The Morning Drill: December 1, 2011

Ministers will say that there have been no reported transmissions in Britain, despite more than 25 cases in the last 12 years where a patient has been exposed to an HIV-infected doctor Photo: ALAMY

Good Morning!

Today is World AIDS Day, as is every December 1.

On to today's dentistry and health headlines:

Doctors, dentists and health workers with HIV could work in NHS

The Department of Health has launched a consultation into the issue with a view to lifting the ban that has been in place for 20 years.

As reported in the Daily Telegraph last week, ministers fear a backlash from patients, but hope that those concerns can be allayed when presented with the facts about possible dangers.

Some countries already permit HIV positive doctors and dentist to work, but despite evidence that any risk is ‘negligible’ the UK still has tough restrictions in place.

The issue is certain to cause controversy. Three years ago a London doctor, Allan Reid, sparked a health scare after treating thousands of patients without telling them he was HIV-positive.

A current court case, in which a dentist with HIV is bringing an action against the Department of Health claiming the current ban is discriminatory and unlawful, also explains why ministers are considering the change. Because of the case, the possibility of a judicial review is hanging over the Government.

Ministers will say that there have been no reported transmissions in Britain, despite more than 25 cases in the last 12 years where a patient has been exposed to an HIV-infected doctor, dentist or other health worker. More than 10,000 patients have been tested.

A working group has recommended that those with HIV should be allowed to undertake “exposure prone procedures” provided they are taking antiretroviral drugs and are being monitored.

A document, seen by the Daily Telegraph, concludes that evidence built up over a number of years shows that the risk of transmission from an infected doctor or dentist to a patient is “extremely low for the for the most invasive clinical procedures such as major surgical operations.”

For less invasive procedures such as normal dentistry the risk is described as “negligible.”

Dentists grinning as demand for new smiles soars

IT WAS once the essential beauty feature for celebrities obsessed with appearance. But that dazzling white smile has moved beyond the Hollywood hills and into the Australian suburbs.

Dentists are reporting a boom in cosmetic dentistry as some surgeries experience a 60 per cent increase in demand.

Middle-aged women are partly driving the trend, using their later-in-life disposable income to fix stained and crooked teeth, with some procedures costing upwards of $15,000.

Dentist who dabbles in opera-singing says patients can't criticize her crooning: lawsuit

A Manhattan dentist who moonlights as an opera singer can’t stand her patients booing her online about her work, a lawsuit charges.

Dr. Stacy Makhnevich, who bills herself as “the Classical Singer Dentist of New York,” is being accused in a Manhattan Federal Court lawsuit of trying to muzzle her patients’ criticism — even before it’s made.

Former patient Robert Lee claims Makhnevich forced him to sign an agreement not to bash her online before she worked on his sore tooth, according to the suit, filed Tuesday.

Lee claims the crooning tooth doctor then hit a sour note when he accused her on the website Yelp of overbilling him by $4,000.

“Avoid at all cost!” his Yelp posting read. “Scamming their customers!”

He said Makhnevich accused him of breaching the “Mutual Agreement to Maintain Privacy” that he signed.

Lee, who has since moved to Maryland, said the dentist began billing him $100 a day for every day his negative Yelp posting remained online.

“I have to wonder what this dentist’s other patients have said to make her feel it was necessary to go to this extreme,” Lee said Wednesday.

Makhnevich — who just released a CD of arias titled “European Opera” — did not return calls left Wednesday at her offices on the 69th floor of the Chrysler Building.

Lee’s lawyer, Paul Levy of the consumer protection group Public Citizen, said the agreement that Makhnevich makes her patients sign violates their constitutional right to free speech and breaches dental ethics.

“This is using these contracts to suppress the other side and deprives the consumer of valuable information,” Levy told the Daily News.

Completing the Circuit to Curb Obesity

Obesity is the most significant chronic healthcare crisis facing the United States, as well as other countries. Already 1 out of every 3 adults, and 1 out of every 6 children or adolescents, in the U.S. is obese! Leptin is a hormone that has received considerable attention since its discovery in 1994 for its role in regulating metabolism (like a thermostat, or adipostat) and implications for obesity. High leptin levels are associated with feeling satiated and an active metabolism. Though many overweight people have high levels of circulating leptin, it’s been found that their hypothalamic neurons do not receive the signal – a phenomenon known as “leptin resistance.” An animal model that mirrors this is db/db mice, which lack leptin receptors on the surface of they hypothalamic neurons and are therefore morbidly obese...

Enjoy your morning!

The Morning Drill: October 5, 2011

A collection of dentistry and health related links/comments for your day.

Children Destined to Be Obese Can Be Identified by Age 3.5

A prospective analysis of body mass index (BMI) in 1957 children from ages 5 months to 8 years reveals that an "atypically elevated BMI trajectory" that leads to obesity is identifiable by age 3.5 years.

