HEALTH, WEIGHT AND DIET CONTROL ADVISORS

Does baby weight have something to do with autism?

2011-10-17T10:09:00.000-07:00

Risk of Autism Is Five Times Higher in Low-Birthweight Babies
By Bonnie Rochman Monday, October 17, 2011
Low-birthweight babies are at risk for all sorts of motor and cognitive delays, and researchers have just added autism to the list. A new study from the University of Pennsylvania finds that premature babies weighing less than 4.5 lbs. at birth are five times more likely than babies born at a normal weight to have an autism spectrum disorder (ASD).

Routine screening for ASD is especially critical in light of medical advances that regularly save babies as little as 1 lb. "It's a public health red flag," says Jennifer Pinto-Martin, director of the Center for Autism and Developmental Disabilities Research and Epidemiology at the University of Pennsylvania (Penn) and the study's lead author. "We have a wave of these children coming down the pike because neonatal care has improved so dramatically. We are saving more and more babies, and the consequences for their health are going to be profound."

The conclusions, which are published Monday in the journal Pediatrics, are the results of a study that began more than two decades ago. Researchers initially followed 1,105 children who were born in three New Jersey counties between 1984 and 1987, some of whom weighed just a pound at birth. READ MORE

Heart Disease Prevalence

2011-10-15T10:40:00.000-07:00

U.S. Coronary Heart Disease Prevalence Dropping
The State Column | Staff | Saturday, October 15, 2011

According to the Centers for Disease Control and Prevention (CDC), the prevalence of coronary heart disease is declining in the U.S. More specifically, surveys from the Behavioral Risk Factor Surveillance System (BRFSS) found that between 2006 and 2010 there has been a significant decrease in overall coronary heart disease, from 6.7 percent down to 6 percent. This decrease in prevalence could be linked to the concerted public-health effort over the past two decades on prevention and treatment programs.

The study admits the decline in coronary heart disease mortality over the past 50 years should result in an increase in the coronary heart disease prevalence. However, to explain the study’s findings, the researchers believe the observed decline in observation is due to a reduction in the population pool of individuals at risk.

The report included extensive data about the differences in coronary heart disease prevalence based on age, sex, race/ethnicity, education, and state of residence.

Coronary heart disease prevalence was generally highest in the south. West Virginia and Kentucky had the highest prevalence of coronary heart disease, 8 percent and 8.2 percent. Alternatively, in 2010, Hawaii and DC had the lowest prevalence, 3.7 percent and 3.8 percent respectively. Most surprisingly, Wisconsin had the lowest rate of heart disease in the nation, a rate of 4.9 percent.

Additionally, the risk of heart disease was influenced by age. The lowest rates of heart disease were among younger people, under the age of 65 years old. In 2010, nearly 20 percent of individuals 65 years old and older had heart disease, compared with about 7 percent of individuals who were between 45 to 64 years old, and about 1 percent of individuals between 18 to 44 years old.

Education appeared to also influence heart disease prevalence. Heart disease was more prevalent among people without a high school diploma, 9.2 percent. People with some college education had a 6.2 percent prevalence rate, and those with more than an undergraduate degree enjoyed the lowest rate of 4.6 percent.

Women tended to have lower rates of heart disease than men, 4.6 percent and 7.8 percent, respectively. Read more...

Thye story behind Steve Job's disease

2011-10-06T13:48:00.000-07:00

Jobs kept illness behind a firewall, lived and worked through pancreatic cancer 7-plus years
The Canadian PressBy Marilynn Marchione, The Associated Press | The Canadian Press – 6 hours ago
Steve Jobs managed to live more than seven years with a rare form of pancreatic cancer that grows more slowly than the common kind. But his need for a liver transplant two years ago was a bad sign that his troubles with the disease probably were not over.

The Apple founder long kept information on his illness behind a firewall, and no new details emerged immediately after his death.

However, medical experts unconnected with his care say Jobs most likely needed the transplant because his cancer came back or spread. They said his death could have been from cancer, the new liver not working, or complications from immune-suppressing medicines to prevent organ rejection.

A liver transplant can cure Jobs' type of cancer, but "if it were to come back, it's usually in one to two years," said Dr. Michael Pishvaian, a gastrointestinal cancer specialist at Georgetown University's Lombardi Comprehensive Cancer Center.

Jobs declared he was cured after surgery in 2004 for an islet cell neuroendocrine tumour, a much more treatable form of pancreatic cancer than the more common form of the disease that killed actor Patrick Swayze two years ago.

But the Apple chief never revealed whether the cancer had spread to his lymph nodes or liver, or how extensive his surgery was. Many doctors speculated he had a Whipple procedure, in which part of the pancreas, part of the small intestine and in some cases part of the stomach are removed and the digestive system is reconstructed.

"It is a big operation but it can be performed very safely by experienced surgeons at experienced centres," said Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care in New York City.

Several years later, Jobs was dramatically thinner and gaunt. In January 2009, he attributed those problems to a hormone imbalance and said there was a simple treatment for it. A few weeks later, he went on a medical leave and then had a liver transplant that was kept secret for two months.

Even then, Jobs would not say why the transplant was needed, though doctors said spread of his cancer to the liver was the likely explanation.

Usually transplants aren't done for people with cancer, but "there is some support for the idea that a liver transplant can be curative" for a neuroendocrine tumour as long as the cancer has not spread beyond the liver, Pishvaian said.

Average survival for people with neuroendocrine tumors that have spread is seven to eight years, and some patients have survived 20 to 30 years, said Dr. Martin Heslin, cancer surgery chief at University of Alabama at Birmingham.

It was not to be for Jobs.

In January, he announced his third and final leave of absence, and resigned in August.

Angela Merkel Says Doctors Ordered Treatment for High Blood Pressure

2011-09-26T08:55:00.000-07:00

By Tony Czuczka - Sep 25, 2011 6:00 PM ET
German Chancellor Angela Merkel indicated that she’s being treated for high blood pressure, saying the condition was discovered two decades ago when she applied for a government job.

A medical exam related to her job application to the German government’s press office “pointed out to me that I have to watch my blood pressure a bit,” Merkel said in response to a question by ARD television talk-show host Guenther Jauch in Berlin late yesterday. “Since then, I’ve been getting good medical treatment.”

While Merkel confirmed that elevated blood pressure led to her rejection for the government job, she said she didn’t challenge it because she won a seat in December 1990 parliamentary elections, the first after East and West Germany reunited following the fall of the Berlin Wall in 1989.

Merkel, who was raised under communism in former East Germany, said she applied for the job after acting as spokeswoman for Lothar de Maiziere, the premier who emerged from the country’s first and last free elections earlier in 1990. Read more

Scientists find way to "disarm" AIDS virus

2011-09-20T17:59:00.001-07:00

By Kate Kelland | Reuters – Mon, 19 Sep, 2011
LONDON (Reuters) - Scientists have found a way to prevent HIV from damaging the immune system and say their discovery may offer a new approach to developing a vaccine against AIDS.

Researchers from the United States and Europe working in laboratories on the human immunodeficiency virus (HIV) found it is unable to damage the immune system if cholesterol is removed from the virus's membrane.

"It's like an army that has lost its weapons but still has flags, so another army can recognize it and attack it," said Adriano Boasso of Imperial College London, who led the study.

The team now plans to investigate how to use this way of inactivating the virus and possibly develop it into a vaccine.

Usually when a person becomes infected with HIV, the body's innate immune response puts up an immediate defense. But some researchers believe HIV causes the innate immune system to overreact. This weakens the immune system's next line of defense, known as the adaptive immune response.

For this study -- published on Monday in the journal Blood -- Boasso's team removed cholesterol from the membrane around the virus and found that this stopped HIV from triggering the innate immune response. This in turn led to a stronger adaptive response, orchestrated by a type of immune cells called T cells.

AIDS kills around 1.8 million people a year worldwide. An estimated 2.6 million people caught HIV in 2009, and 33.3 million people are living with the virus.

Major producers of current HIV drugs include Gilead Bristol Myers Squibb, Merck, Pfizer and GlaxoSmithKline.

Scientists from companies, non-profits and governments around the world have been trying for many years to make a vaccine against HIV but have so far had only limited success.

A 2009 study in Thailand involving 16,000 volunteers showed for the first time that a vaccine could prevent HIV infection in a small number of people, but since the efficacy was only around 30 percent researchers were forced back to the drawing board.

An American team working on an experimental HIV vaccine said in May that it helped monkeys with a form of the AIDS virus control the infection for more than a year, suggesting it may lead to a vaccine for people.

HIV is spread in many ways -- during sex, on needles shared by drug users, in breast milk and in blood -- so there is no single easy way to prevent infection. The virus also mutates quickly and can hide from the immune system, and attacks the very cells sent to battle it.

"HIV is very sneaky," Boasso said in a statement. "It evades the host's defenses by triggering overblown responses that damage the immune system. It's like revving your car in first gear for too long -- eventually the engine blows out.

He said this may be why developing a vaccine has proven so tricky. "Most vaccines prime the adaptive response to recognize the invader, but it's hard for this to work if the virus triggers other mechanisms that weaken the adaptive response."

HIV takes its membrane from the cell that it infects, the researchers explained in their study. This membrane contains cholesterol, which helps keep it fluid and enables it to interact with particular types of cell.

Normally, a subset of immune cells called plasmacytoid dendritic cells (pDCs) recognize HIV quickly and react by producing signaling molecules called interferons. These signals activate various processes which are initially helpful, but which damage the immune system if switched on for too long.

Working with scientists Johns Hopkins University, the University of Milan and Innsbruck University, Boasso's team found that if cholesterol is removed from HIV's envelope, it can no longer activate pDCs. As a result, T cells, which orchestrate the adaptive response, can fight the virus more effectively.

Scientists Develop New Tuberculosis Vaccine

2011-09-05T05:35:00.001-07:00

By IB Times Staff Reporter | September 5, 2011 3:14 AM EDT

Scientists have made a significant advancement in the development of a new vaccine against tuberculosis, which is responsible for approximately 1.7 million deaths worldwide, annually.

Professor William Jacobs of Albert Einstein College of Medicine in New York has devised a prototype vaccine against the tuberculosis microbe, mycobacterium tuberculosis( MTB).

Tuberculosis is common and, in many cases, a lethally infectious disease caused by various strains of mycobacteria, usually mycobacterium tuberculosis. A high lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, an extremely slow rate as compared to other bacteria, which usually divide in less than an hour. Read more...

Listeriosis Outbreak In Colorado Kills Two, Sickens Seven

2011-09-04T08:38:00.000-07:00

by Claire Shefchik on September 3, 2011 12:45 PM
A listeriosis outbreak in Colorado that has already caused two deaths has prompted state health officials to issue warnings against eating undercoooked meats and other dangerous foods.

"Until we have more information about the sources of this outbreak, it is important for people to follow the standard (federal) guidelines" on listeria, Alicia Cronquist, a state epidemiologist, told The Denver Post.

That means cooking hot dogs and deli meats to an internal temperature of 165 degrees. Higher-risk groups, including pregnant women, the elderly and those with compromised immune systems, should also avoid refigerated smoked seafood and non-pasteurized soft cheeses like queso fresco and brie. Read more...

Man Dies From Toothache, Couldn't Afford Meds

2011-09-03T08:17:00.001-07:00

By CARRIE GANN, ABC News Medical Unit

Sept. 2, 2011

A 24-year-old Cincinnati father died from a tooth infection this week because he couldn't afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care.
According to NBC affiliate WLWT, Kyle Willis' wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance.
When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn't afford both, so he chose the pain medications.
The tooth infection spread, causing his brain to swell. He died Tuesday.
Calls to Willis' family were not immediately returned. University Hospital in Cincinnati, where Willis was admitted, did not comment, citing federal privacy laws.Read more

FDA: Breast Implant Safety Studies Will Continue

2011-09-01T05:54:00.000-07:00

Officials Say They Will Work With Companies to Improve Follow-Up Rates
By Brenda Goodman
WebMD Health News
Reviewed by Laura J. Martin, MD
Aug. 31, 2011 -- After two days of testimony on what the FDA should do about troubled long-term safety studies of silicone-gel breast implants, agency officials said the studies would continue.

