www.theweekly.com

/PRNewswire/ — As the “Year of the Healthy Child” draws to a close, U.S. Surgeon General Richard H. Carmona, M.D., M.P.H., today outlined a dozen tips to help keep teenagers safe and healthy. Dr. Carmona’s advice for parents of teens offers suggestions on how to encourage safe driving, healthy eating, and good school performance, and discourage drug use, sex, and activities that may result in injury.

“The values and lessons that you teach your teenager will shape the adults that they become. Although the teenage years have a reputation for bringing parents anxiety, parents can also know the great joy and pride that comes from seeing a child turn into a responsible adult,” Dr. Carmona said. “By appreciating what parents do every day and getting the best information out to parents and children, I hope that every child will grow up healthy, happy, and able to reach his or her own potential.”

The list is the fourth in a series of “Healthy Dozen Tips” that Dr. Carmona released as part of “The Year of the Healthy Child” agenda. The previous tips are available at http://www.surgeongeneral.gov/.

Healthy Dozen for 15 to 17 Year Olds (Middle Adolescence)

1. Teach healthy habits. Teach your teenager how to maintain a high
level of overall health through nutrition, physical fitness, and
healthy behaviors. Make sure your teen gets 8 hours of sleep a night
– a good night’s sleep ensures maximum performance in academics and
sports. Sleep is the body’s way of storing new information to memory
and allowing muscles to heal. Assist your teenager in practicing time
management skills by helping them allot time for school, exercise, and
fun time with friends and family. Encourage your teenager to
participate in social activities, community groups, and/or sports.
Your teen should share in household chores while at the same time
taking on new responsibilities. Work with your adolescent to continue
building decision-making skills and to understand the consequences of
their behavior. http://www.ahrq.gov/ppip/childguide/

2. Promote safe driving habits. Make sure your teenager uses a seat belt
every time he or she is in a car, and ask your child to ensure that
all other passengers are wearing their seatbelts when he or she is
driving. Encourage your young driver to drive responsibly by
following speed limits and avoiding distractions while driving such as
talking on a cell phone, focusing on the radio, or even looking at
fellow passengers instead of the road. Ask them to never drink and
drive, and encourage them to call home or a sober friend if they need
a ride home after consuming alcohol. Remind them that there are
serious consequences for driving irresponsibly, including harming
themselves or someone else.
http://www.cdc.gov/ncipc/fact_book/27_Teens_Behind_Wheel.htm

3. Teach the importance of healthy eating and physical activity. A
healthy diet and adequate exercise maximizes the likelihood of teens
growing up healthy and strong. Because teens are still growing and
adding bone mass, a balanced diet is essential to your child’s health.
Provide three nutritious meals a day, with fruits and vegetables,
supplemented with healthy snacks. Avoid foods and drinks that are
high in sugar, fat or caffeine. Choose fruits, vegetables; bread
cereal, other grains; lean meats, chicken, fish; and low fat dairy
products. The 2005 Dietary Guidelines, as well as the new recipe book
A Healthier You based on the Guidelines, can help you plan healthy
meals for yourself and your teen. Teenagers also need 30 to 60
minutes of physical activities 3 or more times a week. Obesity and
overweight, even in children, can significantly increase the risk of
heart disease, diabetes, and other chronic illnesses, and the vast
majority of overweight teens go on to become overweight adults.
Healthy eating and exercise will ensure that your child maintains a
healthy weight.
http://www.healthierus.gov/dietaryguidelines/index.html

4. Take your child to the doctor and dentist. Preventing disease is
easier — and less painful! — than curing it, so make sure your
teenager gets regular check-ups. Your adolescent should have a
primary health provider, such as a family practitioner or a physician
specializing in adolescent medicine, who knows your child before he or
she has an illness, injury, or issue that requires medical attention.
Adolescents should have a preventive care visit once a year.
Encourage good oral health. Cavities are the most common chronic
disease among U.S. children. Your teen should brush twice a day with a
soft toothbrush and floss daily. Talk with your dentist about fluoride
and dental sealants. Make sure your teen has dental appointments on a
regular basis, and learn dental emergency care. To find a doctor in
your area, visit http://www.nlm.nih.gov/medlineplus/directories.html
To locate dental care, visit:
http://www.nidcr.nih.gov/HealthInformation/FindingDentalCare/default.htm