The study, by Laura E. Pryor, MSc, from the National Institute of Health and Medical Research (INSERM) in Paris, France, and colleagues and reported in the October issue of the Archives of Pediatric and Adolescent Medicine, tracked a subset of the Quebec Longitudinal Study of Child Development.

Three groups of weight gain trajectories clearly emerged: low to stable (54.5%), moderate (41%), and high-rising (4.5%). Plotting age against BMI produces a chart in which the first and second curves run parallel to each other on the x-axis, while the high-rising trajectory veers sharply upward at 3.5 years.

Calif. Medicaid Cuts Open Supreme Court Term

The ability of providers to sue state healthcare authorities over Medicaid cuts was the focus of the Supreme Court's first morning of its new term on Monday.

The case the justices heard challenges several laws passed by the California legislature ordering cuts of up to 10% in reimbursements to providers who participate in Medi-Cal, the state's Medicaid plan. A number of providers in California filed suit against California's Department of Health Care Services seeking preliminary injunctions against the rate cut.

A federal district court denied the injunction, and the providers then took their case to the Ninth Circuit Court of Appeals, which ruled in their favor. The California state government appealed that decision to the U.S. Supreme Court.

But rather than determining whether state officials can cut Medicaid rates to keep their state budgets in check, the justices on Monday focused on whether people or groups can sue a state over the state's perceived noncompliance with federal law.

Federal Medicaid law states that any state accepting federal Medicaid money must set payments for providers that are "consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available ... to the general population."

The healthcare providers in the case -- which is actually three cases consolidated into one -- argue that California set Medicaid reimbursement rates so low that it would endanger the Medicaid program and therefore violate federal law.

Doctors' groups, former Department of Health and Human Services officials, and others who sided with the California providers argued in briefs that doctors and Medicaid recipients should be able to sue their state over adopting policies that would cut payment and potentially harm patients.

An Addiction Vaccine, Tantalizingly Close

Imagine a vaccine against smoking: People trying to quit would light up a cigarette and feel nothing. Or a vaccine against cocaine, one that would prevent addicts from enjoying the drug’s high.

Though neither is imminent, both are on the drawing board, as are vaccines to combat other addictions. While scientists have historically focused their vaccination efforts on diseases like polio, smallpox and diphtheria — with great success — they are now at work on shots that could one day release people from the grip of substance abuse.

“We view this as an alternative or better way for some people,” said Dr. Kim D. Janda, a professor at the Scripps Research Institute who has made this his life’s work. “Just like with nicotine patches and the gum, all those things are just systems to get people off the drugs.”

Dr. Janda, a gruff-talking chemist, has been trying for more than 25 years to create such a vaccine. Like shots against disease, these vaccines would work by spurring the immune system to produce antibodies that would shut down the narcotic before it could take root in the body, or in the brain.

Unlike preventive vaccines — like the familiar ones for mumps, measles and so on — this type of injection would be administered after someone had already succumbed to an addictive drug. For instance, cocaine addicts who had been vaccinated with one of Dr. Janda’s formulations before they snorted cocaine reported feeling like they’d used “dirty coke,” he said. “They felt like they were wasting their money.”

It’s a novel use for vaccines that has placed Dr. Janda, who is 54, in the vanguard of addiction treatment. Because addiction is now thought to cause physical changes in the brain, doctors increasingly advocate medical solutions to America’s drug problem, leading to renewed interest in his work.

Top 5 Unnecessary Health-care Costs

What did the researchers say was the No. 1 most over-used activity by primary care physicians? Prescribing a brand-name cholesterol-lowering drug without trying a less expensive generic first, according to the research posted on-line by the Archives of Internal Medicine.

Doctors’ prescribing a brand-name statin, without first  checking to see if a lower-priced generic drug would cut a patient’s cholesterol sufficiently, results in $5.8 billion in excess health-care spending, according to the research letter published Oct. 1.

The authors found $6.76 billion in what they said was non-recommended health-care spending after analyzing surveys of patient visits to certain primary care doctors’ offices and hospital outpatient departments in 2009.

Other practices deemed inappropriate by the authors: bone density scans for women ages 40 to 64 years, costing $527.4 million; ordering CT Scans or MRI’s for lower back pain, amounting to $175.4 million; and prescribing antibiotics to children with sore throats caused by a virus, worth $116.3 million.

Enjoy your morning!

The Morning Drill: October 4, 2011

A collection of dentistry and health related links/comments for your day.

Survey finds support for dental therapist concept

More Americans are delaying dental care due to cost, and many are open to the concept of a new type of dental care provider if it would make more services available to those who currently cannot afford them, according to a survey released today by the W.K. Kellogg Foundation.