"The current post-approval studies will continue," said William Maisel, MD, MPH, chief scientist in the FDA's Center for Devices and Radiological Health, in remarks after the meeting. "The FDA is committed to seeing them completed and making sure the follow-up rates improve."

The safety studies in question, of nearly 100,000 women with breast implants, which the FDA said were the largest ever required of manufacturers after their devices were marketed to the public, have lost track of up to 79% of the women they enrolled just three years into planned 10-year efforts.

As a result, FDA epidemiologists testified yesterday, the studies had lost the ability to find rare complications, including connective tissue diseases, that they were designed to look for.
Save or Scrap Troubled Studies?

In a second day of testimony, the General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee to the FDA heard plenty of opinions about what should happen with the studies.

Some panelists felt the companies should be compelled by the FDA to finish the studies they had agreed to complete as a condition of the approval of their devices. They asked FDA officials what regulatory powers the agency could wield to do that.

"If you do not meet the conditions of approval the FDA does have regulatory authority to either impose civil penalties or other regulatory actions," said Mark N. Melkerson, director of the Division of Surgical, Orthopedic and Restorative Devices at the FDA's Center for Devices and Radiological Health.

The agency said it was not considering taking silicone breast implants off the market.

Some consumer advocates thought that option ought to be on the table, however.

"It has now been 25 years since FDA declared silicone breast implants a class III device, and in that period, only weak attempts have been made to assess the safety of these implants," said Kate Ryan, of the nonprofit Breast Cancer Action, which is based in San Francisco.

"Follow-up rates on the two large studies are dismal," Ryan said in testimony. "Given that these studies were a condition of approval, Mentor should have done much more to ensure it had the technical skills to locate women and provide women with incentives to participate in this important research."
Manufacturers Respond

Manufacturers fired back against the notion that they weren't doing enough to complete the studies.

"To imply that patient safety is not first on our radar is simply inaccurate," said Caroline Van Hove, a spokeswoman for Allergan. She said the company hoped that the meeting would give the FDA an opportunity to more fully appreciate the complexity of the required studies.

"In general, we are highly committed to collecting quality data in a way that is possible for them and possible for us," she said. Read more

Healthy breast

2011-08-30T10:31:00.000-07:00

Younger women generally do not consider themselves to be at risk for breast cancer. Only five percent of all breast cancer cases occur in women under 40 years old. However, breast cancer can strike at any age, and all women should be aware of their personal risk factors for breast cancer. There are several factors that put a woman at high risk for developing breast cancer, including:

• A personal history of breast cancer or high risk lesion found by biopsy
• A family history of breast cancer, particularly in a mother, daughter or sister
• History of radiation therapy
• Evidence of a specific genetic chance (BRCA1/BRCA2 mutation) -- Women who carry defects on either of these genes are at greater risk for developing breast cancer.

What is different about breast cancer in younger women?
• Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally denser than breast tissue in older women. In addition, breast cancer in younger women may be aggressive. Women who are diagnosed with breast cancer at a younger age are more likely to have a mutated (altered) BRCA1 or BRCA2 gene. If a woman carries a defective BRCA1 or BRCA2 gene, she may have a 30 to 85 percent chance of developing breast cancer in her lifetime.
• Delays in diagnosing breast cancer also are a problem. Many younger women who have breast cancer ignore the warning sign – such as a breast lump or unusual discharge – because they believe they are too young to get breast cancer. Many women assume they are too young to get breast cancer and tend to assume that a lump is a harmless cyst or other growth. Additionally, dismissing a breast lump as a cyst and adopting a "wait and see" approach can delay diagnosis. Read more

Tylenol, Benadryl, Rolaids Recall

2011-01-15T21:12:00.000-08:00

By Bill Berkrot | Reuters – Fri, 14 Jan 2011 7:44 PM EST

NEW YORK (Reuters) - Johnson & Johnson faulted lax cleaning procedures and other problems at a manufacturing plant behind massive recalls of medicines like Tylenol, and said it was recalling nearly 50 million more bottles and packages of consumer medicines.

The healthcare company's reputation has been tarnished by repeated recalls totaling nearly 200 million bottles in the last year and it could face criminal charges from the U.S. Department of Justice.

Johnson & Johnson is now recalling bottles and packages of various kinds of Tylenol, Benadryl, Rolaids and other consumer products, it said on Friday.

J&J said the new recall followed a review of records dating back to 2007 of products made by its McNeil consumer healthcare unit, which produces most of the recalled medicines sold in the United States.

While the company said it had identified a number of areas for improvement, on Friday it disclosed only the cleaning problem and a minor labeling irregularity.

The company investigation found insufficient equipment cleaning procedures and instances where people failed to adequately document cleaning at McNeil's Fort Washington, Pa. plant, the company said. J&J suspended production there last April to address quality control lapses.

McNeil also found one product with a label that did not include all the information required by regulators, J&J said.

The latest recall involved products affected by those issues, the company said, adding that it was "very unlikely" that this harmed product quality.

The company said it recalled nearly 43 million bottles of Tylenol 8 Hour, Tylenol Arthritis Pain, Tylenol Upper Respiratory, Benadryl, Sudafed PE and Sinutab.

Additionally, nearly 4 million bottles, rolls and packages of Rolaids were recalled.

The company last month recalled all batches of Softchews Rolaids produced by an outside manufacturer after people found wood and metal bits in the tablets.

The recalls have kept popular products off drug store and supermarket shelves for months and hit the company's bottom line.

U.S. sales of J&J consumer brands plunged 25 percent in the third quarter. It has begun to sell some of its brands, such as St Joseph's aspirin, the subject of an earlier recall.

McNeil is conducting assessments at other manufacturing sites and will take whatever steps are needed, which could lead to more product recalls, J&J said.

Kurt Bardella, spokesman for Representative Darrell Issa, chairman of the House Committee on Oversight and Government reform, said Issa is seeking ways to ensure the U.S. Food and Drug Administration can "better avoid a situation where a plant like in Fort Washington reaches this level of failure and uncertainty."

Too many departments and agencies have jurisdiction over food safety, creating "unnecessary bureaucratic overlap and confusion," Bardella added.

The FDA declined to comment, citing its investigation into the J&J recalls.

J&J shares closed down 36 cents, or 0.5 percent, at $62.55 on the New York Stock Exchange.

(Reporting by Bill Berkrot and Lewis Krauskopf. Editing by Andre Grenon and Robert MacMillan)

This spice can help you lose weight

2011-01-15T12:43:00.000-08:00

Source: Cinnamonandweightloss.net
How Can Honey Cinnamon Help Weight Loss – The Principle Explained
by Admin, under Cinnamon and Weight Loss
Cinnamon is a well-known spice from the bark of the evergreen cinnamon tree. It comes in either the powdered or the stick form. You can find it easily in many grocery stores and health food stores. Add it to your favorite drink, cookies or fruits. With the many recipes you can make with the spices, you will never have boring meals with it. If you wonder how can honey Cinnamon help weight loss, here are results of researches conducted by experts.

Change in Glucose Metabolism

The body converts the food you eat into smaller forms. For the complex carbohydrates like rice, pasta and bread, they all result into glucose, the primary blood sugar. Since the body uses sugar in its daily metabolism, some of it burns to become the energy that supplies you with power throughout the day. However, if you do not burn the excess in your meal, the body stores the surplus as body fats. In how can honey Cinnamon help weight loss, the spices modify the way the body uses the glucose. Instead of storing them, it accelerates the metabolism to burn the entire glucose intake.

Increase Production of Insulin

In several studies about how can honey Cinnamon help weight loss, experts found out how the spice stimulates the production of insulin in the body. With more of the hormone, the cells increase their metabolism, thereby burning all the glucose taken during a meal.

Reduces Appetite

Another way on how can honey Cinnamon help weight loss is in reducing the appetite of the person. Studies reveal a decrease in the cravings of people who take cinnamon as part of their regular meals.

With the new findings on how can honey Cinnamon help weight loss, you will have a scientific basis for your new regimen. Try the solution and test the veracity of the findings.

Study: Antidepressants may be beneficial to stroke patients

2011-01-09T17:26:00.000-08:00

Source: WebMD
Antidepressants May Aid Stroke Rehabilitation
Stroke Patients Taking Prozac Recovered
More Physical Function Than Those on Placebo
Reviewed by Laura J. Martin, MD
Jan. 9, 2011 -- New research suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants may help people move again after a stroke.

“I think the study is quite exciting,” says Robert Robinson, MD, a neuropsychiatrist who is the Paul Penningroth chair of psychiatry at the University of Iowa. “It is the largest trial to date that has demonstrated that the use of an antidepressant medication can augment the physical recovery from stroke.”

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The study is part of a small but growing cache of evidence that suggests that SSRI antidepressant medications such as Celexa, Lexapro, Paxil, Prozac, and Zoloft may help stroke patients not simply by relieving mood symptoms, which can hinder recovery in their own right by causing people to feel hopeless and tired, but also by helping neurons grow and re-establish connections in the brain that are vital for physical functioning.

If further research continues to confirm the finding, experts say SSRI antidepressants would be only the second kind of drug therapy found to offer any benefit to stroke patients.

The most common drug, a clot buster, must be administered within hours of the stroke to be effective; and studies suggest up to 90% of people who have strokes don’t get to the hospital fast enough to benefit from it.

Significant Improvement in Function
The new study, which is published in The Lancet, looked at improvements in paralysis and weakness in 118 ischemic stroke patients in France who were randomly assigned to receive either 20 milligrams of Prozac or a placebo each day for three months beginning 5-10 days after stroke onset. All study participants received physical therapy.

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On average, after 90 days, patients in the Prozac group had improved 34 points on a 100-point stroke symptom scale. Patients in the placebo group, on the other hand, saw a 24-point improvement. The improvement remained even when researchers adjusted the study results to exclude patients who’d developed depression. The study was sponsored by the French government.

Experts say the finding means SSRI antidepressant medications could make the difference between someone needing help to get out of bed or to walk and being able to do those daily activities on their own.

“We’re not talking about a couple of points on the scale as happens in Alzheimer’s disease where the improvement in barely noticeable,” says Robinson, who co-authored an editorial on the study. “We’re talking about patients who are a whole category improved. We’re talking about clinically and significantly bigger improvement for the patient and their family.”

Robinson has conducted similar studies, one with the drug Prozac and other with the drug Lexapro, which followed patients for up to a year after their strokes.

“Even when you stop the drug, the recovery continues for at least another nine months,” he says.

Top PicksSurviving Stroke: A Personal Story High Blood Pressure? Take the Health Check Cholesterol Confusion? Take the Health Check Join the Discussion in the Stroke Community.

How Antidepressants May Heal the Brain
Robinson says he believes that SSRI antidepressants may help to heal the brain after a stroke in two ways.

“If you have a stroke, the glial cells, the white cells in the brain, release these inflammatory proteins,” Robinson says. “Antidepressants decrease the amount of inflammation produced by the stroke.”

The drugs then encourage the growth of new nerve cells, called neurons, and increase the connections between nerve cells. These actions essentially rewire the brain, making it better able to connect with the rest of the body.

SSRI Antidepressants Relatively Safe, Inexpensive
Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City, who was not involved in the study, notes that many people are already given antidepressants after their strokes, though they are usually prescribed to treat depression, which can be a common problem after brain injury.

“The treatment of people with strokes with antidepressants is not so new. It’s the idea that you can help their motor function is what’s new here,” Bonomo says.

“I think what’s also important about the subject is that it means that people probably need medication,” he says. “Talk therapy doesn’t seem to be sufficient.”

He says SSRI antidepressants have relatively few side effects, so they are low risk even for people with cardiovascular disease.

