Solucion impotencia

According to a recent study of clinical characteristics of teens who underwent laparoscopic RouxenY gastric bypass surgery from 2002 until 2007, doctors may have a much narrower window of opportunity to reverse morbid obesity in teens than previously thought.

The study, conducted at Cincinnati Childrens Hospital Medical Center, appears in the current online edition of the Journal of Pediatrics.

The study focused on 61 teens who underwent laparoscopic RouxenY gastric bypass at Cincinnati Childrens. The results of the study showed that one year after the study, BMI in the overall group of teens presurgery decreased by 37 percent, however because of their starting weights, the teens were still considered to be morbidly obese. This means that doctors can predict what a patients weight will be oneyear post weight loss surgery.

Lead author of the study, Thomas Inge, MD, PhD, Associate Professor of Surgery and Pediatrics, explains that “Current guidelines for adolescent weight loss surgery suggest that we begin to consider surgery only after a teen is 80100 percent overweight. Our new data show that when we intervene when a patient is between 100 and 150 percent over ideal weight, we can expect successfully resolution of obesity. But by the time the teen is 200 percent over their ideal weight for age, the surgery will reduce their weight substantially, but many of the patients will still remain morbidly obese.

This is the first study in adolescents to specifically show that the postoperative weight is strongly influenced by the patients starting weight. This finding raises a concern that waiting until children are super obese to begin to think of surgery may result in major weight loss, but not resolution of obesity and certain medical problems than intervening at an early stage of the disease. For instance, in those who remain significantly obese following surgery, this excess weight can have negative effects on joints and mobility; the longterm risks of remaining seriously overweight are unknown.

Coauthor Dr. Stavra Xanthakos, Assistant Professor of Pediatrics and pediatric gastroenterologist feels that, “We [doctors] have to do a better job of identifying teens who are gaining enormous amounts of weight quickly and get help for them earlier.” Dr. Xanthakos says that when doctors or parents notice that a teen is beginning to gain weight rapidly, there should be a staged approach to managing the weight problem. “If the weight gain is not effectively stopped with initial nutritional or exercise measures, then even more intensive treatments or programs are indicated, and ultimately some very serious thought has to be given to surgery,” said Dr. Xanthakos.

Mary L. Brandt, MD, Professor and Vice Chair of the Michael E. DeBakey Department of Surgery and a pediatric surgeon at Texas Childrens Hospital worries about these results as well. “We are trying to help teenagers who are at high risk for preventable but lifethreatening diseases such as diabetes or obesity induced liver disease. Bariatric surgery will improve the medical condition of obese teenagers regardless of the starting weight of the patient. But our ability to help these children prevent or reverse their lifethreatening diseases will be even greater if our patients are able to approach a normal weight.”

According to Brandt, “The other major implication of this new data is that many insurance companies will delay surgery for years, usually by requiring documentation of multiple attempts at weight loss. Severely obese teenagers only rarely respond to these kinds of treatments and, despite intense efforts to lose weight, often will gain weight during these efforts. Although it is ethically important for these children to have a least one well supervised attempt to lose weight without surgery, this report shows us that delaying the surgery while trying multiple times may not be in their best interest.”

This study, like others, found that after surgery, patients generally show significant improvement or resolution of cardiovascular risk factors such as blood pressure, cholesterol, and triglyceride levels.

Dr. Inge said that the study indicates that families and communities need to take childhood weight problems seriously and aggressively pursue the best treatment options available for them before the weight problem gets out of hand. “As doctors who take care of kids, we have an obligation to identify those patients who are at highest risk and start explaining treatment options to families earlier before the child or teen gets to be two or three times his or her ideal weight, ” said Dr. Inge.

About Cincinnati Childrens

Cincinnati Childrens Hospital Medical Center is one of 10 childrens hospitals in the United States to make the Honor Roll in U.S. News and World Reports 200910 Americas Best Childrens Hospitals issue. It is #1 ranked for digestive disorders and is also highly ranked for its expertise in respiratory diseases, cancer, neonatal care, heart care, neurosurgery, diabetes, orthopedics, kidney disorders and urology. One of the three largest childrens hospitals in the U.S., Cincinnati Childrens is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

President Barack Obama in June 2009 cited Cincinnati Childrens as an “island of excellence” in health care. For its achievements in transforming health care, Cincinnati Childrens is one of six U.S. hospitals since 2002 to be awarded the American Hospital AssociationMcKesson Quest for Quality Prize for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases.