According to the survey of 1,023 adults nationwide, 41% of respondents reported that they or someone in their household has put off dental care because of cost, and 30% said they do not have a place to receive dental care. In addition, 79% said that receiving regular dental care is important, but 40% said they do not have dental insurance.

And more than 80% said they believe it is difficult for people to get free or low-cost dental care in their communities and that the number of Americans who cannot access dental care is "a problem."

Those most likely to be putting off care due to cost are those with annual incomes of less than $30,000 (55%), those without dental insurance (54%), and those with a high school diploma or less (47%). In addition, Latinos (47%) are more likely than African Americans (36%) and whites (42%) to have put off dental care in the last 12 months due to costs. Women are also more likely than men (47% versus 35%) to have put off dental care because of cost.

"This survey clearly shows that people throughout the country are struggling to get dental care," said Sterling Speirn, president and CEO of the W.K. Kellogg Foundation.

One of the most surprising findings, according to Mike Perry, an analyst and partner at Lake Research Partners, the company that conducted the survey, came in response to this question:

    Many efforts are going on to improve affordable access to dental care in our country. One effort is training license dental practitioners to provide preventive, routine dental care to people who are going without care. Would you support or oppose this effort to train licensed dental practitioners?"

More than three-quarters (78%) of survey respondents said they would support the training of licensed dental practitioners to make preventive, routine dental care more accessible, according to the survey.

"We did not provide them with a definition of dental therapists," Perry said. "You introduce the idea of a midlevel dental professional who is out in the community providing routine and preventive dental care and they say, 'Oh, OK, like a physician's assistant.' This research suggests that the general public is open to someone other than a dentist providing routine and preventive care."

Behavioral Therapies Effective in Weight Loss

Behavior-based weight loss interventions are safe and effective, according to a systematic review published in the October 4 issue of the Annals of Internal Medicine.

A 2007-2008 study showed that 32% of US men and 36% of US women were obese. The US Preventive Services Task Force recommends that physicians screen all adults for obesity and institute intensive counseling and behavioral interventions for obese adults.

The researchers, led by Erin S. LeBlanc, MD, MPH, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, reviewed studies of primary care-relevant weight loss interventions for overweight and obese adults. The studies were pulled from MEDLINE, the Cochrane Central Register of Controlled Trials, and PsycINFO (January 2005 - September 2010) and from systematic reviews for studies conducted before 2005.

Mom's Healthy Diet Reduces Birth Defects

An overall healthy diet -- not just folic acid supplementation -- may be key to reducing risk of neural tube and orofacial cleft birth defects, a population-based study indicated.

Prepregnancy dietary quality in terms of fruits and vegetables, grain, calcium, iron, and folate, as well as fat and sugar intake, significantly predicted risk of these defects even after controlling for supplement use, Suzan L. Carmichael, PhD, of Stanford University in Stanford, Calif., and colleagues found.

The highest quality diets were associated with up to 51% lower risk of anencephaly, 34% reduced risk of cleft lip, and 26% lower odds of cleft palate compared with the poorest diets.

These links were stronger than seen with folic acid or other nutrients individually in a prior analysis of the same cohort, the group reported online in the Archives of Pediatrics & Adolescent Medicine.

"It's important to think of nutrition in all of its complexity," Carmichael told MedPage Today.

That doesn't mean the emphasis on boosting folic acid intake through supplements and fortification of the food supply has been misplaced, Carmichael cautioned in an interview.

Folic acid clearly can prevent neural tube defects, which have dropped in prevalence since food fortification, she pointed out, calling it "a huge public success story."

But further progress in tackling the still extensive burden of these birth defects that develop often before women are even sure they are pregnant may require a more whole-diet approach, her group argued.

Drunk on Facebook? That could be a problem

College students' Facebook pages might hold clues to which of them are at risk for alcohol dependence and abuse, according to a new study.

Researchers found that students who had pictures or posts about getting drunk or blacking out were more likely to be at risk of drinking problems, based on a screening test. That was not necessarily the case for students who mentioned alcohol or drinking on their pages, but not in a way that showed that they drank too much or in unhealthy situations.

It's possible that Facebook pages could help schools find out who needs to be assessed for alcohol-related problems -- although privacy and ethical concerns might make that complicated, researchers said.

The question is whether "what's being found on these sites... is actually predictive of clinical conditions," said Dr. James Niels Rosenquist, a social media researcher and psychiatrist from Massachusetts General Hospital who wasn't involved in the new study.

The findings suggest that messages on Facebook sites do seem to be linked to what happens in the "real world," he told Reuters Health.

Enjoy your morning!

The Morning Drill: September 22, 2011

A collection of dentistry and health related links/comments for your day.

Feds sue dentist for firing assistant over OSHA concerns

A Massachusetts dentist is being sued by the U.S. Department of Labor for allegedly firing an employee for raising concerns about needlestick hazards and filing a health hazard complaint with the department's Occupational Safety and Health Administration (OSHA).