5. Promotion of school success/ school achievement. Help your teen to
become responsible for attendance, homework and course selection. Be
sure to have conversations with your child about school and show your
interest in his or her school activities. This will help them express
any frustrations with school or thoughts of dropping out. Encourage
them to pursue their talents and to participate in school activities
that interest them. If your teen has trouble concentrating or is
hyperactive more frequently than others are at the same stage of
development, talk to your health care professional. Your child could
have Attention-Deficit / Hyperactivity Disorder (ADHD). ADHD can be
managed through behavioral or medical interventions, or a combination
of the two.
http://family.samhsa.gov/monitor/highschool.aspx

6. Prevent violence. Prevent bullying by encouraging peaceful
resolutions to conflict and building positive relationships. Teach
teens to respect others, and encourage tolerance. Limit your
adolescent’s exposure to violence in the media, the community, and at
home. Teenagers pay more attention to their parents than you might
realize — they are watching all the time — and teens who grow up in
a family environment filled with violence may learn to view violence
as normal, acceptable behavior. Teach your teens that there is no
place for verbal or physical violence by setting an example with your
words and actions and by showing them respect as well.
http://www.stopbullyingnow.hrsa.gov/

7. Teach your teen to say no to smoking. Teenage smoking is a pervasive
problem in our society. To put the problem into perspective, more
than 4,000 teens will try their first cigarette today. Every day,
more than 2,000 kids become new regular, daily smokers. The pressure
to experiment with tobacco can come from friends and peers. When
adults smoke, they model behavior for children and teens. Smoking
tobacco can turn into a life-long addiction that can be extremely hard
to break. Discuss with your adolescent the very serious health risks
that are associated with smoking, including heart disease, cancer, and
decreased physical activity, as well as the more unattractive physical
qualities that smokers have, including bad breath, stained teeth, and
a long-term cough.
http://www.cdc.gov/tobacco/

8. Know the 4 “W’s” — who, what, when, where. Always know who your teen is hanging out with, what they will be doing, when and for how long
they will be out, and where they will be. And check up on them. Be
aware of the dangers that can arise at teenage parties. Teen parties
present an opportunity to your teen to experiment with alcohol or
tobacco. One approach is to host the party so you have more control
over ensuring that these parties stay safe and fun for everyone
involved. Make sure you review the rules with your teen before the
party. No “crashers” allowed. No tobacco, alcohol, or other drugs. No
one can leave the party and then return. Make sure your teen knows
that you expect them to act responsibly.
http://www.theantidrug.com/advice/advice_ask_questions.asp?from=home

9. Be aware of your teen’s mental health. Help teens increase their self
esteem; taking on new challenges will help build confidence and
demonstrate their strengths. Watch your child for signs of depression
and stress. If your child appears sad, withdrawn, or suddenly dislikes
going to school or hanging out with friends, he or she may be suffering from depression. Teens who participate in risky behaviors — including sex, alcohol, and drugs — are at a higher risk of depression. Make sure you talk to your teen about their feelings, or ask them to talk with a health professional, school counselor, or trusted adult.
http://www.nimh.nih.gov/healthinformation/index.cfm

10. Talk about sex. Even though you may not want to talk to your teen
about sexual issues, if your teen is like most teens, they want you
to. Teens who feel connected to their parents are more likely to have
their first sexual experience later than teens who are not so well
connected to their parents. Teach your teenager that only abstinence
is 100 percent effective against pregnancy and sexually transmitted
diseases. If you think your child is sexually active or thinking
about having sex, discuss how to practice safe sex through condoms and
other forms of contraception. Remind them that condoms are the only
method of birth control that can reduce the risk of contracting a
sexually transmitted disease.
http://www.4parents.gov/