Over 100 certified breastfeeding peer counselors, lactation consultants, nurses, physicians, dietitians and community health workers are expected to gather at Rush University Medical Center on Thursday, August 6 from 8 a.m. until 1 p.m. in Room 500 at 1725 W. Harrison Street, Chicago, to attend the Griffin Inaugural Conference on Breastfeeding The Primary Foundation for Health.

At the conference, experts from Rush, Illinois Department of Human Services, Chicago Department of Public Health and Black Mothers Breastfeeding Association will discuss strategies for organizing Chicago communities to reduce breastfeeding disparities.Dr. Myrtis Sullivan, associate director of the Office of Family Health, Illinois Department of Human Services, will be discussing Chicagos current breastfeeding rates and where there are gaps within the neighborhoods and communities of Chicago.
Dr. Terry Mason, commissioner, Chicago Department of Public Health, is scheduled to speak about the importance of breastfeeding to the reduction in health risks throughout the lifespan. Recent studies show that breastfeeding reduces the risk for infection, obesity, diabetes, and other chronic diseases throughout the lifespan, and as such is the primary foundation for health.
Keynote speaker Kiddada Ramey, president of the Black Mothers Breastfeeding Association in Detroit, Mich., will give a feature presentation on effective strategies for community breastfeeding. Ramey will also address reasons why African American women breastfeed at lower rates than other populations in the United States.
“By bringing experts in the field together for this conference, we will identify hospitalcommunity partnership strategies to increase the rates of breastfeeding initiation and duration among Chicago women,” said Paula Meier, director for clinical research and lactation in the Neonatal Intensive Care Unit at Rush.

“Our goal is to identify geographic areas and populations within Chicago neighborhoods that have low rates of breastfeeding and to discuss the most effective ways we can reduce those breastfeeding disparities,” said Meier.

Anne and Ken Griffin are sponsoring the event.

Continuing education credits applied for from the International Board of Lactation Consultant Examiners. Rush University College of Nursing is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Centers Commission on Accreditation. This CNE activity is being offered for 4.2 contact hours.

Source
Rush University Medical Center

A research published ahead of print in the Archives of Disease in Childhood reports that every hour of the day children are inactive adds three minutes to the time it takes them to fall asleep.

The study indicates that children who fall asleep faster also sleep for longer. Although, it appears one is not the direct consequence of the other.

Research shows that approximately 16 percent of parents of school aged children report that their child finds it difficult to get to sleep.

There is a connection between poor sleeping patterns in children and inferior school performance. It is also linked to an increased risk of overweight and obesity.

Using an activity monitor (called an actigraph) worn for 24 hours, the authors evaluated the daytime activity and sleep patterns of a representative sample of 591 seven year olds.

They obtained full information on sleep patterns for 519 of the children. They took an average of 26 minutes to fall asleep. This is known as sleep latency, ranging from 13 to 42 minutes (interquartile range).

The parents reported that around one in ten of the children regularly found it difficult to fall asleep quickly. These children took around 15.5 minutes longer to get to sleep.

The children, who were physically active during the day, fell asleep more rapidly than their more sedentary peers. The more vigorous activity they did, the faster they fell asleep.

In addition, every hour of the day spent in sedentary activity increased sleep latency by three minutes.

Shorter sleep latency was also associated to longer duration of sleep. It fell by more than 11 minutes for each additional hour of sleep.

The authors comment these findings will validate what many parents already believe that tiring out a child with plenty of physical activity will increase the likelihood that she or he will sleep well.

They write in conclusion “This study emphasizes the importance of physical activity for children, not only for fitness, cardiovascular health and weight control, but also for sleep.”