According to the complaint, filed September 14, 2011, in the U.S. District Court for the District of Massachusetts, N. Terry Fayad, DMD, of Beverly, MA, in November 2010 discharged Rhonda Healey, a dental assistant employed in his practice since 2002, after she raised concerns about an office procedure involving the handling of contaminated needles.

As part of Healey's duties, she placed used, contaminated needles that had been protectively capped into a sharps container, according to the lawsuit. But in October 2010, Dr. Fayad changed the procedure so that workers were required to remove the protective caps from the contaminated needles before putting the needles into the disposal sharps containers, the complaint states.

Dr. Fayad changed the procedure so that more needles would fit in the sharps containers, "reducing the frequency of their disposal by Fayad's disposal service provider and saving Fayad money," the lawsuit alleges.

This procedure exposed the employees to injury and possible infection by bloodborne pathogens such as hepatitis and HIV, the complaint further states.

"No employer should ever treat employees this way," said Marthe Kent, OSHA's New England regional administrator, in a statement. "Workers have the right to perform their jobs without being exposed to life-threatening hazards, as well as the right to raise concerns when faced with such hazards. The Labor Department will take all appropriate legal steps to ensure these rights are enforced."

The lawsuit seeks the employee's reinstatement; payment of lost wages, benefits, and interest; and compensatory and punitive damages. The suit also seeks to enjoin Dr. Fayad from violating OSHA regulations in the future.

23,000 California Nurses to Strike on September 22

Roughly 23,000 members of the California Nurses Association (CNA) plan to be no-shows on September 22 at several dozen hospitals in what organizers call the largest nurses' strike in the nation's history.

The 1-day strike comes amid negotiations between the CNA and 8 individual hospitals operated by nonprofit Sutter Health in northern California that have run aground largely on 2 rocky economic issues for all Americans: healthcare coverage and retirement benefits.

The CNA belongs to an aggressive "super union" with close to 160,000 members called National Nurses United. Its avowed goal is to unionize every registered nurse in the United States. In June 2010, its affiliate in Minnesota organized a 1-day strike by 12,000 nurses in the Twin Cities over wages, pension benefits, and staffing levels. At the time, that walk-off was billed as the biggest nurses' strike ever.

The scheduled California strike affects not only 8 Sutter hospitals, some with multiple campuses, but also 22 Kaiser Permanente hospitals in northern California, as well as Children's Hospital Oakland. The latter hospital is also embroiled in contract negotiations with the CNA, but the Kaiser facilities are not. The Kaiser nurses are instead striking out of sympathy with Kaiser employees belonging to the National Union of Healthcare Workers, whose members include mental health professionals, audiologists, and speech pathologists, in addition to registered nurses. Some 2500 of these National Union of Healthcare Workers members, currently locked in contract talks, began 2-day and 3-day strikes today at Kaiser facilities in southern California. Another 1500 NUWH members employed by Kaiser in northern California will engage in a 1-day walk-off tomorrow.

CNA nurses are scheduled to begin walking picket lines at 7 am tomorrow around the hospitals being struck. The picket lines will come down at 7 am the next day.

Sutter Health, Kaiser Permanente, and Children's Hospital Oakland have assured the public that they will continue to deliver top-notch care during the 1-day strike. That translates into hiring temporary replacement nurses.

Many Unaware of Plastic Surgery Options After Weight Loss Procedures

Most of the 220,000 people who undergo weight loss surgery every year are not aware of the follow-up procedures they could have to remove any loose skin they may have, according to a new study by plastic surgeons.

However, not all patients who undergo so-called bariatric weight reduction surgery need a cosmetic procedure after their dramatic weight loss, said one doctor who's an obesity expert.

Researchers from the American Society of Plastic Surgeons said that although 75 percent of bariatric patients don't know about body contouring, many might choose to have this plastic surgery if they were fully informed of their options.

"Bariatric surgery isn't just a commitment to weight loss. It often requires body contouring surgeries to help the patient's skin fit their new body," the study's lead author, Dr. Jason Spector, ASPS Member Surgeon, said in a society news release. "Many massive weight loss patients suffer large amounts of loose, sagging skin as a result of their rapid weight loss that, if not removed, can cause rashes, wounds, infection, and limit comfortable mobility. It is apparent that insufficient counseling at the time of bariatric surgery is obscuring viable body contouring options for these patients."

The study included 284 patients who had had weight loss surgery. The researchers found that only 25 percent had discussed body contouring procedures with their bariatric surgeon before or after surgery.

Although only 14 percent were referred to a plastic surgeon for consultation and just 11 percent had a body contouring procedure, nearly 40 percent of the patients said they might have chosen to have the plastic surgery if they knew more about it.

Lack of awareness about body contouring wasn't the only reason why the patients studied didn't undergo the procedure, the researchers noted. Nearly one-third said the plastic surgery, which is rarely covered by insurance, was too expensive.