Bad breath (halitosis): Causes and prevention

2011-01-06T05:59:00.000-08:00

Source: Wikipedia
Halitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis has a significant impact — personally and socially — on those who suffer from it or believe they do (halitophobia), and is estimated to be the third-most-frequent reason for seeking dental aid, following tooth decay and periodontal disease.[1]
n most cases (85–90%), bad breath originates in the mouth itself.^[2] The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity, smoking, and alcohol consumption.^[3]^[4] Since the mouth is exposed to less oxygen and is inactive during the night, the odor is usually worse upon awakening ("morning breath"). Bad breath may be transient, often disappearing following eating, brushing one's teeth, flossing, or rinsing with specialized mouthwash.
Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees.^[5] It can negatively affect the individual's personal, social, and business relationships, leading to poor self-esteem and increased stress.
The term halitosis dates from the 1870s, combining the Latin halitus, meaning 'breath', with the Greek suffix osis often used to describe a medical condition, e.g., "cirrhosis of the liver". Bad breath is not, however, a modern affliction. Records mentioning bad breath have been discovered dating to 1550 B.C. A mouthwash of wine and herbs was one recommended way of solving the problem^{[citation needed]}.

Cause

Tongue

The most common location for mouth-related halitosis is the tongue. Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90 percent of all cases of mouth-related bad breath.^[6] Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells, and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the "rotten egg" smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan, Allyl methyl sulfide, and dimethyl sulfide.

Cleaning the tongue

The most widely-known reason to clean the tongue is for the control of bad breath. Methods used against bad breath, such as mints, mouth sprays, mouthwash or gum, may only temporarily mask the odors created by the bacteria on the tongue, but cannot cure bad breath because they do not remove the source of the bad breath. In order to prevent the production of the sulfur-containing compounds mentioned above, the bacteria on the tongue must be removed, as must the decaying food debris present on the rear areas of the tongue. Most people who clean their tongue use a tongue cleaner (tongue scraper), or a toothbrush.

Mouth

There are over 600 types of bacteria found in the average mouth. Several dozen of these can produce high levels of foul odors when incubated in the laboratory. The odors are produced mainly due to the breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. For example, the breakdown of cysteine and methionine produce hydrogen sulfide and methyl mercaptan, respectively. Volatile sulfur compounds have been shown to be statistically associated with oral malodor levels, and usually decrease following successful treatment.^[7]
Other parts of the mouth may also contribute to the overall odor, but are not as common as the back of the tongue. These locations are, in order of descending prevalence: inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses, and unclean dentures.^[8] Oral based lesions caused by viral infections like Herpes Simplex and HPV may also contribute to bad breath.^[9]

Gum disease

There is some controversy over the role of periodontal diseases in causing bad breath. While bacteria growing below the gumline (subgingival dental plaque) have a foul smell upon removal, several studies reported no statistical correlation between malodor and periodontal parameters.^[10]^[11]

Nose

The second major source of bad breath is the nose. In this occurrence, the air exiting the nostrils has a pungent odor that differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.^[7]^[8]

Tonsils

In general, putrefaction from the tonsils is considered a minor cause of bad breath, contributing to some 3–5% of cases. Approximately 7% of the population suffer from small bits of calcified matter in tonsillar crypts called tonsilloliths that smell extremely foul when released and can cause bad breath.^[7]^[12]

Esophagus

The Cardia, which is the valve between the stomach and the esophagus, may not close properly due to a Hiatal Hernia or GERD, allowing acid to enter the esophagus and gases escape to the mouth.^[13] A Zenker's diverticulum may also result in halitosis due to aging food retained in the esophagus.

Stomach

The stomach is considered by most researchers as a very uncommon source of bad breath (except in belching). The esophagus is a closed and collapsed tube, and continuous flow (as opposed to a simple burp) of gas or putrid substances from the stomach indicates a health problem—such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the esophagus—which will demonstrate more serious manifestations than just foul odor.^[2]
In the case of allyl methyl sulfide (the byproduct of garlic's digestion), odor does not come from the stomach, since it does not get metabolized there.^[14]

Systemic diseases

There are a few systemic (non-oral) medical conditions that may cause foul breath odor, but these are extremely infrequent in the general population. Such conditions are:^[15]^[16]

Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure.
Lower respiratory tract infections (bronchial and lung infections).
Renal infections and renal failure.
Carcinoma.
Trimethylaminuria ("fish odor syndrome").
Diabetes mellitus.
Metabolic dysfunction.^[17]

Individuals afflicted by the above conditions often show additional, more diagnostically conclusive symptoms than bad breath. People troubled by bad breath should not conclude that they suffer from these conditions or disease.

Halitophobia (delusion halitosis)

Some one quarter of the patients seeking professional advice on bad breath suffer from a highly exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of Olfactory Reference Syndrome. These patients are sure that they have bad breath, although many have not asked anyone for an objective opinion. Halitophobia may severely affect the lives of some 0.5–1.0% of the adult population.^[18]

Diagnosis

Self diagnosis

Scientists have long thought that smelling one's own breath odor is often difficult due to acclimatization, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis is not easy because of preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of bad taste (metallic, sour, fecal, etc.), however bad taste is considered a poor indicator.^[19]^[20]
For these reasons, the simplest and most effective way to know whether one has bad breath is to ask a trusted adult family member or very close friend ("confidant"). If the confidant confirms that there is a breath problem, he or she can help determine whether it is coming from the mouth or the nose, and whether a particular treatment is effective or not.^[21]
One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. This test results in overestimation, as concluded from research, and should be avoided.^[2] A better way would be to lightly scrape the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs are now available, but there are few studies showing how well they actually detect the odor. Furthermore, since breath odor changes in intensity throughout the day depending on many factors, multiple testing sessions may be necessary.

Professional diagnosis

If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath. They often use some of several laboratory methods for diagnosis of bad breath:

Halimeter: a portable sulfide monitor used to test for levels of sulfur emissions (to be specific, hydrogen sulfide) in the mouth air. When used properly, this device can be very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical applications. For example, other common sulfides (such as mercaptan) are not recorded as easily and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.^[22]
Gas chromatography: portable machines, such as the OralChroma, are currently being introduced.^[23] This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.^[24]
BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.^[25]
β-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor.^[26]

Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts ("organoleptic measurements"). The level of odor is usually assessed on a six-point intensity scale.^[1]^[7]^[27]

Management

At the current time, chronic halitosis is not very well understood by most physicians and dentists, so effective treatment is not always easy to find. Five strategies may be suggested:

Gently cleaning the tongue surface twice daily is the most effective way to keep bad breath in control; that can be achieved using a tooth brush, tongue cleaner or tongue brush/scraper to wipe off the bacterial biofilm, debris, and mucus. An inverted teaspoon may also do the job. Scraping or otherwise damaging the tongue should be avoided, and scraping of the V-shaped row of taste buds found at the extreme back of the tongue should also be avoided. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.^[2]
Eating a healthy breakfast with rough foods helps clean the very back of the tongue.^[16]
Chewing gum: Since dry-mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Chewing may help particularly when the mouth is dry, or when one cannot perform oral hygiene procedures after meals (especially those meals rich in protein). This aids in provision of saliva, which washes away oral bacteria, has antibacterial properties and promotes mechanical activity which helps cleanse the mouth. Some chewing gums contain special anti-odor ingredients. Chewing on fennel seeds, cinnamon sticks, mastic gum, or fresh parsley are common folk remedies.
Gargling right before bedtime with an effective mouthwash (see below). Several types of commercial mouthwashes have been shown to reduce malodor for hours in peer-reviewed scientific studies. Mouthwashes may contain active ingredients that are inactivated by the soap present in most toothpastes. Thus it is recommended to refrain from using mouthwash directly after toothbrushing with paste (also see mouthwashes, below).^[28]
Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gumline. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist).^[8]

Mouthwashes

Before discussing them, it is important to note that there has not been a single documented medical case of successfully cured chronic halitosis using any of the currently available mouthwashes. However a 2008 systematic review determined the efficacy of antibacterial mouthrinses for treating bad breath.^[29] Mouthwashes often contain antibacterial agents including cetylpyridinium chloride, chlorhexidine (which can cause temporary staining of the teeth)^[30], zinc gluconate, essential oils, and chlorine dioxide. Zinc and chlorhexidine provide strong synergistic effect.^[31]^[32] They may also contain alcohol, which is a drying agent.
Other solutions rely on odor eliminators like oxidizers to eliminate existing bad breath on a short-term basis.
A relatively new approach for home-care of bad breath is by oil-containing mouthwashes. The use of essential oils has been studied,^[33] was found effective and is being used in several commercial mouthwashes, as well as the use of two-phase (oil:water) mouthwashes, which have been found to be effective in reducing oral malodor.^[34] also advances in oral science has made advice websites available world wide.

Traditional remedies

According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is an excellent remedy against bad breath. In South Asia, it was a custom to chew areca or betel nut and betel leaf among lovers because of the breath-freshening and stimulant drug properties of the mixture. Both the nut and the leaf are mild stimulants and can be addictive with repeated use. The betel nut will also cause tooth decay and dye one's teeth bright red when chewed. Both areca nut and the betel leaf chewing however are recognised risk factors for squamous cell carcinoma. Their use is not recommended.

Society and culture

Bad breath often evokes a reaction characteristic of disgust among those who interact with bad breath sufferers. This is a natural defensive reaction designed to protect the body from potential sources of disease: The major chemical compounds of bad breath are the same as those emitted by rotting food (Putrescine), feces (Skatole), and even dead bodies (Cadaverine), all potential sources of disease and infection.
When the brain detects these compounds, it protects the body by forcing physical recoil (which moves the body away), scrunching up the nose (which constricts the nasal passages, and prevents further intake of noxious odors), and by causing gagging (which stops anything being swallowed). It may also produce nausea and vomiting, which ejects anything that has already been swallowed. Although these reactions are involuntary, they are often misinterpreted as a personal judgement on the sufferer, and can severely damage personal relationships.

Research

In 1996, the International Society for Breath Odor Research (ISBOR) was formed to promote multidisciplinary research on all aspects of breath odors. The eighth international conference on breath odor took place in 2009 in Dortmund, Germany.