“Falling asleep the determinants of sleep latency”
G M Nixon, J M D Thompson, D Y Han,D M O Becroft, P M Clark, E Robinson,K E Waldie, C J Wild, P N Black, E A Mitchell
Online First Arch Dis Child 2009; doi 10.1136/adc.2009.1574453
Arch Dis Child

A survey of UK adults found that nearly two thirds are risking their health by not doing enough exercise and putting themselves at greater risk of potentially fatal illnesses like cancer, heart disease and stroke.

The Opinium Research survey was conducted in April this year for the Chartered Society of Physiotherapy (CSP) thorugh an online poll of 2,084 UK adults. A regional breakdown is published on the CSP website.

Despite overwhelming evidence that exercise is essential to health, helps fight obesity and reduces peoples risk of developing chronic and life threatening disease, it appears that the 63 per cent of UK adults know they are putting their health at risk by not doing enough exercise.

Last week the CSP launched a UKwide campaign “Move for Health” to raise the importance of exercise in maintaining good health and preventing disease. They have also produced a downloadable leaflet called the Easy Exercise Guide.

Secretary of State for Health, Andy Burnham expressed his support for the campaign

“Making just small increases in your activity levels can make a big difference to your overall longterm health.”

“Active people are up to 50 per cent less likely to be at risk of major chronic disease such as coronary heart disease, stroke, diabetes and cancer. But not enough of us do the recommended 30 minutes, five days a week,” said Burnham.

The survey results, which were adjusted to be representative of the UK adult population as a whole, showed that20 per cent of UK adults exercise only once a month or less.
41 per cent said they would take regular exercise if it led to a longer life.
52 per cent said they would take regular exercise if it helped them lose weight.
Only 13 per cent knew how much exercise they should do every day, while as many as 56 per cent thought it was less than the recommended amount.
39 per cent said they got out of breath quite quickly when they walked up a flight of stairs.
Women appeared to be less fit than men, with 43 per cent saying they got out of breath quickly compared with 34 per cent of men.
The most common reason people gave for not taking regular exercise is they are too busy with work (35 per cent), or they did not exercise because they felt too tired or unwell (25 per cent).
53 per cent said that they would take more regular exercise if they could fit it into their daily routine.
39 per cent said it would help if exercise were free.The CSP recommends one hour of exercise every day for children and thirty minutes at least five times a week for adults.

Regarding the second most common reason people said they did not exercise, that being because the felt too tired or unwell, the CSP said physiotherapists often recommend exercise as a way to treat lethagy, stress and depression, and boost work performance.

CSP spokesperson Bridget Hurley, who is a chartered physiotherapist told the media that

“Without sufficient physical activity you increase your risk of lifethreatening illnesses.”

“Regular physical activity is as important as eating five portions of fruit and vegetables a day, and people need to understand that you cant keep putting it off,” she said.

As part of the “Move for Health” campaign, physiotherapists around the UK are showing people that you dont need expensive equipment and lots of spare time to do exercise that benefits health.

As Hurley explained

“Exercise doesnt need to be expensive, boring or time consuming. Just going outside at lunchtime for a halfhour walk every day will greatly increase your fitness levels.”

One way to break out of the vicious cycle of feeling ill and tired which then stops you wanting to exercise is to gradually become more active and build up to the recommended amount. It does not have to be a huge leap.

“Were all aware that exercise is important for our health and finding an activity that you enjoy, such as dancing or gardening, will make it much easier to maintain the sort of lifestyle that is good for us,” said Hurley.

“The CSP has a range of free materials to help you find easy ways to be more active without injuring yourself or overdoing it,” she added.

Survey responses by region.
CSP Easy Exercise Guide

Source Chartered Society of Physiotherapy, UK.

Written by Catharine Paddock, PhD

Charles Darwin and his contemporaries postulated that food consumption in birds and mammals was limited by resource levels, that is, animals would eat as much as they could while food was plentiful and produce as many offspring as this would allow them to. However, recent research has shown that, even when food is abundant, energy intake reaches a limit, even in animals with high nutrient demands, such as lactating females. Scientists at the Research Institute of Wildlife Ecology in Vienna suggest that this is due to active control of maternal investment in offspring in order to maintain longterm reproductive fitness.