U.S. health officials push flu shots for all

U.S. health officials are looking to capitalize on significant gains in flu vaccination rates with a new campaign emphasizing the need for all Americans over six months of age to get a flu shot.

Last season, nearly 131 million people, or 43 percent of the U.S. population, received the influenza vaccine, representing a steady increase over several years, according to the U.S. Centers for Disease Control and Prevention.

But as the memory and urgency of the 2009 flu pandemic fades, health officials want to make sure Americans continue to turn up for their annual flu shots by offering them in more places and in new forms, including vaccination with a tiny needle designed to make the experience as painless as possible.

"Eight million more Americans got vaccinated against the flu last year. That is the most people who have ever been vaccinated in this country," Dr. Thomas Frieden, director of the CDC, said at a news conference.

Enjoy your morning!

The Morning Drill: September 7, 2011

A collection of dentistry and health related links/comments for your day.

Living With a Smoker Increases Absenteeism in School Children, U.S. Study Confirms

Children who live in households where they are exposed to tobacco smoke miss more days of school than do children living in smoke-free homes, a new nationwide study confirms. The report from investigators at Massachusetts General Hospital (MGH) -- which finds these children have higher rates of respiratory illnesses that can be caused by second-hand smoke and details the probable economic costs of their increased school absence -- has been released in the online edition of Pediatrics.

"Among children ages 6 to 11 who live with smokers, one quarter to one third of school absences are due to household smoking," says Douglas Levy, PhD, of the Mongan Institute for Health Policy at MGH, the paper's lead author. "On a national basis these absences result in $227 million in lost wages and time for caregivers or their employers."

The authors note that one-third of U.S. children live with at least one smoker, and more than half of those aged 3 to 11 have detectable levels of a blood marker for tobacco exposure. Second-hand smoking has been shown to increase incidence of ear infections and several respiratory conditions, and school absenteeism is an accessible measure of serious illness in children. Earlier studies of the relationship between lost school days and household smoking have focused on local populations and did not evaluate the severity of the problem's impact. The MGH team analyzed data from the 2005 National Health Interview Study, an annual in-person survey of representative households nationwide.

Weight Loss Without the Hunger: Eat a Lighter Lunch, Scientists Say

Losing weight without a grumbling stomach or expensive liquid diet can be as simple as eating a lighter lunch, finds a new Cornell University study to be published in the October issue of the journal Appetite.

Participants who ate portion-controlled lunches did not compensate by eating more calories later in the day, leading researchers to believe the human body does not possess the mechanisms necessary to notice a small drop in energy intake.

"Making small reductions in energy intake to compensate for the increasing number of calories available in our food environment may help prevent further weight gain, and one way of doing this could be to consume portion-controlled lunches a few times a week," said doctoral student Carly Pacanowski, who co-authored the study with David Levitsky, Cornell professor of nutritional sciences and of psychology.

N.C. Medicaid cuts take hold in October

New cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid.

Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million.

In addition to getting rid of routine adult eye care and glasses, the state plans to limit payments for deep cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year.

Insurer's cuts leave dentists nursing $60 million toothache

Caring for your teeth costs more in Washington than just about anywhere else in the country, according to the state's largest dental insurer, which recently slashed payments to dentists for the first time in more than 50 years.

Washington Dental Service (WDS), a nonprofit that insures about 1.5 million patients in Washington, says the $60 million it expects to save in cuts to dentists has allowed it to offer a more affordable plan to small businesses.

Angry and dismayed dentists, hit with cuts of up to 15 percent or more, warn that the drastic reductions will hurt patients, who have grown accustomed to dentists who take time to focus on prevention and options, instead of just waiting until something hurts or breaks.

About 95 percent of the dentists in the state accept payments from WDS, but in the wake of the June 15 cuts, some have dropped the insurer, and many say they're still considering doing so.

Dentists, most of whom own their own clinics, say they have no control over rising overhead costs and warn they likely will have to make drastic changes in their practices.

"Never in my 23 years in practice has there been a bigger threat to the way I take care of my patients," said Dr. Chris Pickel, a Northgate-area dentist and immediate past president of the Seattle-King County Dental Society.

"This is a big tipping point right now," Pickel said. "It forces dental practices to go to a volume-based system, where you see more patients per day," limiting time for proactive, preventive care.

Enjoy your morning!

The Morning Drill: September 1, 2011

A collection of dentistry and health related links/comments for your day.

Cavities ache many in the Latino community

Do you know what is the most chronic infectious disease among children in the U.S.?

According to the Centers for Disease Control and Prevention (CDC), it is tooth decay — what most of us call cavities. More than one out of every four children aged 2-5 years and half of those aged 12-15 years have tooth decay.

The problem is even more prevalent in the Latino community.

