The Daily Drill: August 29, 2011

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

Bath Salts: An 'Ivory Wave' Epidemic?

The "bath salts" in question have no legitimate use for bathing; the name is slang for a group of designer drugs that contain 3,4-methylenedioxypyrovalerone (MDPV) or 4-methylmethcathinone (mephedrone).[1] Emergency department (ED) visits and calls to poison control centers in 2011 have skyrocketed due to ingestion of "bath salts." In the United States, over 4000 calls to poison control centers were made regarding exposure to "bath salts" as of July 31, 2011, and about 1500 ED visits due to exposure were reported in the first quarter of 2011.[2]

With names including "Ivory Wave," "White Lightning," and "Vanilla Sky,"[2] these designer drugs are sold as tablets, capsules, or powder in sealed envelopes and can be bought by consumers of any age in many states. They are often sold at tobacco stores, gas stations, and head shops (ie, specialty shops that sell drug paraphernalia and "legal high" products) and are widely available on the Internet.[2,3]

The packets usually are marked "not for human consumption" or are marked as plant food in order to avoid government regulation. The powder can be smoked, snorted, injected, administered rectally, and wrapped in pieces of paper and ingested or "bombed."[3] These chemicals cannot be detected by routine drug screening, making the substances attractive for misuse.[4]

Both MDPV and mephedrone are stimulants.[1] Mephedrone has amphetamine- or cocaine-like effects related to the alkaloid cathinone which is derived from the active ingredient of the Khat plant. The clinical effects of synthetic cathinones begin within 20 minutes of oral ingestion and last from 2 to 4 hours. If snorted, the effects begin within minutes and the peak occurs in less than 30 minutes.[5]

Effects may include intense stimulation, alertness, euphoria, elevated mood, and a pleasurable "rush." Users may describe feelings of closeness, sociability, and moderate sexual arousal. Other physical symptoms are typical of stimulants and include tremor, shortness of breath, and loss of appetite.[3,5,6] Changes in body temperature regulation accompanied by hot flashes and sweating (characterized by a strong body odor) are common as are nose and throat bleeds with burns and ulcerations caused from snorting the "bath salts."[5]

Effects on the cardiovascular system include tachycardia, hypertension, peripheral vasoconstriction, and chest pain. Psychiatric effects at higher doses can include anxiety, agitation, hallucinations, paranoia, and erratic behavior.[5] Depression has been associated with mephedrone use as have reports of successful suicide attempts during use.[5,7] Withdrawal symptoms are not typically reported, but users often describe strong cravings for the drug.[3

Pediatricians seek to KO youth boxing

Steven Galeano was a problem child. He couldn't stay out of fights and was "off the hook," his father Edwin recalls.

But then Steven decided he wanted to start boxing, like his brothers. For the last four years, he has been venting his anger and frustration on the heavy bag at John's Boxing Gym, in the Bronx, New York, rather than on other neighborhood kids.

"I [learned] how to control myself," Steven says. "If I have something on my mind, a little stress, I just take it out on the bag."

Along the way, he and his trainers also noticed that he has talent. He's now a ranked 12-year-old boxer in the U.S. and proud -- "so far" -- of what he's accomplished.

Boxing has turned Steven around, according to his father, but if the nation's leading organization of pediatricians has its way, Steven would trade in his boxing gloves for a basketball, tennis racket, or swim goggles.

In a new policy statement published today in the journal Pediatrics, the American Academy of Pediatrics, along with the Canadian Paediatric Society, is recommending that doctors "vigorously oppose boxing for any child or adolescent" under the age of 19 because of the risk of concussions and other injuries, and instead steer kids toward non-collision sports.

"There's no reason why we as pediatricians should be condoning such a thing, when we know that the risk is not zero for these kids, and perhaps the damage may be more long lasting," says Claire LeBlanc, M.D., the lead author of the statement and the chair of a CPS committee on sports medicine and active living.

The pediatricians based their recommendation, in part, on the number of boxing injuries recorded by U.S. and Canadian health officials. In 2003, for instance, there were roughly 14 boxing-related hospital visits for every 1,000 people between the ages of 12 and 34 who participate in the sport, according to data from the U.S. Consumer Product Safety Commission.

New iPhone app offers rewards for exercising

Need some motivation to hit the gym? Perhaps some free merchandise will do the trick.

At least this is the premise that Nexercise is built upon, a free iPhone app that tracks activities ranging from running and weightlifting to fencing and polo and rewards users with free and discounted merchandise in the hopes that users will adopt long-term exercise habits.

"We're trying to create a lifestyle - not a quick fix," said co-founder Benjamin Young. "We don't focus on how many miles you ran or how many pounds you've lifted. You get points in the game for healthy behaviors."

Users can accumulate points based on the length of their workouts and for other behaviors that reinforce frequent exercise habits. Exercising with a friend or on a rainy day, for instance, allows users to accumulate bonus points.

"A lot of it is driven by research studies. If you exercise with someone, you're more likely to continue to exercise." said Young.

Receiving prizes is more of a lottery rather than direct redemption. Users with more points have greater chances of winning prizes, and those that have reached higher levels have access to more valuable prizes.

According to Young, the chances of winning a prize at the lowest level are about 25 percent, with prizes ranging from $5 gift cards and coupons for items such as energy bars, up to $250 gift cards.
Recent integration earlier this month with Kiip, a San Francisco-based advertising startup, provides access to prizes from retailers such as makeup company Sephora and vitamin and supplements maker GNC among many others.

Thousands of California parents not vaccinating their children despite whooping-cough outbreak

Thousands of California parents are choosing not to vaccinate their children, despite last year's record-setting whooping cough outbreak.

And the number is growing, much to the alarm of pediatricians and state health officials who fear diseases that were once nearly eradicated may proliferate as a result.

Over the past decade, "personal belief exemptions" have tripled. Signed by parents, PBEs allow children to enter school missing some or all vaccines. Statewide, more than 2 percent of kindergartners have such exemptions.

With a 9.5 percent PBE rate -- more than four times the state average -- Santa Cruz County is close to the epicenter of this often heated and emotional debate. In the county's northern part, the parents of about 17 percent of entering kindergartners signed exemptions last fall -- one of California's highest rates.

State experts say that as long as 95 percent of a population is immunized, "herd immunity" keeps contagious diseases from spreading. But vaccine refusal tends to concentrate in geographical areas like northern Santa Cruz County, and that creates risk.

While most Bay Area counties have exemption rates on par with the state average, certain schools within them have high rates of vaccine refusal, including Contra Costa County's East Bay Waldorf, which closed temporarily in 2008 after at least 16 children came down with whooping cough. Last year, that school reported a 75 percent exemption rate.

Enjoy your morning!