The research, presented by Dr Teresa Valencak at the Society for Experimental Biology Annual Meeting in Glasgow has shown that, when their energy reserves are low or when their offspring are kept in cooler temperatures, Brown hares are able to increase their energy turnover and rate of milk production above that normally observed. This indicates that, ordinarily, the hares are operating at below their maximum capacity and shows that this is not due to any kind of physiological constraint, such as length of digestive tract or maximum capacity of mammary glands. Also, as the hares were provided with plentiful food, there could be no limitation of energy turnover due to food availability.

The way that females regulated their energy expenditure according to pup demand and their own fat reserves but did not exceed certain levels fitted with the groups theory that using energy at close to the maximum rate has costs for animals which may compromise their ability to successfully reproduce in the future. If a hare puts most of its energy into a litter of pups then it will have little left over for growth and body repairs for example, which may shorten its life or make it less able to produce or care for young in the future. By actively limiting the rate of energy turnover, a mother can prevent this and maintain a higher level of reproductive success over her lifetime.

Source
Tess Livermore
Society for Experimental Biology

A new study by Indiana UniversityPurdue University Indianapolis (IUPUI) researchers contradicts the conventional wisdom that living near a fast food outlet increases weight in children and that living near supermarkets, which sell fresh fruit and vegetables as well as so called junk food, lowers weight.

The IUPUI investigators in economics, pediatrics, geography and urban planning compared childrens weights over time before and after one of these food purveyors moved near the childrens residences. Living near a fast food outlet had little effect on weight and living near a supermarket did not lower it.

The IUPUI researchers also report that residing near certain recreational amenities fitness areas, kickball diamonds, and volleyball courts lowers childrens body mass indexes (adjusted for normal childhood growth). The researchers estimated that locating one of these facilities near the home of an overweight eightyearold boy could lower his weight by three to six pounds. Surprisingly, living in proximity to a track and field facility (typically on the campus of a middle or high school) was associated with weight gain.

Reducing obesity in children is a high priority in health care and public policy, yet its causes and, consequently, what medical interventions might be effective, are not well understood.

“This study contradicts anecdotal information and provides scientifically verified insights into a wide range of variables that we hope will help physicians and public policy makers fight childhood obesity more effectively,” said the studys first author Robert Sandy, Ph.D., professor of economics and assistant executive vice president of Indiana University.

The IUPUI research, published in the National Bureau of Economic Researchs Economic Aspects of Obesity, utilized electronic medical records of visits over 11 years to pediatric clinics in inner city Indianapolis to determine the effects on body mass of environmental changes, such as the opening or closing of a convenience store or the installation of a playground or opening of a recreational trail.

The researchers looked at data for more than 60,000 children between the ages of 3 and 18. The children were 53 percent AfricanAmerican, 30 percent Caucasian and 12 percent Hispanic. Most were poor, and publically insured.

The effect of each environmental change, for example the closing of a fast food establishment or installation of a baseball diamond, was studied at 0.10 mile, 0.25 mile, 0.50 mile and 1.00 mile from a childs residence.

Earlier studies typically have looked at one moment in time, the socalled snapshot approach, not a decadelong expanse of data.

“Previous studies did not benefit from the wide range of information we acquired such as details of both sick and well doctor visits, changes in a childs address, annual food service establishment inspection data, aerial photographs of neighborhoods and crime statistics over time. And other studies have not taken into account, as we did, families selfselecting their locations for example families who value exercise may be more likely to live near a park,” said Dr. Sandy.

Notes

Authors of the study are Robert Sandy, Ph.D., Department of Economics, School of Liberal Arts, IUPUI; Gilbert Liu, M.D., Department of Pediatrics, IU School of Medicine, IUPUI; John Ottensmann, Ph.D., School of Public and Environmental Affairs, IUPUI; Rusty Tchernis, Ph.D., Department of Economics, IUBloomington and National Bureau of Economic Research; and Jeff Wilson, Ph.D., and O.T. Ford, B.S., both of the Department of Geography, School of Liberal Arts, IUPUI.

“Studying the Child Obesity Epidemic With Natural Experiments” was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. In their next study the IUPUI researchers plan to study children in Boston; Wilmington, Del.; Nashville, Tenn.; Jacksonville and Orlando, Fla.