11. Encourage injury prevention. Your teenager should wear a helmet and
protective gear when bicycling, riding a motorcycle, playing contact
sports, using in-line skates, or riding a skateboard. Use of safety
equipment can reduce injuries and even save your teenager’s life.
Because 80 percent of lifetime sun exposure occurs in childhood, it’s
important for parents to help their children practice sun safety.
Just one blistering sunburn in childhood can double a child’s risk of
developing skin cancer later in life. Teach your child about sun
safety, including staying inside during midday when the sun is the
hottest; wearing a hat and sunglasses when outside; and applying
sunscreen of SPF 15 or higher frequently. Tanning beds should be
avoided.
http://www.hhs.gov/safety/index.shtml#injury

12. Talk to your children about the dangers of illicit drugs and alcohol.
Drugs and alcohol are more available to teens than you may be aware.
It can be difficult for your child to “just say no” to drugs and
alcohol. Young people who don’t know the facts about tobacco, alcohol,
and other drugs are at greater risk of trying them. Your child may be
interested in using drugs as a way to fit in or as a way to deal with
the pressures of adolescence. Build your child’s self-esteem with
praise and support for decisions. A strong sense of self-worth will
help your child to say no to drugs and alcohol — and mean it. Plan to
discuss a wide variety of topics with your child including alcohol,
tobacco, and other drugs and the need for peer-group acceptance.
You’re the best role model for your child, so avoid tobacco, alcohol
abuse, or other drugs yourself. Take a stand against drug issues –
your child will listen.
http://www.nida.nih.gov/parent-teacher.html

Source: U.S. Department of Health and Human Services
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today.reuters.com/

NEW YORK (Reuters Health) – For adults with early, aggressive rheumatoid arthritis (RA), treatment with a combination of Humira (adalimumab) and methotrexate appears to be more effective than treatment with either agent alone, according to results of the PREMIER study.

Humira is a human antibody designed to block a protein known as tumor necrosis factor, which plays a key role in inflammation. So-called TNF-blockers such as Humira have brought relief to many people with inflammatory conditions such as RA or the intestinal disorder Crohn’s disease.

In the PREMIER study, 799 patients with early, aggressive RA who had never been treated with methotrexate were randomly assigned to Humira injections plus oral methotrexate, or to Humira or methotrexate alone.

Dr. Ferdinand C. Breedveld, from Leiden University Medical Center in the Netherlands, and colleagues report in the journal Arthritis and Rheumatism that combination therapy with Humira plus methotrexate was “significantly superior” to either methotrexate alone or Humira alone in improving signs and symptoms of disease, inhibiting RA progression, and effecting clinical remission.

At the end of 1 year, 62 percent of those in the combination group achieved an “ACR50″ response — that is a decrease of at least 50 percent in the number of both tender and swollen joints — compared with only 41 percent of those in the Humira group and 46 percent of patients in the methotrexate group. This pattern was sustained at 2 years.

Patients in the combination arm also experienced less joint damage compared with patients on monotherapy.

At the end of 2 years, clinical remission was achieved by 43 percent in the combination group, 23 percent in the Humira group, and 21 percent in the methotrexate group.

There were no significant differences among groups in the incidence of serious adverse events or in the number of subjects who withdrew because of adverse events. Withdrawal because of a lack of efficacy was less frequent in the combination therapy group (4.9 percent versus 19.0 percent and 17.9 percent).

The PREMIER study was sponsored by Humira manufacturer Abbott Laboratories.

SOURCE: Arthritis and Rheumatism January 2006.
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Doctors and pharmacies are expecting ‘an awful lot of confusion’ over the Part D drug benefit when patients start arriving next week.

By Lisa Girion, Times Staff Writer
latimes.com

For physicians and pharmacists, the day after the New Year’s holiday is often the busiest. This year they are bracing for even longer lines as baffled patients try to use Medicare’s new drug benefit.

Much has been made about confusion among seniors over choices presented by Medicare Part D, which adds prescription discounts to the federal health insurance plan for the elderly. Doctors and pharmacists will find out just how confused they are when patients — some of whom may not know they were automatically signed up for the program — start arriving next week.

This comes on top of a surge of business that traditionally follows the New Year’s holiday as patients seek help with colds and the flu and new employer-sponsored health plans take effect.

John Cronin, senior vice president of the California Pharmacists Assn., described it as a “sort of a triple witching hour for pharmacists.”