According to government statistics, 40 percent of Mexican-American children aged 6-8 years have untreated tooth decay. Amongst Mexican-American adolescents – those aged 12-19 years – one in five suffers from the same condition.

If left untreated, tooth decay can snowball into much larger problems that permeate various aspects of a child's growth and development, says the CDC.

Teen Boys Drink a Whole Lot of Sugar

Average daily sugar consumption among male teenagers in the form of sodas, energy drinks, and sweetened fruit juices was more than double the government's recommended limit for all added sugar in the diet, a large national survey found.

Among boys and young men 12 to 19 years old participating in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, so-called sugar drinks accounted for a mean of 273 calories in their daily diet, according to data compiled Cynthia L. Ogden, PhD, and colleagues at the CDC's National Center for Health Statistics.

The U.S. Department of Agriculture's recommended daily limit for added sugars in all forms -- including candies, baked goods, ice cream, and other foods in addition to drinks -- is 128 calories. The "DASH" diet for reducing blood pressure has an even lower limit of about 50 calories in sugar daily.

Findings from the NHANES analysis appeared in NCHS Data Brief No. 71, released this week.

Men in their 20s and 30s were not far behind their teen counterparts, with an average daily intake of 252 calories from sugar drinks in the NHANES data.

More Runners Are Going Bare

Barefoot or minimalist running is on the rise. To assist runners with their transition, the Minnesota Chiropractic Association (MCA) is hosting a public education program designed to help "safely" transition runners who want to move toward minimalist or barefoot running.

Seminar participants will learn the benefits of barefoot running, gain valuable injury prevention information and techniques to assist with their transition while gaining insight from experienced barefoot and minimalist runners.

According to the Journal of Medicine & Science in Sports & Exercise, 70 percent of traditional runners experience some level of injury. Presenter, Dr. Candace Salmi, says, "Barefoot running, when done correctly, can be energizing while having a positive impact on the body."

Silicone Breast Implants Will Stay on Market

An FDA official said silicone breast implants made by Johnson & Johnson’s Mentor and Allergan will stay on the market, and that the agency will work with the companies to increase participation in post-approval studies, Dow Jones Newswires reports. Companies have struggled to maintain follow-up on the 80,000-plus women originally included in those studies, originally planned to last a decade, with Allergan tracking about 60.5% of them for two years and Mentor following 21% for three years. If more women aren’t tracked, the studies won’t be able to detect possible long-term health issues.

Enjoy your morning!

Video: Obesity Continues to Balloon in the United States and the U.K.

Nearly half of all in the United Kingdom could be obese in fewer than twenty years.

Obesity is out of control.

The number of obese people in the United States will increase from 99 million in 2008 to 164 million by 2030, and the number of obese people in the United Kingdom will increase from 15 million to 26 million, a new study predicts.

Obesity-related diseases and health care costs will soar as a result, according to the report published Aug. 26 in The Lancet.

Already, the U.S. and U.K. obesity rates are the highest among the 34 member nations of the Organization for Economic Development and Cooperation (OECD), the study said.

The U.S. obesity rate will rise from 32 percent to about 50 percent for men, and from 35 percent to between 45 percent and 52 percent for women. The U.K. obesity rate will rise from 26 percent to between 41 percent and 48 percent for men, and from 26 percent to between 35 percent and 43 percent for women.

The report, based on analyses of U.S. data from 1988 to 2008 and U.K. data from 1993 to 2008, is the second article in the journal's obesity series.

Diet and exercise folks!

You can read more here.

The Morning Drill: August 26, 2011

A collection of dentistry and health related links/comments for your day.

Bright Now! Dental Opens Another California Dental Office in Fresno

Smile Brands Inc., the nation's leading provider of business support services to dental groups in the United States, is pleased to announce the grand opening of its next Bright Now! Dental office in Fresno, CA – the 67th office in the state of California. Bright Now! Dental will continue to grow in the state with offices slated to open in Murrieta, Upland, San Jose, Simi Valley, and Stockton later this year.  

Smile Brands Inc. is the largest provider of support services to dental groups in the United States. Smile Brands Inc. provides comprehensive business support services so dentists can spend more time caring for their patients and less time on the administrative, marketing and financial aspects of the dental practice. Smile Brands Inc. services support more than 1,100 dentists and hygienists practicing in over 320 Bright Now! Dental, Monarch Dental, and Castle Dental offices in 18 states.

Based in Irvine, Calif., Smile Brands Inc. and its affiliated dental offices combined employ approximately 4,200 people nationwide.

Steve Jobs Faces Uphill Battle Against Cancer: Experts

One of the hallmarks of Steve Jobs' tenure as CEO of Apple Inc. was the secrecy that shrouded products he was about to unveil -- from the iPod to the iPhone to the iPad -- creating tremendous consumer interest.