Source
Cindy Fox Aisen

Body mass index (BMI) should be taken into account when assessing a cancer patients vitamin D status, according to researchers at Cancer Treatment Centers of America (CTCA), who found that obese cancer patients had significantly lower levels of vitamin D compared to nonobese patients.

The association between vitamin D and obesity remains unsettled with studies reporting conflicting findings on the relationship between the two. This association assumes even greater importance in cancer because of the alleged role of vitamin D in cancer.

“Currently, the dietary recommendations for vitamin D do not take into account a patients BMI,” said Carolyn Lammersfeld, national director of nutrition for CTCA and a principal investigator in the study. “We investigated the relationship between vitamin D and BMI in a large sample of cancer patients and found that as BMI groups increased from normal to overweight or obese classifications, there was a significant decrease in vitamin D.”

The researchers evaluated a group of 740 cancer patients seen at CTCA from January 2008 to June 2008. Of the 740 patients, 303 were male and 437 female, with a mean age at presentation of 55.7 years (SD = 10.2). The mean BMI was 27.9 kg/m2 (SD = 6.7). The most common cancers were lung (134, 18.1%), breast (131, 17.7%), colorectal (97, 13.1%), pancreatic (86, 11.6%), prostate (45, 6.1%) and ovarian (39, 5.3%). The mean vitamin D (serum 25(OH)D) was 21.9 ng/ml (SD = 13.5).

The study concluded that obese cancer patients (BMI >=30 kg/m2) had significantly lower levels of vitamin D compared to nonobese patients (BMI

Mayo Clinic researchers are reporting that persons who undergo bariatric surgery may have a greater chance of experiencing broken bones, especially in their hands and feet. The study is based on a review of nearly 100 surgical cases at Mayo spanning 21 years and presented at the Endocrinology Society Annual Meeting in Washington, D.C.

“We knew there was a dramatic and extensive bone turnover and loss of bone density after bariatric surgery,” says Jackie Clowes, M.D., Ph.D., a Mayo rheumatologist and senior author on the study. “But we didnt know what that meant in terms of fractures.”

The research team worked with Rochester Epidemiology Project records to develop the chart review of 97 of the 292 patients who underwent the bariatric procedure between 1984 and 2004. The findings, adjusted for age and gender factors, showed 21 individuals experienced 31 fractures within an average of seven years after surgery. Fractures were reported in the hip, spine and humerus (upper arm bone), with the majority of fractures in the hands and feet.

“Weve shown that risk of fractures after this type of weight loss surgery is clinically significant,” says Elizabeth Chittilapilly Haglind, M.D., Mayo endocrinologist and lead author, who is presenting today. “More research is needed to confirm our findings and understand the specific risk factors and mechanisms involved.”

Others on the Mayo team were Kurt Kennel, M.D.; Maria CollazoClavell, M.D.; Sara Achenbach; Elizabeth Atkinson; and L. Joseph Melton, M.D.

Source
Robert Nellis

There is more medical evidence that pregnant women should steer clear of advice to “eat for two.”

Alison Stuebe, M.D., assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine, reviewed data for more than 1,300 women and found that those who consumed extra calories, as well as fried foods and dairy products, were more likely to gain more than is recommended during pregnancy thats 35 pounds or more for a woman with a normal body mass index, or BMI.

Stuebe found that eating an extra 500 calories a day increased the odds of gaining too much by 10 percent. “Thats the number of calories in a muffin or a bagel with cream cheese at Dunkin Donuts,” Stuebe says. “It doesnt take much for the calories to add up.”

Gaining too much weight is linked with complications at birth, such as preeclampsia or requiring a Csection, as well as higher odds that both mom and child will be obese later in life.

But the study results are good news theres something women can do to reduce risks for themselves and their babies. “Its a twofer,” Stuebe says. “If you take care of yourself, its good for you and for your baby.”

Several eating habits reduced moms risk of gaining too much. Women with vegetarian diets in early pregnancy were half as likely to gain an unhealthy amount of weight, and those who exercised vigorously for a half hour a day reduced their risk by 20 percent. The researchers also found that consuming more monounsaturated fat, found in olive oil and nuts, was linked with a lower risk of excessive weight gain.