References

^ ^a ^b Loesche WJ, Kazor C. Microbiology and treatment of halitosis. Periodontology 2000. 2002;28:256–79. PMID 12013345.
^ ^a ^b ^c ^d Rosenberg M. The science of bad breath. Sci Am. 2002 Apr;286(4):72–9. PMID 11905111.
^ Rosenberg M, Knaan T, Cohen D. Association among bad breath, body mass index, and alcohol intake. J Dent Res. 2007 Oct;86(10):997–1000. PMID 17890678.
^ Knaan T, Cohen D, Rosenberg M. Predicting bad breath in the non-complaining population. Oral Dis. 2005;11 Suppl 1:105–6.
^ Bosy A, Oral malodor: philosophical and practical aspects. J Can Dent Assoc. 1997 Mar;63(3):196–201 PMID 9086681.
^ "Scientists find bug responsible for bad breath". Reuters. April 7, 2008. http://www.reuters.com/article/idUSTON77980320080407.
^ ^a ^b ^c ^d Rosenberg M. Clinical assessment of bad breath: current concepts. J Am Dent Assoc. 1996 Apr;127(4):475–82. PMID 8655868.
^ ^a ^b ^c Scully C, Rosenberg M. Halitosis. Dent Update. 2003 May;3
^ Oral Herpes Dentists UK Helth Centre
^ Stamou E, Kozlovsky A, Rosenberg M. Association between oral malodour and periodontal disease-related parameters in a population of 71 Israelis. Oral Dis. 2005;11 Suppl 1:72–4. PMID 15752105.
^ Bosy A, Kulkarni GV, Rosenberg M, McCulloch CA. Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations. J Periodontol. 1994 Jan;65(1):37–46. PMID 8133414.
^ Finkelstein Y, Talmi YP, Ophir D, Berger G. Laser cryptolysis for the treatment of halitosis. Otolaryngol Head Neck Surg. 2004 Oct; 131(4):372–7. PMID 15467602.
^ Gastroesophageal Reflux Steven M Schwarz. 2009 May 13
^ http://www.webmd.com/news/19991127/garlic-bad-breath-king
^ Tangerman A. Halitosis in medicine: a review. Int Dent J. 2002 Jun;52 Suppl 3:201–6. PMID 12090453.
^ ^a ^b Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol. 1977 Jan;48(1):13–20. PMID 264535.
^ Tangerman A, Winkel EG. Intra- and extra-oral halitosis: finding of a new form of extra-oral blood-borne halitosis caused by dimethyl sulphide. J Clin Periodontol. 2007 Sep;34(9):748–55. PMID 17716310.
^ Lochner C, Stein DJ. Olfactory reference syndrome: diagnostic criteria and differential diagnosis. J Postgrad Med. 2003 Oct-Dec;49(4):328–31. PMID 14699232.
^ Tanaka M, Anguri H, Nishida N, Ojima M, Nagata H, Shizukuishi S. Reliability of clinical parameters for predicting the outcome of oral malodor treatment. J Dent Res. 2003 Jul; 82(7):518–22. PMID 12821711.
^ Rosenberg M, Kozlovsky A, Gelernter I, Cherniak O, Gabbay J, Baht R. and Eli I. Self-estimation of oral malodor. J Dent Res. 1995 Sep; 74(9):1577–82. PMID 7560419.
^ Eli I, Baht R, Koriat H, Rosenberg M. Self-perception of breath odor. J Am Dent Assoc. 2001 May; 132(5):621–6. PMID 11367966.
^ Rosenberg M, McCulloch CA. Measurement of oral malodor: current methods and future prospects. J Periodontol. 1992 Sep;63(9):776–82. PMID 1474479.
^ van den Velde S, Quirynen M, van Hee P, van Steenberghe D. Halitosis associated volatiles in breath of healthy subjects. J Chromatogr B Analyt Technol Biomed Life Sci. 2007 Jun 15;853(1–2):54–61. PMID 17416556.
^ Murata T, Rahardjo A, Fujiyama Y, Yamaga T, Hanada M, Yaegaki K, Miyazaki H. Development of a compact and simple gas chromatography for oral malodor measurement. J Periodontol. 2006 Jul;77(7):1142–7. PMID 16805675.
^ Kozlovsky A, Gordon D, Gelernter I, Loesche WJ, Rosenberg M. Correlation between the BANA test and oral malodor parameters. J Dent Res. 1994 May; 73(5):1036–42. PMID 8006229.
^ Sterer N, Greenstein RB, Rosenberg M. Beta-galactosidase activity in saliva is associated with oral malodor. J Dent Res. 2002 Mar;81(3):182–5. PMID 11876272.
^ Greenman J, Duffield J, Spencer P, Rosenberg M, Corry D, Saad S, Lenton P, Majerus G, Nachnani S, El-Maaytah M. Study on the Organoleptic Intensity Scale for Measuring Oral Malodor. J Dent Res. 83(1): 81–85, 2004. PMID 14691119.
^ Yaegaki K, Coil JM, Kamemizu T, Miyazaki H. Tongue brushing and mouth rinsing as basic treatment measures for halitosis. Int Dent J. 2002 Jun;52 Suppl 3:192–6. PMID 12090451.
^ Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006701. DOI: 10.1002/14651858.CD006701.pub2 http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006701/frame.html
^ Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006701. DOI: 10.1002/14651858.CD006701.pub2 http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006701/frame.html
^ Thrane PS, Young A, Jonski G, Rölla G (2007). "A new mouthrinse combining zinc and chlorhexidine in low concentrations provides superior efficacy against halitosis compared to existing formulations: a double-blind clinical study". J Clin Dent 18 (3): 82–6. PMID 17913002.
^ Young A, Jonski G, Rölla G (2003). "Combined effect of zinc ions and cationic antibacterial agents on intraoral volatile sulphur compounds (VSC)". Int Dent J 53 (4): 237–42. PMID 12953892.
^ Carvalho MD, Tabchoury CM, Cury JA, Toledo S, Nogueira-Filho GR. Impact of mouthrinses on morning bad breath in healthy subjects. J Clin Periodontol. 2004 Feb;31(2):85–90. PMID 15016031.
^ Rosenberg M, Gelernter I, Barki M, Bar-Ness R. Day-long reduction of oral malodor by a two-phase oil:water mouthrinse as compared to chlorhexidine and placebo rinses. J Periodontol. 1992 Jan;63(1):39–43. PMID 1552460.

Foods that give you a flat stomach

2011-01-06T05:52:00.000-08:00

Source: realbuzz.com
Top 5 flat-belly foods
Dreaming of a flat stomach without hitting the gym? The good news is your dream may not be too far away. Whether you’re hoping to blitz away a muffin top or are battling with bloating, your diet is integral to shaping up this problem area. Start eating your way to a trimmer waistline with these top 5 foods for a flat stomach.
Flax seeds
Flax seeds (often referred to as linseeds) are nutritious seeds packed with monounsaturated fats (MUFAs) - which are actually a lot more diet-friendly than they sound. Monounsaturated fats, unlike saturated fats (the "bad" fats found in junk food), not only lower cholesterol levels but they can also help to reduce body fat. Liz Vaccariello, author of The Flat Belly Diet, advocates these healthy fats for those wanting to specifically target belly fat.

Not only will these super seeds tackle love handles, but they are great for those suffering from bloating. Flax seeds provide high levels of fibre and can help to keep the digestive system running smoothly, helping to banish bloating, constipation and other digestive problems. Try adding a tablespoon of freshly ground flax seeds to your morning cereal, lunchtime salad, or homemade smoothie to start enjoying their belly-flattening benefits.
Berries
Blackberries, blueberries, acai berries... what do these fruits have in common? They could all help you to squeeze back into your skinny jeans. Studies have suggested that those wanting to lose their belly fat should opt for fruit that is blue or red in colour (such as cherries, red grapes and many types of berries). In fact, it is the chemicals that are responsible for giving these fruits their colour (anthocyanins) that, according to recent research, also burn abdominal fat.
Yoghurt
Not only is yoghurt low in fat and calories, so good as a weight loss food, but many yoghurts also contain active cultures (probiotics) which promote the growth of good bacteria in the gut and help with digestion, excess gas and bloating. Yoghurt is luckily easy to fit into any diet plan as part of a meal or a snack between meals. You could also try combining natural yoghurt, berries and flax seeds in a morning smoothie or bowl of cereal, getting you off to a great tummy-trimming start before you even leave the house.

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Whole grains
Whole grains are great for weight management and shedding those excess pounds. Not only are they a low-fat source of slow-release energy but, due to their high levels of fibre, they will help to regulate the digestive system and also keep you feeling fuller for longer. Eating whole grains also helps to lower levels of cortisol (the stress hormone) and insulin in the body, both of which encourage fat to be stored around the belly.

Many people, however, instinctively opt for wheat as their primary source of whole grains, which is often not the best choice. Not only is wheat difficult to digest - which can cause bloating in some - but it is better to eat grains in their natural form rather than as a processed flour. Good alternatives to try are brown rice, oats, buckwheat and spelt. Quinoa - although technically a seed - is also a nutritious alternative that can be used in the place of grains such as pasta and couscous.
Water
While it's not technically a food, a lack of water in your diet could be the one thing still standing in your way of a flat stomach. Bloating is something that affects many women and the problem is often worsened - or even instigated - by a lack of fluids in the system. Drinking water will help to flush toxins out of the system, curb hunger, improve the digestive system and reduce fluid retention, all of which will leave your stomach looking flatter.

If you are aiming for a flat belly, it is important to drink a minimum of eight glasses of liquids a day. Although this does not have to be water, it is best to go for liquids that are still (fizzy drinks can cause bloating) and low in calories. If you don't fancy plain water, a good alternative is green tea - which is also rumoured to have fat burning benefits - or fennel, dandelion or peppermint teas, all of which can combat bloating......Read more from realbuzz.com

Early signs of cancer

2010-09-01T08:15:00.001-07:00

8 cancer signs highlighted

Fri Aug 27, 1:44 PM

NEW.BRUNSWICK (CBC) - There are eight signs, symptoms or test results that could improve early diagnosis of some cancers, British doctors say.

The researchers focused on changes that gave a one in 20 or higher chance of turning out to be cancer.

The symptoms include:

- Coughing up blood.
- Rectal blood.
- Breast lump or mass.
- Difficulty swallowing.
- Post-menopausal bleeding.
- Abnormal prostate tests.
- Anemia.
- Blood in urine.

In certain age and sex groups, the eight symptoms or findings point to the need for urgent investigation by family doctors, Dr. Mark Shapley and colleagues from Keele University (halfway between Manchester and Birmingham) said in Friday's online issue of the British Journal of General Practice.

The conclusion was based on an analysis of 25 studies from the U.K., U.S., Netherlands, Belgium, Australia, Denmark and Germany.

The age of the patient is important, said Dr. Kevin Barraclough, a GP from Stroud.

"Iron deficiency anemia in a 21-year old female is extremely unlikely to be due to colorectal cancer, whereas in a 60-year old male, cancer is likely," Barraclough wrote in a journal editorial accompanying the study.

The red flags reinforce the importance of encouraging patients to discuss worrying symptoms early with their GP, said Prof. Amanda Howe, honorary secretary of the Royal College of General Practitioners, which publishes the journal.

When to have another pregnancy after a miscarriage by David Liu

2010-08-08T08:08:00.000-07:00

Women should try to have another pregnancy immediately after a miscarriage if they want to have a healthy baby, a new study published in the British Medical Journal suggests.

The study found women who got pregnant within six months of a miscarriage were more likely to have a healthy pregnancy, compared to those who delayed six months or longer to conceive again.

The World Health Organization reportedly recommends that women who have a miscarriage should wait at least six months before getting pregnant again.

Sohinee Bhattacharya from the University of Aberdeen and colleagues examined data from over 30,000 women who attended Scottish hospitals for maternal care between 1981 and 2000. These women had another pregnancy after a miscarriage.

The study was meant to determine how the interpregnancy internal following a miscarriage would affect the outcome of the next pregnancy.

The researchers found women who had another pregnancy within six months of a miscarriage were at lower risk of another miscarriage, termination of pregnancy or ectopic pregnancy compared to those who became pregnant after six months.

In the study, the live birth rate was found at 85.2 percent in women who got pregnant again within six months of a miscarriage compared to 73.3 percent in those who had another pregnancy after 24 months.

In addition, women who had another pregnancy within six months were less likely to have a Cesarean section, give premature birth or have low birth weight babies compared to those who had another pregnancy six months to 12 months after a miscarriage, the study found.

The authors say that although the study involved women in Scotland and the results may not be applicable to those in developing countries, the findings suggest that women in Scotland should not wait six months to have another pregnancy.

The authors conclude: "our research shows that it is unnecessary for women to delay conception after a miscarriage."

Not all studies led to the same conclusion as the current one.

Sholapurkar S. L. at the Royal United Hospital in Bath, United Kingdom said in an early report that many studies suggest that after full term and preterm delivery, the interpregnancy interval of less than 18 months and more than 5 years after a spontaneous miscarriage was associated with elevated risk of poor perinatal and maternal outcome.

Reporting in the Feb 2010 issue of Journal of Journal of Obstetrics and Gynaecology, Sholapurkar cited one study, which he believed is of good quality, saying that the interval length between a miscarriage and the next pregnancy does not affect the pregnancy outcome when the next pregnancy occurs within 50 months of a miscarriage.

A miscarriage, also known as spontaneous abortion, is a spontaneous loss of a fetus before the 20th week of pregnancy.

One in five pregnancies end in miscarriages before 24 weeks. And Women at the age of 35 or older are more likely to have a miscarriage. At the age 40, the rate of miscarriage is 30 percent compared to 50 percent for those aged 45 or older, according to the background information in the study by Bhattacharya et al.

Most miscarriages are caused by chromosome problems that make it impossible for the fetus to continue to develop, according to The U.S. National Library of Medicine. The problems have nothing to do with the mother or father's genes.

Other possible causes include hormone problems, infection in pregnancy, physical problems with the mother's reproductive organs, problem with the immune system and certain diseases in the mother.

Women who are at higher risk for a miscarriage are those who are 35 years of age or older and who have had previous miscarriages.

Miscarriages in some cases can be preventable. Treatment for diseases that induce miscarriages before pregnancy can help prevent the devastating event.

Some adverse events such as exposure to x-rats drugs and alcohol, high levels of caffeine and infectious diseases should be avoided prior to or during pregnancy.

What food consumers need to know?