Jobs' announcement Wednesday night that he was stepping down as the head of the hugely successful technology company he co-founded in a northern California garage 35 years ago was similarly thin on details, although speculation immediately turned to his ongoing health problems.

In a letter to Apple's board, the 56-year-old Jobs said he "always said if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know. Unfortunately, that day has come."

This much is known about the health of Jobs, a legendarily private man: Since 2004, he has been fighting a rare form of pancreatic cancer called neuroendocrine cancer. In January, he took his second medical leave from Apple after undergoing a liver transplant for tumors that had spread to that organ.

Pancreatic cancer expert Dr. Craig Devoe, from the department of medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., said that "neuroendocrine tumors are uncommon, with only a few thousand cases a year."

For those that affect the pancreas, the numbers are even lower with fewer than 1,000 cases a year in the United States. In contrast, there are around 40,000 cases of other pancreatic cancers a year, Devoe said.

Dr. David M. Levi, a professor of clinical surgery, liver and GI transplantation at the University of Miami Miller School of Medicine, said neuroendocrine cancer "is an unusual tumor. It can arise in a number of places, including the pancreas." Such tumors can also start in the lungs.

It's one of the few tumors that can benefit -- to some extent -- from a transplant, Levi said. Jobs' cancer started in the pancreas and then spread to the liver, making the liver transplant an option, Levi said, adding he has treated patients with this type of cancer and done liver transplants.

While the prognosis for neuroendocrine cancer is often better than for the more common type of pancreatic cancer, in which patients generally live less than a year after diagnosis, neuroendocrine cancer "can also be bad," Levi said.

Neuroendocrine cancer can return after treatment, Levi explained. And while a liver transplant can be effective, "it is not as great a picture as we first thought," he said. "A lot of these patients who have transplants eventually do recur."

"The vast majority of patients that have recurrent disease will die of their disease. One of the problems with the [liver] transplant is that now you are on immunosuppressant drugs, and while they keep you from rejection or destroying the liver, the immune system also would have helped deal with tumors," he said.

Weight Loss from Cutting Calories Less than Expected

Common rules of thumb exaggerate how much weight people will lose from a given dietary calorie reduction, leading to unrealistic expectations and disappointment, researchers said.

Whereas patients are often told that cutting 500 calories a day will let them lose a pound a week, a more realistic formula is that such a caloric reduction would lead to a 50-pound loss over three or more years, according to Kevin D. Hall, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md., and colleagues.

Even then, they explained in the Aug. 27 issue of The Lancet -- a special edition devoted to obesity -- such weight loss is possible only if the calorie reduction is actually maintained over that time.

The standard rules -- endorsed by the National Institutes of Health and the American Dietetic Association, among others -- fail to consider that human metabolism responds dynamically to changes in diet and body composition, Hall and colleagues asserted.

If a 300-pound dieter could really lose a pound a week by cutting his regular diet by 500 calories, he would vanish entirely in six years.

"This ubiquitous weight-loss rule (also known as the 3,500 [calorie]-per-pound rule) was derived by estimation of the energy content of weight lost, but it ignores dynamic physiological adaptations to altered body weight that lead to changes of both the resting metabolic rate as well as the energy cost of physical activity," the researchers wrote.

When people gain weight, their baseline energy needs increase, to keep the extra tissue alive and to move it around. Likewise, when weight is lost, their baseline needs decrease.

So when people cut calories below the baseline requirement -- thereby triggering weight loss -- the gap between their intake and their baseline energy needs begins to shrink. At some point, it may disappear altogether, at which point weight loss stops.

Hall and colleagues put together what they said was a better model of caloric intake and resultant weight loss, incorporating feedback mechanisms to reflect metabolic changes over time in response to diet and body weight.

It indicated that weight change in response to caloric restriction occurs over a relatively long period of time.

Each reduction of 100 kilojoules daily -- 24 calories -- in intake eventually leads to a loss of 1 kg (2.2 lbs) in body weight, the researchers determined. But only half that loss occurs in the first year. In three years, 95% of the ultimate loss will be realized.

Enjoy your morning!

The Morning Drill: August 18, 2011

A collection of dentistry and health related links/comments for your day.

Being Overweight May Take Years Off Seniors' Lives

Elderly people with extra body fat may not live as long as those who maintain a normal weight, according to a new study that contradicts previous research.

In following seniors over an extended period of time and accounting for changes in their weight, researchers found a higher body mass index (BMI), or height-to-weight ratio, is associated with a shorter life expectancy.

"We had a unique opportunity to do 29 years of follow-up with a cohort that was also followed for mortality outcomes," said study lead author Pramil N. Singh, associate professor in the School of Public Health at Loma Linda University, in a university news release. "Across this long period of time, we had multiple measures of body weight, which provided a more accurate assessment."

