gathered data on 1,314 children born in Quebec, Canada, between 1997 and 1998.

Parents reported how many hours a week their children viewed television at 29 months and again at 53 months. The researchers gathered teacher and parent reports on academic performance, psychosocial and health habits, and the children's body mass index or BMI.

At age 29 months, the average TV viewing was 8.82 hours a week, Pagani found. At 53 months, the average was 14.85 hours.

Although that may not sound high, Pagani notes that the range was wide. "This is an average," she says, so many children watched more.

At 29 months, 11% of the toddlers were watching more than two hours a day. By age 53 months, 23.4% of the children were watching more than two hours a day.

Current recommendations by the American Academy of Pediatrics discourage television viewing for children under age 2 and suggest no more than one or two hours of "screen time" (TV, computers) daily for older children.
Television Viewing and Kids: Effects

Television viewing had undesirable effects, even after the researchers adjusted for a number of variables that might account for the effects, such as family configuration and education of the mother, and the amount of TV they viewed as fourth graders.

"We considered all kinds of competing explanations," Pagani tells WebMD. But even after taking all the factors into account, the effects remained, she says.

"Basically we saw kids who watch excessive TV at 29 months were more likely to be less productive in class [in fourth grade] as rated by their teachers," she tells WebMD. "They were performing less well in mathematics. We also saw negative effects in anything that required effortful exercise -- how often they exercised, whether they liked to do anything that requires effort. And their body mass index was greater."

The children exposed to too much TV were also likely to be victimized, she found, explaining that social relationships take practice and effort. "Kids who do too much media, studies have shown this, tend to be socially isolated."

Not having social skills, she says, may make the kids targets for being teased and insulted by classmates.

Each additional hour of TV viewing at age 29 months (over the average for each child) was linked to a range of effects, Pagani found, including:

* 7% decrease in classroom engagement
* 6% decrease in math achievement
* 10% increase in being victimized by peers
* 13% decrease in physical activity on weekends
* 9% higher intake of soft drinks
* 5% increase in probability of being overweight as calculated by BMI

Television Viewing and Kids: Other Opinions

The new findings are no surprise to Ed Christophersen, PhD, a clinical child psychologist at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who reviewed the study results for WebMD.

The new research, he says, documents what he and his colleagues have believed about the link between too much TV and developmental and other problems.

"This study pulls together multiple measures that many of us thought were affected by early TV, but now we know they are," Christophersen tells WebMD. He reminds parents that TV time limits should also include "screen" time from computers and other media.

Most parents are aware of the hazards of too much screen time, says Rahil Briggs, PsyD, director of the Healthy Steps at Montefiore Medical Center and assistant professor of pediatrics at Albert Einstein College of Medicine in New York, who also reviewed the findings.

Parents rely on TV for a break, she finds. "I think it's because parents are overworked, exhausted, and really highly stressed."

Although that's fine for occasional "breathing room," she suggests parents think of other ways to relax without leaning on TV.

"Take your child to the park," she suggests, so he can learn to interact and you can still relax a bit.

"If you have to plop down in front of the TV, have a conversation with your kid about what you are watching," she says. "Make it an interactive experience."

SOURCES: Linda S. Pagani, PhD, psychosocial professor, University de Montreal and researcher, Sainte-Justine University Hospital Research Center, Montreal, Canada.

Pagani, L. Archives of Pediatrics & Adolescent Medicine, May 2010; vol 164: pp 425-431.

Rahil Briggs, PsyD, director, Healthy Steps at Montefiore Medical Center; assistant professor of pediatrics, Albert Einstein College of Medicine, New York.

Ed Christophersen, PhD, clinical child psychologist, Children's Mercy Hospitals and Clinics, Kansas City, Mo.

©2010 WebMD, LLC. All Rights Reserved.

Thursday, May 6, 2010

Skin Problems


Skin Problems



say "roh-ZAY-sha") is a skin disease that causes redness and pimples on your nose, cheeks, chin, and forehead. The redness may come and go. People sometimes call rosacea "adult acne" because it can cause outbreaks that look like acne. It can also cause burning and soreness in the eyes and eyelids.

Rosacea often flares when something causes the blood vessels in the face to expand, which causes redness. Things that cause a flare-up are called triggers. Common triggers are exercise, sun and wind exposure, hot weather, stress, spicy foods, alcohol, and hot baths. Swings in temperature from hot to cold or cold to hot can also cause a flare-up of rosacea.Rosacea can be embarrassing. And if it is untreated, it can get worse. If the symptoms bother you, see your doctor and learn ways to control rosacea.

Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.



DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Other members of this class include aspirin, naproxen (Aleve), indomethacin (Indocin), nabumetone (Relafen) and several others. These drugs are used for the management of mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The FDA approved ibuprofen in 1974.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets of 200, 400, 600, and 800 mg; Chewable tablets of 50 and 100 mg; Capsules of 200 mg; Suspension of 100 mg/2.5 ml and 100 mg/5 ml; Oral drops of 40 mg/ml.

STORAGE: Ibuprofen should be stored at room temperature, between 15-30°C (59-86°F).

PRESCRIBED FOR: Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases.

DOSING: For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.

Arthritis is treated with 300 to 800 mg 3 or 4 times daily.

When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily. Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.

Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.

Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.

Ibuprofen should be taken with meals to prevent stomach upset.

DRUG INTERACTIONS: Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs. Ibuprofen may increase the blood levels of lithium (Eskalith) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity. Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure. When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.

PREGNANCY: There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart..

NURSING MOTHERS: Ibuprofen is not excreted in breast milk. Use of ibuprofen while breastfeeding, poses little risk to the infant.

Monday, May 3, 2010

OTC Pain Medication and Fever Reducers (Analgesics, Antipyretics)


OTC Pain Medication and Fever Reducers
(Analgesics, Antipyretics)



Medical Author: Annette O. Gbemudu, PharmD, MBA
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

* Introduction to OTC pain medication and fever reducers
* What are the classifications of pain?
* What are the types of headaches?
* What causes fever?
* What are the different classes of pain relievers and fever reducers?
* Aspirin
* Acetaminophen
* Nonsteroidal antiinflammatory drugs (NSAIDs)
* What about overdoses of pain relievers and fever reducers?

Introduction to OTC pain medication and fever reducers

Pain is the most common reason for people to seek medical advice, pain medicine is the most frequently purchased over-the-counter (OTC) medication. Fever is one of the most common reasons that children visit the doctor. Moreover, one in five emergency room visits for children is due to fever. Since OTC medicines that are effective in treating pain also are effective at reducing fever, they will be considered together in this article.

What are the classifications of pain?

Pain can be classified as acute, chronic non-malignant, chronic malignant. Headaches are the most common cause of pain and can be considered a separate class of pain.

Acute pain

Acute pain is experienced by everyone; it is usually short in duration with an identifiable pathology, a predictable prognosis, and treatment that usually includes analgesics. Acute pain is most often due to injuries. Examples of injuries include:

* muscle soreness due to overuse, sprains or strains, or viral infections,

* tears of the ligaments,

* broken bones,

* bruises, and

* cuts.

Acute pain from such injuries can respond well to OTC pain medication. Muscle soreness also may respond well to heat and massage.

Chronic non-malignant pain

Chronic non-malignant pain often begins as acute pain, but it continues beyond the typical time expected for resolution of the problem or persists or recurs for other reasons. It is a type of pain associated with progressive, debilitating diseases such as arthritis. Treatment for chronic non-malignant pain can include OTC medications . However, because of the chronic nature of the pain, regular use of OTC medications can lead to side effects.

Chronic malignant pain

Chronic malignant pain is pain associated with advanced, progressive diseases (often fatal) such as cancer, multiple sclerosis, AIDS, and terminal kidney disease. OTC medications for pain may be useful for the management of chronic malignant pain. However, stronger prescription medications are usually necessary.

What are the types of headaches?

Headaches are the most common reason that pain medications (analgesics) are taken. Headaches can be classified into three types:

1. muscle contraction,

2. migraine or vascular, and

3. sinus.

Muscle contraction headache

A muscle contraction headache, the most common type, results from the continuous tightening of the muscles in the upper back, neck, or scalp. This type of headache often is described as a tight, pressing, or throbbing sensation of the head. It can be brought on by emotional stress and anxiety ("tension headaches"). Acute muscle contraction headaches generally respond well to OTC analgesics, but chronic muscle contraction headaches can require physical therapy or relaxation techniques.

Blood Pressure Medication

Blood Pressure Medication



harmacy Author: Omudhome Ogbru, PharmD
Medical Editor: Jay W. Marks, MD

* ACE inhibitors
* Angiotensin receptor blocker (ARB)
* Beta-blockers
* Calcium channel blockers (CCBs)
* Diuretics
* Alpha-blockers
* Alpha-beta blockers
* Clonidine
* Minoxidil

ACE inhibitors

ACE inhibitors are medications that slow the activity of the enzyme ACE, which decreases the production of angiotensin II (a very potent chemical that causes the muscles surrounding blood vessels to contract, thus narrowing the vessels). As a result, the blood vessels enlarge or dilate, and blood pressure is reduced.