Vaccination in pregnancy can lead to miscarriage, according to some media reports. Dr. Joe Mercola, owner of mercola.com reported that some pregnant women who received swine flu vaccine ended up having a miscarriage.

Pregnant women's diet during pregnancy may play a significant role. One study reported in the International Journal of Obstetrics and Gynecology suggests that eating fruits and veggies in pregnancy may reduce the risk.

Dr. Maureen Maconochie from the London School of Hygiene and Tropical Medicine and colleagues followed up thousands of pregnant women and found those eating fruits and vegetables often in pregnancy were 46 percent less likely to experience a miscarriage than those who did not use fruit and veggies as often.

Additionally, the researchers found women who used chocolate, vitamin tablets, dairy products, fish and white meat during pregnancy were also less likely to have a miscarriage.

On the other hand, women who were underweight were 70 percent more likely to have a miscarriage, and stress resulting from separation, divorce, illness and a stressful job boosted the risk by 60 percent, the authors found.

UK report: fetus can't feel pain before 24 weeks By Sylvia Hui

2010-06-25T14:11:00.000-07:00

By Sylvia Hui, The Associated Press

LONDON - Human fetuses cannot feel pain before the age of 24 weeks, a British medical association said Friday — delivering a setback for anti-abortion activists campaigning to lower the country's 24-week time limit.

Lawmakers who were considering lowering the limit to 20-22 weeks had commissioned the study by the Royal College of Obstetricians and Gynecologists.

Citing evidence from medical research and post-mortem reports, the group said nerve connections in the brain were not sufficiently formed to allow pain perception until after 24 weeks, and that even after 24 weeks, the fetus was in a state of sleep-like unconsciousness or sedation.

"There was fairly good evidence that the pathways necessary to feel pain really just aren't there before 24 weeks — although they very clearly are there after," said Richard Anderson, a professor in human reproductive sciences with the University of Edinburgh, who was part of the study.

Some doctors disagree with the findings, arguing that fetuses can experience distress by the age of 20 weeks. The U.S. state of Nebraska recently passed a bill banning abortion at and after 20 weeks of pregnancy.

But the American College of Obstetricians and Gynecologists has said it knows of no legitimate evidence that shows a fetus can experience pain. It said a fetus' brain begins its final stage of development between the 20th and 40th weeks of pregnancy, and that certain hormones that develop in the final trimester also must be present for it to feel pain. It's not known exactly when those hormones appear.

In Britain, the Abortion Act of 1967 allows surgical abortions up to 24 weeks. A woman can still abort her baby after 24 weeks if doctors agree the mother's life is in danger or there is strong evidence that the fetus would be born with a severe disability.

The law, however, does not extend to religiously conservative Northern Ireland, where abortions are still banned unless a woman's life is in danger or at mental or physical risk. As a result an estimated 1,400-2,000 women from the British territory travel annually to England or other European Union nations to end their pregnancies.

"We have no real evidence because the unborn baby can't speak," said Bernie Smyth, director of Precious Life, an anti-abortion group active in both Northern Ireland and the Republic of Ireland. "The fact is babies have been born at 24 weeks, they have survived, and they do feel pain."

Prime Minister David Cameron had backed reducing the limit to between 20 and 22 weeks before he came to power in May. The House of Commons voted in 2008 to keep the existing limit, and Cameron's office issued a statement Friday saying no changes were planned in the policy. It said the prime minister would be led in his decision by science.

Campaigners against abortions said the report's conclusions were not definitive and did not change their view that terminating pregnancies is wrong.

"Performing abortion humanely does not justify the fact that you are terminating a human life," said Josephine Quintavalle of the London-based Comment on Reproductive Ethics.

But supporters of the current abortion laws said the findings would reassure women considering a late-term termination.

"It is vitally important to protect a woman's right to access abortion services, and British law rightly recognizes this principle," said Tony Kerridge of the sexual health charity Marie Stopes International. "The findings should give comfort and reassurance to any woman who finds herself in the extremely distressing position of having to make the decision to terminate a pregnancy at a later gestation."

The charity said late abortions were extremely rare in Britain. Last year there were fewer than 3,000 abortions above 20 weeks gestation, Kerridge said.

7-year-old girl dies after Botox injections

2010-06-06T06:57:00.000-07:00

A 7-year-old girl died after a Botox injection paralyzed her lungs, her family says, and they are suing pharmaceutical company Allergan for wrongful death.

Botox is the trade name for the botulinim toxin, which is produced by the botulism bacteria. Botulinim toxin blocks nerve signaling, leading to muscle paralysis, and has been called the single most toxic protein known. In small doses, it is approved for use to smooth away facial wrinkles. Although it is not approved in the United States for the treatment of muscle spasms such as those caused by cerebral palsy, U.S. law allows doctors to prescribe drugs for unapproved uses if they wish.

Kristen Spears began Botox treatment for cerebral palsy-related spasms at age six. In November 2007, Spears died from pneumonia and respiratory failure, which her family claims was caused when the botulinim toxin spread to her lungs and weakened her breathing muscles.

Spears' case is the first Botox-related wrongful death lawsuit to reach trial. The company claims that the drug actually improved Spears' breathing, and that she died from complications of her underlying cerebral palsy. To counter this claim, the plaintiffs' lawyers will seek to prove that the Botox spread beyond its injection site in Spears' body.

According to the nonprofit watchdog group Public Citizen, there have been at least 180 reported cases of serious side effects from Botox and at least 16 related deaths. Concern over these side effects led the FDA to mandate a "black box" label for Botox in April 2009, warning that improper injection may allow the toxin to spread to other parts of the body, with potentially fatal consequences.

Records unsealed as part of the lawsuit show that as early as 2005, Allergan knew that serious side effects could result from use of the drug.

Allergan makes $1.3 billion a year in Botox sales, $47 million from its use as a cerebral palsy treatment alone.

Sources for this story include:
- www.ktla.com/news/landing/ktla-boto...
- http://www.webmd.com

Vanessa Williams promotes Botox by Grinza Staff

2010-05-21T11:04:00.000-07:00

SOURCE: GRINZA.COM

Vanessa Williams says that she went for Botox injections to remove the wrinkles on her face, which made her look tired and angry.

The 47-year-old embraces her age, but admits that she needs Botox to prevent age lines from appearing on her face.

“The latest thing I'm into is Botox, which I've been doing every six months,” Williams told WorkingMother.com. “I do it lightly because I want to have an expressive face that has movement. Dr. Raj Kanodia does my Botox in Los Angeles.”

She further explained: “My goal is to look like me. I have four kids. I'm proud of my age. I just don't want to look tired or angry. I had little lines between my eyebrows that made it look like I was furrowing my brow. (The doctor) softened those lines and others across my forehead.”

Williams says that she wants to advocate Botox to other elderly women, because her experience with the anti-wrinkle drug has been a success. “Women should share!” exclaimed Williams.

Salma Hayek Pinault says that she does not agree with younger actresses going for plastic surgery.

Hayek says that she has had “no surgical tweaks” and “no Botox”.

“I think it is terrible, these girls in their late 20s injecting their faces and lips,” said the 43-year-old to The Star. “One told me, ‘If I kill my muscles now, I’ll never get wrinkles.’ Can you imagine?”

And according to the Hayek, she had “never been happier.”

ORIGINAL ARTICLE>>>>

Can Autism Diet Help Autistic Children? By David Liu

2010-05-21T07:30:00.000-07:00

One in 100 children in the United States suffer autism. A new study in the April 2010 issue of Nutritional Neuroscience suggests that a strict gluten-free and casein free diet may help autistic children.

The trial led by Whiteley P and colleagues from the University of Sunderland in the United Kingdom showed children with autism assigned a gluten- and casein-free diet improved their behaviors among other things.

The trial consisted of two stages. The researchers tested the diet in two groups of children with autism spectrum disorders or ASDS.

In the stage one, 72 Danish children aged 4 to 12 years were given the strict diet (group A) or a control diet (group B) and evaluated at baseline, 8, and 12 months for their behaviors and developmental level, inattention and hyperactivity.

The children's behaviors were assessed using Autism Diagnostic Observation Schedule (ADOS) and the Gilliam Autism Rating Scale (GARS). Their developmental level, inattention and hyperactivity were measured using Vineland Adaptive Behaviour Scales (VABS) and Attention-Deficit Hyperactivity Disorder - IV scale (ADHD-IV).

Data from 26 children in the dietary intervention group and 29 controls showed a significant improvement in the diet group on subdomains of ADOS, GARS and ADHD-IV measures.

Because of the observation, in the second stage, group B children were also assigned the gluten-free and casein-free diet and 18 children in Group A and 17 in Group B completed the intervention dietary program in another 12 months.

The trial results indicated that clinical improvements were sustainable although a plateau effect of the intervention was observed.

Whiteley et al. concluded that the gluten- and casein- free diet may have a positive impact on developmental outcome in children with autism. But more studies are needed to confirm the findings.

Gluten and gluten-like proteins are found high in wheat and other grains such as oats, rye, barley, bulgar, durum, kamut and spelt, and foods made from those grains.

Casein is a protein found in milk and dairy products containing milk such as cheese, butter, yogurt, ice cream, whey and some margarines. It can be present as an ingredient called caseinate in non-dairy products.

The gluten-free and casein-free diet is believed to help children with autism because many of them also suffer gastrointestinal (GI) ailments including constipation, diarrhea and vomiting.

One theory speculates that people with autism cannot digest gluten and casein properly. And these proteins can be digested to form peptides that act like opiates leading to abnormal behaviors in autistic children.

However, Susan Hyman, MD from Golisano Children's Hospital at the University of Rochester Medical Center in Rochester, N.Y. and colleagues conducted a smaller study and found that the gluten-free, casein-free diet does not seem to help children with autism.

In the study of 22 children aged 2 to 5.5 years, the researchers conducted a different type of test. What they did is put all the participants on the strict gluten-free, casein-free diet for at least four weeks, and then gave them 20 grams of wheat flour, 20 grams of milk powder, either or both.

The researchers compared the children's behaviours before and 24 hours after the "challenge" and they found no difference in their behaviors.

A health observer criticized the study design saying that there was no reason in real life that children with autism on a strict diet should be "challenged". The results he said could simply hint that children on the diet had improved their behaviors in a way that a small amount of milk and wheat products did not affect them anymore.

In any way, wheat and milk are not essential vitamins so parents of the children with autism may let their children try a non-gluten and non-dairy diet to see if the diet actually helps them. They don't have to wait for others to tell them whether the diet works or not.

Autismweb.com says "foods that CAN be eaten on a gluten-free, casein-free diet include rice, quinoa, amaranth, potato, buckwheat flour, soy, corn, fruits, oil, vegetables, beans, tapioca, meat, poultry, fish, shellfish, teff, nuts, eggs, and sorghum, among others."

David Liu

Even healthy children may show asthma-like symptoms during exercise. By Jeannine Stein

2010-05-21T05:22:00.000-07:00

SOURCE:latimes.com/Health

Exercise-induced asthma is a well-known condition in both adults and children. But a new study finds that kids with no history of asthma may exhibit asthma-like symptoms after bouts of intense exercise.

H6zdcykf The study, presented at the American Thoracic Society's international conference in New Orleans this week, included 56 healthy children, average age 15. Researchers from UC Irvine and Miller Children's Hospital in Long Beach gave each child two exercise tests -- one at a constant work rate, the other a progressive test usually done to measure aerobic capacity.

After testing for pulmonary function, 45% of the study participants had at least one abnormal result. That was seen in 14% of participants after the constant work rate test, in 20% after the progressive test, and 11% had at least one abnormal result after both tests. No substantial differences were found in the number of abnormal outcomes in the two tests.

Decreases in pulmonary function can occur when heavy exercise triggers an inflammatory response, constricting bronchial tubes.

"We did not expect to see pulmonary function abnormalities after short periods of heavy exercise in such a large number of healthy children in our subject population," said Dr. Alladdin Abosaida, lead author of the study, in a news release. "We speculate that either the inflammatory response to exercise or cellular changes that may occur as the result of dehydration of the airway surface, or both, led to mild airway obstruction."

Abosaida added that more research is needed to discover why this type of lung dysfunction might be occurring in children.