Stuebe did the research while at Brigham and Womens Hospital in Boston. The results were published May 19, 2009, in the online version of the American Journal of Obstetrics and Gynecology (available to subscribers).

It might be obvious that a healthy diet and exercise reduce the odds of gaining too much weight during pregnancy, but more and more women are doing just that. Part of the problem is that providers dont counsel moms on weight gain, Stuebe says. Other studies have shown that moms who get advice from their doctor or midwife are more likely to gain in a healthy range.

Stuebes study offers some guidelines to share with expecting moms. Eating fried foods “was a huge predictor of excessive weight gain,” she says. Women who ate one serving a day were fourtimes as likely to gain too much weight.

Some study results were surprising. For example, dairy products, including those made with lowfat milk, were associated with more weight gain. More studies are needed to sort out why milk products were associated with extra gain.

The study used data from Project Viva, a prospective cohort of mothers and babies in the Boston, Mass., area. The study is ongoing, and researchers are currently following up the children at age seven.

For now, Stuebe says, her study results offer guidelines for moms to make healthy choices during pregnancy. “The next step is to study whether moms who get this advice have healthier weight gain than those who do not,” she says.

In the meantime, moms should follow existing guidelines to get regular exercise, and avoid fried foods and highcalorie snacks. Otherwise, after childbirth, they may find themselves struggling to unload extra pounds.

“And losing for two is a lot of work,” Stuebe says.

There is more medical evidence that pregnant women should steer clear of advice to “eat for two.”

Alison Stuebe, M.D., assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine, reviewed data for more than 1,300 women and found that those who consumed extra calories, as well as fried foods and dairy products, were more likely to gain more than is recommended during pregnancy thats 35 pounds or more for a woman with a normal body mass index, or BMI.

Stuebe found that eating an extra 500 calories a day increased the odds of gaining too much by 10 percent. “Thats the number of calories in a muffin or a bagel with cream cheese at Dunkin Donuts,” Stuebe says. “It doesnt take much for the calories to add up.”

Gaining too much weight is linked with complications at birth, such as preeclampsia or requiring a Csection, as well as higher odds that both mom and child will be obese later in life.

But the study results are good news theres something women can do to reduce risks for themselves and their babies. “Its a twofer,” Stuebe says. “If you take care of yourself, its good for you and for your baby.”

Several eating habits reduced moms risk of gaining too much. Women with vegetarian diets in early pregnancy were half as likely to gain an unhealthy amount of weight, and those who exercised vigorously for a half hour a day reduced their risk by 20 percent. The researchers also found that consuming more monounsaturated fat, found in olive oil and nuts, was linked with a lower risk of excessive weight gain.

Stuebe did the research while at Brigham and Womens Hospital in Boston. The results were published May 19, 2009, in the online version of the American Journal of Obstetrics and Gynecology (available to subscribers).

It might be obvious that a healthy diet and exercise reduce the odds of gaining too much weight during pregnancy, but more and more women are doing just that. Part of the problem is that providers dont counsel moms on weight gain, Stuebe says. Other studies have shown that moms who get advice from their doctor or midwife are more likely to gain in a healthy range.

Stuebes study offers some guidelines to share with expecting moms. Eating fried foods “was a huge predictor of excessive weight gain,” she says. Women who ate one serving a day were fourtimes as likely to gain too much weight.

Some study results were surprising. For example, dairy products, including those made with lowfat milk, were associated with more weight gain. More studies are needed to sort out why milk products were associated with extra gain.

The study used data from Project Viva, a prospective cohort of mothers and babies in the Boston, Mass., area. The study is ongoing, and researchers are currently following up the children at age seven.

For now, Stuebe says, her study results offer guidelines for moms to make healthy choices during pregnancy. “The next step is to study whether moms who get this advice have healthier weight gain than those who do not,” she says.

In the meantime, moms should follow existing guidelines to get regular exercise, and avoid fried foods and highcalorie snacks. Otherwise, after childbirth, they may find themselves struggling to unload extra pounds.

“And losing for two is a lot of work,” Stuebe says.