“There’s going to be an awful lot of confusion,” said Cronin, a pharmacist who owns two drugstores in San Diego County. “Is it going to be mass confusion that’s overwhelming or is it going to be a trickle? We really don’t know.”

The drug benefit is meant to lighten the load of high drug prices for elderly patients. But because it is not a one-size-fits-all program, pharmacies and physicians will have to figure out which of the hundreds of plans their patients are on — and untangle myriad different premiums, co-payments, approved drug lists and coverage areas.

Some pharmacists and physicians have spent weeks trying to help patients get ahead of the problem.
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By Jan Hefler
Inquirer Suburban Staff
philly.com

Chuck Eldridge slices open the chest of a 76-year-old retired engineer with a clogged aortic valve. He spreads wide the rib cage and goes in.

Eldridge cradles the heart, poking gently to feel for disease. “Ten-minute warning,” Eldridge says, alerting the surgeon that he will soon be needed at the table in Abington Memorial Hospital’s operating room.

Eldridge is a nurse.

Renowned cardiac surgeon V. Paul Addonizio tapped him 17 years ago to be his first assistant.

While an increasing number of highly trained nurses are taking on routine tasks that doctors performed, Eldridge’s setup is rare.

Traditionally, first assistants are surgeons or resident doctors. To qualify, Eldridge needed a registered nurse’s license, at least two years of operating-room experience, one year of training to become a registered nurse first assistant (RNFA), and 2,000 clinical hours in operating rooms.

Addonizio and Eldridge have worked across the table from each other in more than 5,000 operations, including many innovative breakthroughs requiring five or more hours of carefully orchestrated maneuvers.

“We’re brothers in a battlefield,” said Addonizio, who was chief of cardiac surgery at Temple University Hospital before he instituted Abington’s open-heart program in 1996.

“I just consider myself privileged to watch Paul work,” said Eldridge, a Burlington Township resident.

Eldridge does the preliminary surgical work – opening the chest and harvesting veins for bypass – then positions the heart for the surgeon to repair.

He was with Addonizio when the surgeon performed the first pediatric autotransplant five years ago. Addonizio removed a 17-year-old girl’s heart, placed it into an icy saline solution, and excised a tumor.

Eldridge also assisted when Addonizio became the first to use human skin to replace parts of the heart.

These were just two of several world firsts the two achieved.

“We’ve had a lot of adventures together,” Addonizio said. Their long association allows them to be quick and efficient. Resident surgeons who rotate into the operating room every few months would not offer the same opportunity, Addonizio said. And having a nurse as an assistant eliminates competition among surgeons, a situation that can slow the pace, he said.

Jane Rothrock, founder of the RNFA program at Delaware County Community College and author of the program’s first textbook, said she had trained about 2,000 RNFAs since 1985. She estimated that only 200 closely assisted in operating rooms, mostly in cardiac and orthopedic cases.

Rothrock foresees an upswing as RNFAs achieve recognition. She said Temple University Hospital and Thomas Jefferson University Hospital’s Rothman Institute used them. And Addonizio has added six more RNFAs to his team as backups.

Addonizio credits Eldridge with making many of his accomplishments possible. The surgeon has published numerous medical reports and is known for his fast pace – an average of 300 operations a year – and willingness to take on high-risk patients, many 80 to 90 years old.

“Our goal was to push back some frontiers. Chuck had an incredible innate ability, and I put him through rigorous training… . Everything we do is so well-choreographed,” he said. The two have even developed their own micro-instruments and techniques.

“Technically, Chuck is superb… . He was a Marine and brings that philosophy with him – that it’s maximum effort every day… . He is honest to a fault and very serious,” Addonizio said.

Eldridge said he had been “carrying on the love of the heart and heart surgery” since he got into nursing 25 years ago. Unable to afford medical school, he pursued nursing. His career got exciting when, in 1984, he participated in the first heart transplant in the tri-state area as a scrub nurse at Temple.

Eldridge said his job is to anticipate Addonizio’s moves. “While he’s adjusting the needle, I’m doing the scurrying to get the exposure he needs. We talk very little, but he gives away his intentions by the needle angle,” Eldridge said.