-- Jeannine Stein

Human Gene Catalog Shows It's Mostly a Mystery. By Maggie Fox, Health and Science Editor

2010-05-21T05:17:00.000-07:00

Source: ABC News ABC News/Technology

WASHINGTON (Reuters) - They live in us and on us, helping digest food and keeping acne at bay, and researchers said on Thursday that most of these germs are turning out to be new to science.

The first look at 178 different microbes that live in or on the human body shows that more than 90 percent of their genetic sequences were unknown and raise questions about how scientists classify species among micro-organisms.

"Most people don't even realize how much microbial diversity we have on and in us," said Karen Nelson of the J. Craig Venter Institute in Rockville, Maryland, who leads the ongoing study.

"We are dependent on them for digestion of plant material and some vitamins," she added in a telephone interview.

Yet scientists know very little about the many hundreds of different types of bacteria, viruses and yeast that inhabit the skin, mouth, scalp and most of all, the gut.

"The oceans and the soils have gotten more attention than the human body," Nelson said.

Researchers at the Baylor College of Medicine in Houston; the Broad Institute in Cambridge, Massachusetts; Washington University in St. Louis and the Venter Institute are working on the $157 million, five-year Human Microbiome Project to survey all the microbes important to human health.

FIGHTING DISEASE

There are hints that healthy colonies of microbes not only process vitamins, but maintain pH balance on the skin, prevent tooth decay, protect against diarrheal infections and defend against sexually transmitted infections.

The researchers recruited 300 healthy volunteers who are allowing themselves to be swabbed and examined. "At least 15 additional projects will focus on disease conditions," Nelson said.

Reporting on Thursday in the journal Science, Nelson and colleagues described 500,000 new genetic sequences, all from bacteria so far. "There is a lot of diversity. We don't really know what this means," she said.

They found more than 29,000 new proteins, which are the compounds made by cells based on their genetic sequences. This suggests these microbes are up to a great deal of previously undocumented activity.

"This initial work lays the foundation for this ambitious project and is critical for understanding the role that the microbiome plays in human health and disease," said National Institutes of Health director Dr. Francis Collins.

"We are only at the very beginning of a fascinating voyage that will transform how we diagnose, treat and ultimately, prevent many health conditions."

One they examined, a bacteria called Lactobacillus reuteri, seems to have a distinct genetic sequence for each species whose gut it inhabits -- rats, pigs and people. Nelson said there are also indications that individual people host their own unique species of germs.

L. reuteri, found in breast milk, may protect against rotavirus infections, other researchers have found,

In 2006 Steven Gill of the State University of New York in Buffalo estimated that 90 percent of the cells on the human body are actually bacteria....Read more>>>

The Array of Uses for BOTOX

2010-05-21T05:15:00.000-07:00

BOTOX has been the most popular nonsurgical cosmetic procedure for many years and in 2009 there were about 2.5 million procedures done in the U.S., according to the American Society for Aesthetic Plastic Surgery.

ALBANY, NY, May 21, 2010 /24-7PressRelease/ -- BOTOX has been the most popular nonsurgical cosmetic procedure for many years and in 2009 there were about 2.5 million procedures done in the U.S., according to the American Society for Aesthetic Plastic Surgery.

BOTOX is derived from a protein made by the bacterium Clostridium botulinum. The protein is toxic and causes botulism when ingested in large amounts. Botulism paralyzes all the body's muscles, including the heart muscle, causing death. However, BOTOX uses tiny amounts and the injections are done to specific muscles. The effect is then to temporarily paralyze the injected muscle for a desired cosmetic improvement.

Cosmetic Uses
The most common reason BOTOX is used cosmetically is to smooth out frown lines and horizontal forehead lines. It can also be used to treat crows' feet, the laugh lines at the outside edge of each eye, and fine lines around the lips.

The presence in a muscle of the BOTOX protein blocks messages from the brain telling it to contract. When the muscle stops contracting, the facial expressions it contributes to are stopped or partly stopped (frowning, scowling, raised eyebrows etc.). The skin is then able to smooth out and give you a younger, fresher look.

Medical Uses
Recently, BOTOX has been used to treat Essential Tremor. This is a condition where the hands or fingers shake, or the voice, shoulders, arms, or legs, depending on which muscles are affected, and how many. BOTOX injections stop the muscles from contracting, which stops or reduces the tremor.

This is not the first medical use of BOTOX. It can be used in almost any condition that involves involuntary muscle movement. In 2007, studies were done on use of BOTOX for IOAB (Idiopathic Over-Active Bladder - meaning urinary incontinence with no known cause). The injections give fast improvement in urinary frequency for a limited time.

- Multiple Sclerosis (MS) is a better-known condition where BOTOX has been very helpful. MS involves involuntary, jerky movements and spasticity (muscle stiffness). Repeat injections can be given every three months to maintain muscle relaxation.
- Cerebral Palsy is caused by a birth injury, premature birth, or an infection or alcohol addiction in the mother. The baby's brain is damaged and muscle movement impaired. BOTOX can reduce muscle spasms and the involuntary movements that are so tiring for the patient.
- Erb's Palsy is another condition caused at birth when the baby's shoulder is caught against the mother's pelvis and the shoulder nerves are torn. The arm on that side develops a muscle imbalance, with some muscles stronger than others. BOTOX can be used to temporarily shut down the strong muscles and allow the weaker ones to become stronger from greater use.

There are other conditions where BOTOX is part of disease treatment or management and no doubt more such BOTOX use will be developed in the future.

- "BOTOX, like any other medical treatment, must be used judiciously. Individuals seeking Botox are considered patients in every sense of the word, as referring to them as clients or some other term, in my mind dilutes the fact that these and others are real medical treatment and should be treated as such. I tell the physicians that I train to be attentive to all facets of treatment including appropriate dilution, placement, and patient comfort, as this has important impact on patient satisfaction," said Dr. Arthur Falk of Albany, New York. " I routinely see my patients a week after treatment as this enables me to evaluate and improve on my injection technique. These feedback sessions which may involve a little extra tweaking, are at no additional charge and dramatically enhance satisfaction with our services."

If you are in Albany, Troy, Schenectady or Saratoga Springs, New York, and would like to know more about BOTOX injections for cosmetic facial improvement, it would be best to choose an experienced cosmetic surgeon like Dr. Falk (visit www.aboutfacedoc.com).

Columbia University Study Shows Modified Citrus Pectin Fights Prostate Cancer

2010-05-20T09:57:00.001-07:00

Modified citrus pectin could be a valuable tool in the fight against prostate cancer, according to the results of a new published study.

SANTA ROSA, Calif., May 20 /PRNewswire/ -- Researchers at Columbia University recently analyzed the positive effects of Modified Citrus Pectin (MCP) on human and mouse prostate cancer cell lines. The results, as reported by lead researcher Dr. Aaron Katz in the online-first publication of Integrative Cancer Therapies, show that MCP inhibits cell proliferation and induces apoptosis (programmed cell death) in both androgen-dependent and androgen-independent cancer cells in a time and dose-dependent manner.

Prostate cancer is the second leading cause of cancer death in men, and 1 in 6 will get prostate cancer during his lifetime. Dr. Jun Yan, lead author, explains, "Our findings clearly demonstrate that MCP possesses anti-prostate cancer properties in both androgen-dependent (hormonal sensitive) and androgen-independent (hormonal resistant) prostate cancer cells. These results strongly suggest that MCP can be a promising chemopreventive and therapeutic agent against this malignancy."

Modified Citrus Pectin is derived from the pith of citrus fruit, and modified to meet specific molecular chain and weight characteristics. Data suggests that MCP interferes with the binding properties of cancer cell surface proteins called galectins.

"Considering the low molecular weight of the MCP used in the study," Dr. Yan continues, "we speculate that this new MCP will be more readily absorbed in the human body, which means that the relative concentration reaching the prostate gland will be greater. Therefore, taking this MCP may be an excellent way to prevent prostate cancer, given that prostate cancer is regarded as a preventable cancer. Moreover, this MCP may be an effective adjuvant medicine for cancer therapy."

Rich in a polysaccharide component called galactosyl, MCP binds to galectin proteins and prevents cancerous cells from adhering to each other and to the inner wall of blood vessels, thereby inhibiting both tumor growth and angiogenesis. This study supports the results of previous research on MCP, which demonstrated clinical benefit in patients with advanced solid tumors, as well as its ability to lengthen PSA doubling time in men with recurrent prostate cancer. It also showed ability to induce apoptosis through the inhibition of the MAPK signal pathway and activation of Caspase-3.

Dr. Isaac Eliaz (www.dreliaz.org), whom the study authors acknowledge for his development of the Modified Citrus Pectin used in their most recent analysis, notes the importance of this new research, saying, "Androgen-dependent prostate cancer is the more common type of prostate cancer, and the one more often found in localized and less aggressive disease. What is most significant is the ability of this specific type of MCP to induce apoptosis in androgen-independent prostate cancer cell lines, which is the more aggressive cancer that can metastasize and lead to death. Slowing down the progression of this cancer has a direct effect on prolonging the life of these individuals."

"The anti-metastatic role of MCP is well established," continues Dr. Eliaz. "The fact that it can have a direct effect on the cancer itself makes it important in prevention, in early stage prostate cancer (which is usually hormonal sensitive-androgen dependent), and in later stage advanced prostate cancer. Its safety and the fact that it doesn't work via hormonal induced mechanisms of action makes it an excellent agent to be used in conjunction with other therapies."

Ongoing research on this MCP in prostate as well as breast cancer continues to show encouraging results, and additional studies are forthcoming.

Source: Integrative Cancer Therapies

Middle-Age Belly Fat Linked to Dementia By Susan Brady

2010-05-20T09:51:00.000-07:00

If you suffer from girth imbalance—also known as belly fat—you certainly are not alone. It is estimated that 50 percent of adult Americans carry unhealthy supplies of fat around their middle. Excess fat, particularly in the abdomen, can lead to a higher risk of heart disease, stroke, diabetes, and premature death. Researchers have now concluded that that creeping middle age belly fat also predisposes us to the risk of developing Alzheimer’s and other forms of dementia.

Dementia is an age-related disease that robs its victims of memory and cognitive functions; things like perception, reasoning, judgment, thinking, and speech. One in ten Americans over the age of 65 suffers from some form of dementia; 60 to 80 percent suffer its most common form, Alzheimer’s disease.

Researchers at Boston University School of Medicine studied 733 adults, with an average age of 60. The group was composed of 30 percent men and 70 percent women. Each individual went through body mass (BMI) measurements as well as scans to assess abdominal fat. The results, concurrent with other similar studies, showed that as the BMI increased, brain volume decreased.

“Our data suggests a stronger connection between central obesity . . . and risk of dementia and Alzheimer's disease,' said Sudha Seshadri, leader of the study published in the journal Annals of Neurology.

This means that for people reaching middle age, their 50s and 60s, there is a direct correlation between the increase in the waistline and decrease in brain size. Consequently the chances of some form of dementia hitting this particular group of people increases.

Two recent studies on genetics and dementia reported that people genetically predisposed to obesity have a higher risk of dementia-related disorders, such as Alzheimer’s. The fat mass and obesity gene (FTO gene) predisposes carries to obesity as well as brain deficits. Carriers of the FTO gene can fight nature, however, by staying on a low-fat diet and following a regular exercise regimen.
Abdominal fat is becoming known as the most dangerous kind of fat to carry. The good news is that belly fat is easier than other kinds of fat to get off. It is the first fat that comes off with diet and exercise. So if you are ready to decrease your risk of dementia and are interested in beginning your weight loss now, visit the HealthNews diet pages and test out our Individual Diet Selection tool, which can help find the right diet for you lifestyle.

'Autism Diet' May Not Improve Symptoms By Kathleen Doheny - WebMD

2010-05-20T09:46:00.000-07:00

The so-called autism diet -- a gluten-free, casein-free eating plan -- does not appear to improve the symptoms of children with the group of neurodevelopmental disorders known as autism spectrum disorder or ASD, according to a new study.

About one in 110 U.S. children has ASD, which includes classic autism as well as Asperger's syndrome and other forms marked by difficulties in social interaction and communication. Bowel problems are also common in ASD children.