Angiotensin II is a very potent chemical that is formed by the enzyme angiotensin converting enzyme (ACE). Angiotensin II is released within the body and causes the muscles surrounding blood vessels to contract, thus narrowing the vessels and increasing blood pressure. ACE inhibitors are medications that inhibit the activity of ACE which decreases the production of angiotensin II. As a result, ACE inhibitors cause the blood vessels to enlarge or dilate, and this reduces blood pressure.

Examples of ACE inhibitors include:

* enalapril (Vasotec),

* captopril (Capoten),

* lisinopril (Zestril and Prinivil),

* benazepril (Lotensin),

* quinapril (Accupril),

* perindopril (Aceon),

* ramipril (Altace),

* trandolapril (Mavik),

* fosinopril (Monopril), and

* moexipril (Univasc ).

Angiotensin receptor blockers (ARBs)

Angiotensin II receptor blockers (ARBs) are medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate), and blood pressure is reduced.

Examples of ARB drugs include:

* losartan (Cozaar),

* irbesartan (Avapro),

* valsartan (Diovan),

* candesartan (Atacand),

* olmesartan (Benicar),

* telmisartan (Micardis), and

* eprosartan (Teveten).

Beta-blockers

Beta blockers are drugs that block norepinephrine and epinephrine (adrenaline) from binding to both beta 1 and beta 2 receptors on organs and muscles, including the muscles that cause blood vessels to narrow and the heart to beat. By blocking the effect of norepinephrine and epinephrine, beta blockers reduce blood pressure by dilating blood vessels and reducing heart rate. They also may constrict air passages because stimulation of beta receptors in the lung cause the muscles that surround the air passages to contract.

Swine Flu (Swine Influenza A [H1N1] Virus)


Swine Flu
(Swine Influenza A [H1N1] Virus)



Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators think the 2009 swine flu strain, first seen in Mexico, should be termed novel H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Recent investigations show the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

Why is swine flu (H1N1) now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus' antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.
Picture of antigenic shift and antigenic drift in swine flu (H1N1).

Medications and Drugs


Medications and Drugs



DRUG CLASS AND MECHANISM: FluMist is a nasal vaccine that protects against infection with the influenza virus or the "flu." FluMist contains live influenza virus that has been weakened so that it causes minimal or no symptoms. When FluMist is inhaled, the body responds to the weakened viruses in FluMist by developing antibodies that fight influenza viruses. These antibodies protect against later infections by the naturally-occurring influenza virus. FluMist is effective only against the strains of influenza virus that are included in it, and the strains of virus change from year to year. FluMist has no effect on the flu once infection has begun. FluMist should be given shortly before the flu season begins to allow time for antibodies to be produced and for protection throughout the entire flu season. FluMist does not prevent 2009 H1N1 (swine flu) virus infection. The FDA approved FluMist in June 2003.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: No.

PREPARATIONS: Intranasal Spray: prefilled single use intranasal spray, 0.2 ml

STORAGE: FluMist should be stored refrigerated between 2-8 C (35-46 F).

PRESCRIBED FOR: FluMist is used for preventing influenza virus infections (flu) in individuals 2 to 49 years of age.

DOSING: Children 2 to 8 years of age who have not previously received. FluMist should be given 2 doses of 0.2 ml one month apart. Children 2 to 8 years of age, who previously received FluMist and adults 9 to 49 years of age, should be given 1 dose (0.2 ml) each season. FluMist is administered by inhaling through the nose and is not given by injection. Half of a single dose (0.1 ml) should be inhaled into each nostril while in a standing position.

Since FluMist contains viruses that are likely to cause the flu in the upcoming season, FluMist developed for previous seasons will not be effective and should not be used.

DRUG INTERACTIONS: Children 5 to 17 years of age who are receiving aspirin therapy should not be given FluMist because of the association between aspirin, influenza infection and Reye's syndrome.

Use of FluMist together with antiviral drugs that are active against the influenza virus has not been evaluated. Since there is a potential for these agents to reduce the effectiveness of FluMist (by preventing infection with the weakened viruses in FluMist), such antiviral agents should not be administered until 2 weeks after FluMist therapy, and FluMist should not be administered until 48 hours after antiviral therapy is discontinued.

PREGNANCY: FluMist should not be given to pregnant women.

NURSING MOTHERS: Use of FluMist during breast feeding has not been adequately evaluated, and it is not known whether FluMist is excreted in breast milk.

SIDE EFFECTS: The most common side effects of FluMist are cough, runny nose, nasal congestion, sore throat, headache, restlessness, muscle aches, tiredness or weakness and fever. Hypersensitivity reactions have also been reported. FluMist should not be administered to individuals with asthma because it may increase wheezing.

Reference: FluMist Prescribing Information, 2009