His interest in the heart was sparked in 1977 when, as a volunteer firefighter in Bellmawr, he saved a 50-year-old heart attack victim by using cardiopulmonary resuscitation. Later, he enrolled in Cooper University Hospital’s nursing school in Camden.

Manoj R. Muttreja, medical director of the cardiac surgery program at Abington, has seen Addonizio and Eldridge at work. They can replace a valve in 20 to 30 minutes – about half the national average – which is critical when a patient is on a heart and lung machine, he said.

In their personal lives, the surgeon and nurse are worlds apart. Addonizio, 58, is a quiet, serious man who loves opera. Eldridge, 54, loves motorcycle racing, bow hunting and country music.

Eldridge said motorcycle racing was not too different from heart surgery. Both require the utmost concentration and precision and carry life and death implications, he said. “It all comes down to the moment of truth,” he said.

On a morning last month in the operating room, Eldridge and Addonizio were hunched over John Smith, a retired engineer from Warminster with a failing heart valve. As they worked nonstop for three hours, their heads nearly bumped.

That week, a recovering Smith discussed his experience. He was aware Addonizio had used a nurse as his assistant and said it did not give him pause.

“Everyone told me what a good surgeon he was, and I had no reason to question it. I don’t know why I would think otherwise,” Smith said. “I feel wonderful.”
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Scientists discover how the most deadly malaria parasite tricks the immune system.redherring.com

Australian scientists have figured out how the world’s most deadly malaria parasite evades the immune system in a discovery that could lead to new treatments for the disease that kills an estimated 2.7 million people a year.

The findings were published online Wednesday in the journal Nature.

It turns out that the parasite, Plasmodium falciparum, is a master at deception, switching between different camouflage proteins as a fugitive might change jackets to evade the police. Like the police, human immune system cells cannot predict which camouflage the parasite will use next.

The parasite activates one camouflaged protein at a time, keeping the others inactive until the immune system recognizes that particular disguise and a new one is needed.

“It’s like a leopard being able to change its spots,” said Alan Cowman, an international research scholar at the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia.

“New forms come up, and the immune system beats them down again,” he added. “Because of this a lot of people think you need five years of constant exposure to malaria in its different disguises to gain immunity.”

Many children, who make up three quarters of the estimated 2.7 million people who die annually from malaria, do not live through the infection long enough to develop immunity.

Promoting Change

The researchers were able to explain how the parasite exercises such control over the camouflage proteins it expresses. It does this using a special region of DNA called a promoter.

“The promoter is all you need for activation and silencing,” said Dr. Cowman. “It’s the main site of action where everything is happening. This is the first time anyone has actually been able to infiltrate an antigenic variation program.”

P. falciparum uses a protein to decorate the exterior of the red blood cells it invades. The protein causes the cells to adhere to the lining of the blood vessels, taking them out of the main circulation where the cells would likely be destroyed.

However white blood cells can still learn to identify the infected red blood cells and destroy them. Therefore the parasite has evolved a genetic mechanism which allows it to switch to a different protein.

New Therapies

The scientists say their new discovery could lead to new treatments which interfere with the parasite’s strategy of switching disguises.

Given the global toll of the disease, few would argue that pharmaceutical research into malaria has been disappointingly limited.

There is new hope, however. In late October, the Bill and Melinda Gates Foundation announced it would give $258.3 million for the development of a malaria vaccine, drugs, and research to combat the disease (see Gates’ $258M Grant for Malaria).

This is a significant step up from the $323-million total global funding in 2004 for malaria research and development. But critics would argue that still much more needs to be done. Researching and developing a drug all the way to approval frequently costs pharmaceutical companies more than $1 billion.

Only two companies are listed by pharmaceutical industry organization PhRMA, as working on malaria treatments.

Hollis-Eden Pharmaceuticals, based in San Diego, California, says that mid-stage clinical trials of its drug Immunitin proved successful at reducing parasite count and cleared malarial parasites in most patients within a week.

Immtech International, based in Vernon Hills, Illinois, is also in mid-stage clinical trials for a drug called DB289.
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