The use of the so-called autism diet has become popular, with up to 27% of parents reporting its use and anecdotal reports praising it. It eliminates the proteins gluten and casein.

But in the small group of children studied, "we did not see a demonstrable improvement," says the study researcher Susan Hyman, MD, associate professor of pediatrics, Golisano Children's Hospital at the University of Rochester Medical Center in Rochester, N.Y. She is due to present the findings Saturday at the International Meeting for Autism Research in Philadelphia.

The new study results follow another report, published in the summer edition of Research in Autism Spectrum Disorders, concluding that 14 published studies of the gluten-free, casein-free diet did not find it useful.

Putting the Autism Diet to the Test
Hyman and her colleagues enrolled 22 children with ASD, all between 2 and 1/2 and 5 and 1/2 years old. After dropouts, 14 finished the 18-week study. None of these 14 participants had wheat or milk allergies, celiac disease (in which the small intestine is damaged from eating gluten), or iron deficiency.

All the children participated in at least 10 hours a week of early intensive behavior intervention to make the group as similar as possible. All children were put on a strict gluten-free, casein-free diet.

The autism diet has become popular based on a theory that some children have insufficient enzyme activity in their gastrointestinal tracts, resulting in incomplete digestion of casein, a protein found in milk and other dairy products, and gluten, a protein found in wheat, barley, and other grains. The incomplete breakdown is what leads to the symptoms, advocates of the dietary approach contend.

After being on the autism diet for at least four weeks, the children were given a ''challenge'' snack once a week with either 20 grams of wheat flour, 20 grams of evaporated milk, both, or neither. The routine continued until each child received each snack three times over 12 weeks.

All the snacks were made to look identical, with similar taste and texture, and no one knew which snack was being given.

Parents, teachers, and researchers observed the children's behavior and symptoms before the challenges and two and 24 hours after. ''We looked at various parameters of behavior before and after the challenges," Hyman says.

4 Must-See ArticlesWhat It's Like to Have Autism Gluten-Free Diets for Autism On a Mission to Get My Son Better Join the Discussion in the Autism Community

Putting the Autism Diet to the Test continued...
Included were measures of improvements in sleep problems, common in children with ASD, improvement in bowel problems, also common, as well as improvement in socializing and language.

''There was no difference with the challenge compared to the placebo," Hyman says

Anecdotal reports from parents, especially in children with autism and significant GI symptoms, may be fueling interest in the diet, Hyman says.

Despite the results, nutritional interventions and effects on autism warrant more study, Hyman says.

One of her co-researchers, Patricia Stewart, PhD, RD, a senior instructor of pediatrics at the University of Rochester Medical Center, agrees. ''I think we need bigger studies that are more inclusive," she says, perhaps including children with GI issues. ''There could be subpopulations that benefit."

Second Opinion
One plus of the study is that the scientific community is focusing on whether the diet plan, long popular with parents, works, says David Mandell, ScD, associate director of the Center for Autism Research at The Children's Hospital of Philadelphia and associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine, Philadelphia.

"Parents have been trying what we call complementary and alternative treatment for a long time, and I think the scientific community has tended to ignore them," say Mandell, who reviewed the study results for WebMD.

Critics might point out that an 18-week study is not long enough to produce real change, he says. "Some parents would say six months to a year [is needed to notice changes]."

"This [study] is a very specific type of study, a challenge,'' he says. "That's very different than randomizing them to a gluten-free, casein-free diet compared to a regular diet." Such a comparison study would help, he says.

Mandell still expects parents to try the autism diet, despite the results saying it's ineffective.

If they do, he has this advice. "Approach it with even more skepticism than they would have before." Deficiencies in calcium and vitamin D can occur with the diet.

Mandell says parents should decide what specific symptoms or behavior they are trying to change with the diet and develop a way to assess that change once the diet is introduced.

That may reduce the subjective assessment that's a natural reaction to many interventions for autism, he says. "We all want to believe our kids are getting better based on what we do."

Study: Postpartum depression affects fathers too. By Shari Roan, Los Angeles Times

2010-05-20T09:41:00.000-07:00

An analysis finds that 10% of men suffer serious depression at some point between a pregnant partner's first trimester and one year after childbirth. Stress and sleep deprivation can be factors.

They might relish becoming parents, but they can also be unprepared for the infant in their lives. They're sleep-deprived, confused and irritable. They're the fathers.

Discussions of the connection between mental health and childbirth have long focused on women, but a sizeable portion of men experience prenatal and postpartum depression too, according to research released Tuesday.

The study, published in the Journal of the American Medical Assn., found that 10.4% of men experienced serious depression at some point between his partner's first trimester and one year after childbirth, more than double the depression rate for men in general. American men were more likely to experience prenatal or postpartum depression compared with men in other countries, 14.1% in the U.S. compared with 8.2% internationally.

"It's viewed as a disorder of motherhood. It's not viewed by health professionals and the public as a problem in fathers," said James F. Paulson, the lead author of the study and an assistant professor of pediatrics at Eastern Virginia Medical School in Norfolk.

But depression in either parent can affect both the couple's relationship and the child's development, Paulson said, adding that further study is needed.

"There have been a few very good studies documenting negative child outcomes when fathers are depressed," he said. "That alone makes this a significant public health concern and something we need to pay more attention to."

Paulson analyzed the findings of 43 studies involving 28,004 participants. The men were from the United States, China, Ireland, Britain, Australia and several other developed nations.

The most vulnerable period for depression in men was three to six months postpartum, he found, with a quarter of the men who experienced depression afflicted during this time period.

An estimated 14% to 23% of women experience depression during pregnancy and 5% to 25% have postpartum depression, according to the American College of Obstetricians and Gynecologists.

Paternal depression has not been well documented historically, and many of the studies in the meta-analysis were conducted only in the last five to 10 years, Paulson said. The contemporary father may be more vulnerable to this malady than previous generations of fathers because of the increasing number of women in the workplace and the corresponding expectations that he shoulder more responsibilities at home.

"We are expecting dads to be more involved in parenting than we ever have before," said Will Courtenay, a psychotherapist and researcher on paternal depression in Berkeley who was not involved in the study. "Most dads are welcoming of that, but they don't have any models about what a dad is supposed to do. That creates uncertainty, and that uncertainty can lead to anxiety and depression."

Further, paternal depression symptoms are much less likely to be recognized than maternal depression, Paulson said. A woman may be sad, withdrawn and weepy while depressed; men may appear more irritable or angry and become detached from the family.

In women, the condition is often linked to biological and hormonal changes associated with pregnancy and birth. But hormones are not the sole cause of pregnancy-related depression even in women.

"This narrow focus really makes it difficult to understand depression in men," Paulson said. "We know, in fact, there are many factors, hormonal and other, related to depression in women."

The depression of either parent can include how one partner's depression affects the other and how intimacy, conflict management and division of responsibilities change after having a baby. In the meta-analysis, men had a higher risk of depression if their partner also had depression.

"If we see depression in one partner that should prompt us to screen for depression in the other partner," he said.

Marital dissatisfaction, financial stress and having a sick or colicky baby could increase the risk of depression in one or both partners, said Courtenay, who is conducting a study on new fathers in collaboration with the Center for Men at McLean Hospital in Belmont, Mass.

" Sleep deprivation likely plays one of the biggest roles for men and women," he said. "We know that if normal, healthy adults go without good sleep for just one month, they begin to show signs of clinical depression."

Why alcohol affects people in very different ways

2010-05-20T02:46:00.000-07:00

Researchers have found the key that could explain why alcohol affects people in different ways-a receptor gene variant.

A genetic variant of a receptor in the brain's reward circuitry could determine whether the neurotransmitter dopamine is released in the brain following alcohol intake, found researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Dopamine is involved in transmitting the euphoria and other positive subjective effects produced by alcohol.

The findings help explain the diverse genetic susceptibility for alcohol use disorders,
"By advancing our understanding of the neurobiology that underlies the addictive properties of alcohol, this finding helps us understand why alcohol affects people in very different ways. This kind of information also aids the development of personalized medications for alcohol problems," said NIAAA Acting Director Dr. Kenneth R. Warren.

Receptors for brain molecules known as opioid peptides help initiate the neurochemical reactions that underlie the positive effects produced by alcohol.

Activation of the mu-subtype of opioid receptor following alcohol consumption triggers the release of dopamine from the forebrain.

"But there is much variation in alcohol-induced responses that are thought to be related to dopamine. Previous studies by our group and others suggest that variants of opioid genes may contribute to the observed variation, possibly through effects on alcohol-induced dopamine release," explained Dr. Markus Heilig.

For example, he noted that people who carry the mu-opioid receptor variant designated as 118G report increased euphoria following alcohol consumption.

Heilig's group has reported that a similar mu-opioid receptor variant in monkeys heightened the stimulating effects of alcohol and increased their alcohol consumption.

In the current study, first author Dr. Vijay A. Ramchandani and colleagues explored whether the 118G mu-opioid receptor variant influences dopamine release from a forebrain region called the ventral striatum in response to alcohol.

Using human positron emission tomography (PET), an imaging technique that allowed the researchers to analyze dopamine activity in the brain, they compared dopamine release in two groups of people that had been given a dose of alcohol.

The groups consisted of those who carried a copy of the gene for the 118G mu-opioid receptor variant, and those who carried only genes for the more common 118A variant.
They found that only people with the 118G variant had a dopamine response to alcohol - no such response happened in subjects with the 118A receptor variant.

"Taken together, our data strongly support a causal role of the 118G variant of the mu-opioid receptor to confer a more vigorous dopamine response to alcohol in the ventral striatum. The findings add further support to the notion that individuals who possess this receptor variant may experience enhanced pleasurable effects from alcohol that could increase their risk for developing alcohol abuse and dependence. It may also explain why these individuals, once addicted, benefit more from treatment with blockers of endogenous opioids," said Ramchandani.

The study has appeared online in Molecular Psychiatry .

Original article>>>>>>>>>>

Processed meat raises risk of diabetes, heart disease and cancer By LARA SALAHI and Dr. KELLY KYANKO

2010-05-19T10:57:00.000-07:00

Eating processed meats like hot dogs, bacon and deli meat could increase your risk for heart disease and diabetes compared to eating unprocessed red meats like beef and lamb, according to a new study.
Study finds that processed meats increase health risks more than other red meat.

But many experts were not convinced that the findings tipped the scale in favor of red meat.

The study published today in Circulation looked at 20 studies involving more than 1 million participants from 10 different countries. Researchers found that eating as little as 2 ounces of processed meat per day -- a few strips of bacon, a hot dog or smoked sausage -- increased the risk of heart disease by 42 percent and the risk of diabetes by 19 percent.

However, the culmination of studies examined found eating unprocessed red meat like steak, burgers and roasts did not seem to carry the same risks.
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The study suggested that the increased risk of heart disease and diabetes with processed meat may be related to the higher salt and preservatives that are normally found in processed meats.

While research found that both red meat and processed meats contained similar amounts of saturated fat and cholesterol -- both a contributing factor for heart disease and stroke -- processed meats had on average four times higher levels of salt and other preservatives, according to lead author of the study Renata Micha, research fellow in the department of epidemiology at Harvard School of Public Health.

On average a 50 gram serving of red meat contains about 127 mg of sodium, while the same serving amount of processed meat contains about 575 mg of sodium, according to data based on a 2005-2006 United States National Health and Nutrition Examination survey.

Don't Give Up on Meat, Experts Said

Although the research findings took harder aim at processed meat, many said the study is not enough to suggest that people should stop eating processed meat, or to exonerate red meat from health risks similar to those processed meat, including heart disease and diabetes.

According to Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic, the study did not take into account a person's overall lifestyle as a contributing factor for heart...Read more>>>

Growth hormone and breast cancer

2010-05-18T04:49:00.002-07:00

“A hormone that helps children grow may cause breast cancer, and women with high levels are at higher risk,” reported The Independent.

This report is based on a large review that combined the results of 17 studies on the relationship between levels of insulin-like growth factor (IGF1) and the development of breast cancer. It found that women with higher levels of IGF1 were at greater risk of developing oestrogen-dependent breast cancer. Women with the highest levels of this hormone in their blood were 28% more likely to develop breast cancer than those with the lowest levels.