For the study, recently published in the Journal of the American Geriatrics Society, researchers examined 6,030 healthy adults who never smoked. They found that men older than 75 years with a BMI greater than 22.3 would live nearly four years less than those with a lower BMI.

Similarly, women older than 75 years with a BMI greater than 27.4 would live roughly two years less than other women their age who were of normal weight.

A BMI between 18.5 and 24.9 is considered normal weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.

The study pointed out, however, that the negative effects of excess weight kick in for men and women at different BMIs. Men experienced a greater risk of dying beginning with a BMI of 22.3, while this risk did not appear for women until they had a BMI of 27.4.

The study authors suggested this difference may be because in postmenopausal women body fat is the main source of estrogen, which may help protect them from heart disease and hip fractures.

These findings contradict previous studies, which concluded that overweight elderly people live longer than their thinner peers. The authors of the current study said previous findings are limited because they do not account for participants' weight changes over an adequate length of time and consider how these fluctuations in weight might affect their life expectancy.

70% Indonesians have tooth decay: Association

Nearly 70 per cent of Indonesians have tooth decay and yet only 1.6 per cent of them have sought treatment, an association has said.

School of Dentistry Association chairman Eky S. Soeria Soemantry said Tuesday in Jakarta that the figures covered children and adults.

He added that up to 89 per cent of children under the age of 12 had tooth cavities.

"People are reluctant to have regular dental checks because they're afraid it'll hurt and they think it's costly," Eky said.

He said that the modern equipment in dental clinics and hospitals enabled treatment for tooth decay to be relatively painless.

He added that the cost should not be too high if patients visited dentists before the tooth decay became severe, tempointeraktif.com reported.

From omnivore to vegan: The dietary education of Bill Clinton

By the time he reached the White House, Bill Clinton's appetite was legend. He loved hamburgers, steaks, chicken enchiladas, barbecue and french fries but wasn't too picky. At one campaign stop in New Hampshire, he reportedly bought a dozen doughnuts and was working his way through the box until an aide stopped him.

Former President Clinton now considers himself a vegan. He's dropped more than 20 pounds, and he says he's healthier than ever. His dramatic dietary transformation took almost two decades and came about only after a pair of heart procedures and some advice from a trusted doctor.

His dietary saga began in 1993, when first lady Hillary Clinton decided to inaugurate a new, healthier diet for her husband. In a meeting, she asked Dr. Dean Ornish to work with the White House chefs, who were accustomed to high fat, French cuisine.

"The president did like unhealthy foods, and we were able to put soy burgers in White House, for example, and get foods that were delicious and nutritious," said Ornish, director and president of the Preventive Medicine Research Institute in Sausalito, California. Other new menu items included such healthy fare as stir fry vegetables with tofu, and salmon with vegetables.

Even with the revamped White House menu, Clinton battled his weight throughout his two terms as president. At his annual physical in 1999, the White House physician noted the president had put on 18 pounds since a checkup two years earlier. The prescription: refocus on exercise and a low-calorie diet.

Clinton didn't know it, but weight was not his biggest health concern. The 42nd president has a family history of heart disease, and plaque was building up in the coronary arteries leading to his heart, undetected by White House doctors.

Most Physicians Will Be Sued for Malpractice by Age 65

The risk of getting sued for malpractice in any given year ranges from 2.6% for psychiatrists to 19.1% for neurosurgeons, but over a medical lifetime, most physicians across all specialties can expect to face at least 1 lawsuit, according to an article published today in the New England Journal of Medicine (NEJM).

The findings, drawn from the files of a major malpractice insurance carrier with clients across the country, represent more fodder for the ongoing debate on tort reform, a subject dear to organized medicine.

Physicians in the 5 least-sued specialties — psychiatry, pediatrics, a category called "other specialties" in the study, family medicine, and dermatology — have a 75% chance of getting sued by age 65. The odds increase to 99% for physicians in the 5 most-sued specialties: neurosurgery, thoracic cardiovascular surgery, general surgery, orthopaedic surgery, and plastic surgery.

Despite physicians having a high lifetime risk for malpractice litigation, most plaintiffs do not receive a payment in the form of a settlement or jury award, write lead author Anupam Jena, MD, PhD, from Harvard Medical School, Boston, Massachusetts, and coauthors, echoing what other students of medical liability have found. On a yearly basis, 7.4% of all physicians are hit with a malpractice claim, but only 22% of these claims lead to a payment. Through age 65, physicians in the low-risk specialties run a 19% risk of facing a suit that pays off for the plaintiff, compared with a 71% risk for the high-risk specialties.

The size of average payments across specialties also was all over the map, ranging from $117,832 for dermatologists to $520,923 for pediatricians. However, this variability does not appear related to how often a particular specialty is sued. Neurosurgeons, for example, are roughly 6 times more likely to face a malpractice suit than pediatricians, but their average payment of $344,811 is substantially lower.

Enjoy your morning!