The nature of the studies that were included means there is some certainty that higher hormone levels preceded the development of cancer (and not vice versa). However this is still not proof of cause and effect. Although there may be future implications for breast cancer prevention as blood levels of IGF1 can be influenced by dietary factors, this has not been examined by this research, and requires further study.

Where did the story come from?

The study was carried out by researchers from the Endogenous Hormones and Breast Cancer Collaborative Group, in the Cancer Epidemiology Unit at the University of Oxford. Contributors from institutes in Europe, the US and Australia also took part. The analysis was funded by Cancer Research UK and published in the peer-reviewed medical journal The Lancet Oncology.

The study was accurately reported in The Independent, though the headline mistakenly claimed that the “growth hormone causes breast cancer”. The study did show a positive link between the hormone and breast cancer risk, but this type of research cannot establish cause and effect.

What kind of research was this?

This was a pooled analysis of raw data from 17 individual studies from 12 countries, which looked at the possible links between blood levels of insulin-like growth factor 1 (IGF1) and breast cancer risk. IGF1 is a natural chemical in the body that is mainly secreted by the liver. It is essential for early growth and development.

Several previous studies have indicated there may be an association, but these studies were small with inconsistent results. It was unclear whether other factors were involved, such as menopausal status, the presence of other chemicals and the role of oestrogen. By pooling the data from several studies (which were largely nested case control studies), the researchers aimed to establish the risk more precisely and to find out whether other risk factors play a role.

To identify these studies, the researchers searched one electronic database and did further searches of the reference lists of the studies they identified. It is possible they may have missed some potentially eligible studies. Differences between the individual studies also need be taken into account. For example, the population that was studied, how levels of growth hormones were measured, and the length of follow-up. The researchers took this into account where appropriate.

What did the research involve?

The researchers systematically searched a research database for studies that looked for associations between breast cancer risk, IGF1, and another chemical that binds the hormone (IGF binding protein 3; IGFBP3). They say that most IGF1 in the body is bound to IGFBP3, so most previous studies have also looked at levels of this protein to see whether women with a high concentration of IGF1 relative to IGFBP3 are at an increased risk of breast cancer. Studies were only eligible if they were prospective in design, which means they had identified and followed a group of women over time to find out who went on to develop breast cancer and who did not, and what factors might be involved.

The raw data from the individual studies on blood levels of IGF1 and IGFBP3 and other factors associated with breast cancer risk, such as menopausal status was collated. Established statistical techniques were used to analyse the relationship between breast cancer, IGF1 and other possible risk factors, and to calculate the risk that might be associated with increasing concentrations of IGF1. The women were put into one of five categories according to their levels of IGF1 and IGFBP3.

What were the basic results?

In total 17 studies matched the inclusion criteria, providing data on 4,790 women who developed breast cancer and 9,428 women who did not develop the disease and who formed the control group. Average ages ranged from 35 to 72. Most women had experienced pregnancy, and most menopausal women had gone through a natural menopause. Average BMI was 23 to 28.

IGF1 concentrations were higher in certain groups, including taller women, moderately overweight women and in moderate consumers of alcohol.

The researchers found that, overall, the higher a woman’s blood level of IGF1, the higher her breast cancer risk. Women in the top fifth of cases, with the highest levels of IGF1, had a 28% higher risk of breast cancer than women in the bottom fifth, who had the lowest levels of IGF1 (odds ratio 1.28, 95% CI 1.14 to 1.44). The risk was not substantially changed by the presence of other chemicals or by menopausal status, or by the researchers' adjustments for other risk factors, but the relationship seemed to be limited to oestrogen-receptor-positive cancers.

How did the researchers interpret the results?

The researchers say their analysis confirms there is a link between levels of the hormone IGF1 and breast cancer-risk. They say it is not known if the hormone actually causes breast cancer, but there are “plausible biological mechanisms that could explain such an effect”.

If the link is causal, then this has important implications for prevention, since levels of IGF1 are influenced by nutritional factors, such as energy and protein intake. They advise that the possibility of lowering breast cancer risk by reducing IGF1 should be explored.

Conclusion

This is a large, well-conducted review of studies examining a link between insulin-like growth factor and breast cancer development. The researchers also adjusted for numerous other potential risk factors for breast cancer that may have confounded the relationship. It confirms a previously suspected link between IGF1 and breast-cancer risk, and tells us more about the size of the risk and whether any other factors are involved.

However, the researchers point out that:

* As with all reviews, individual study designs and methods often vary. In this case, IGF1 and IGFB3 and other risk factors were measured using various methods, which could make the results less reliable.
* Hormone concentrations varied substantially between studies. The reasons for this are unclear, and although the researchers allowed for this, it may bias the results. Also, hormone levels were measured only on one occasion, and may not necessarily represent hormone levels over a woman’s lifetime.

As the researchers say, there may be future implications for breast cancer prevention as IGF1 levels can be influenced by diet. This will need to be examined in future research. Further study is also needed to see why the relationship appeared to be specific to oestrogen receptor-positive breast cancers.

High-fat diet may worsen asthma By Mark Vavoulis

2010-05-18T04:49:00.000-07:00

People with asthma may want to consider eliminating burgers, fries and other high-fat foods from their diets. A new study has found that a meal high in fat can increase airway inflammation and may inhibit the response to a common asthma reliever medication.

Researchers at Australia’s University of Newcastle recruited 40 asthmatic subjects who were randomized to receive either a high-fat, high-calorie "food challenge" or a low-fat, low-calorie meal. Respiratory "sputum" samples were taken before they ate the meals and four hours after, and were analyzed for inflammatory markers.

They found those who consumed the high-fat meal had increased airway inflammation and decreased response to the bronchodilator medication albuterol.

"This is the first study to show that a high fat meal increases airway inflammation, so this is a very important finding," said the study’s lead author Lisa Wood, Ph.D. "The observation that a high fat meal changes the asthmatic response to albuterol was unexpected as we hadn’t considered the possibility that this would occur."

Asthma prevalence has increased dramatically in westernized countries in recent decades, suggesting that environmental factors such as dietary intake may play a role in the onset and development of the disease. Westernized diets are known to be relatively higher in fat than more traditional diets.

Researchers say further research on the relationship between diet and asthma is needed.

Breast Cancer Walk Raises $5.8 Million By Rachel Rossitto

2010-05-17T09:59:00.000-07:00

Thousands gathered at the University of Massachusetts Boston for the completion of the eighth annual Avon Walk for Breast Cancer yesterday, some there to support loved ones, others finishing the walk themselves, and some to celebrate their personal victories over the disease.

This year’s event, which began Saturday, had 2,560 participants and garnered $5.8 million for the fund-raising event. Participants either walked a marathon or a marathon and a half, 26.2 and 39.3 miles respectively. All walkers commit to raising at least $1,800 individually.

Many in attendance had either survived cancer or knew someone who had battled the disease. Jerry and Mary Astell of Hampstead, N.H. fell into both of those categories. The husband and wife were both diagnosed with breast cancer, him in 2007 and her a year later, and both defeated it. Jerry Astell not only survived breast cancer, which is rare in men, but a subsequent bout with colon cancer, as well.

“We raised money this weekend because we know you can’t beat breast cancer by yourself,’’ Mary Astell told the cheering crowd while onstage with her husband.

Walkers finished the trek by entering a fenced-off walkway directly in front of the outdoor stage in the middle of the university’s quad. Friends and family members who did not participate but attended the closing ceremony surrounded the area while the walkers made their entrance. Cancer survivors made their way through an even smaller, fenced-off walkway within the larger one and stood directly in front of the stage, waving white pom-poms in the air as they completed their journey.

Financial adviser and television host Suze Orman made an appearance, awarding grants to 11 New England organizations engaged in fighting breast cancer.

Massachusetts General Hospital received the largest amount, $750,000. Tufts University and Beth Israel Deaconess Medical Center each received grants of $300,000; University of Massachusetts Amherst was given $285,000; Dana Farber Cancer Institute received $200,000; Silent Spring Institute, Cambridge Health Alliance, and Lifespan Foundation each received $150,000; Central Maine Medical Center received $140,000; and Community Servings and Bay State Medical Center both were given $100,000.

“You are changing the course of breast cancer here in Boston as well as the rest of the world,’’ Orman told the crowd. “You should be proud, Boston!’’

Original article>>>

Healthy weight, healthy blood pressure

2010-05-17T09:55:00.001-07:00

Hypertension is the medical term for high blood pressure, and is often referred to as the 'silent killer' because there are rarely visible symptoms warning you that your blood pressure is high. In more advanced cases, headaches, visual disturbances, nosebleeds, nausea and vomiting, sleepiness and even seizures may be experienced. Two out of three people with high blood pressure are unaware of the condition and is estimated that one in four South Africans between the ages of 15 and 64 years suffers from high blood pressure. Hypertension is one of the leading causes of heart attacks, strokes, kidney failure and premature death.

What is high blood pressure?

Blood pressure is the pressure of the blood in your arteries that is needed to keep blood flowing through your body. High blood pressure develops if the walls of the larger arteries lose their natural elasticity and become rigid, and the smaller blood vessels become narrower.

A normal blood pressure is ideally 120/80 or less and a high-normal reading may go up to 139/89. If your blood pressure is above this, the Heart and Stroke Foundation SA recommends that you have your BP number checked by a medical doctor.

Risk factors for high blood pressure:

* A family history of high blood pressure.
* Ethnic groups: the black African population has a greater predisposition to hypertension.
* Age: the risk of developing high blood pressure increases with age (it occurs most often in men over the age of 35 years).
* Being overweight (especially around the stomach area) contributes to a 2-6 times higher risk.
* An unhealthy diet, including a high salt intake.
* Excessive alcohol consumption.
* Physical inactivity.
* Smoking.
* Stress.
* Pregnancy.
* Certain medications like birth control pills, steroids and anti-inflammatory drugs.
* Severe kidney disease.

What harm does high blood pressure do?

An uncontrolled, high blood pressure can lead to a heart attack or stroke, kidney failure and damage to eyesight (glaucoma, blindness). The increased workload can also make the heart become too weak, less efficient and eventually lead to heart failure. Tiredness, shortness of breath and swollen ankles are often experienced.

How to lower your blood pressure level?

* Eat small, regular meals every day.
* Eat a healthy, balanced diet.
* Enjoy a variety of fruits and vegetables (at least 5 servings a day).
* Include foods that are high in fibre (e.g. whole grains and nuts).
* Avoid fatty foods, especially those that are high in saturated fats (e.g. full cream dairy products, meat, chicken skin and fried foods).
* Eat foods that are high in fibre and whole grains (limit refined foods and drinks high in added sugars).
* Choose Heart Mark products when shopping or eating out as these are healthier alternatives – visit www.heartmark.co.za for a list of products endorsed by the Heart and Stroke Foundation SA.
* Overweight people are advised to lose weight. Losing as little as 5% to 10% of your total body weight can lead to a meaningful drop in blood pressure.
* Limit total salt (sodium chloride) intake. This not only includes table salt but also salt that is hidden in foods).
* If you drink alcohol, do so in moderation. Limit daily intake to one drink per day in women and two drinks per day in men.
* Caffeine in coffee, tea, cola drinks, chocolate, energy drinks and weight loss products may cause blood pressure to increase temporarily.
* Include regular physical activity as part of your daily routine (aim for at 30 minutes five times a week).

Free Blood Pressure screenings are offered by the Heart and Stroke Foundation SA on a monthly basis at malls throughout Cape Town. Contact Nuha on 021 447 4222 for venue and date information. The Heart and Stroke Foundation SA (HSFSA) encourages all South Africans to have their blood pressure checked at least once a year (more often if there is a history).

Furthermore, the Director of Health and Nutrition and Registered Dietitian at the HSFSA, Shan Biesman-Simons implores all hypertension sufferers to take all blood pressure medication exactly as prescribed, don't stop or change it unless advised to do so by your doctor.

For more information on high blood pressure, visit www.heartfoundation.co.za or contact a HSFSA Dietitian on the Heart Mark Diet Line on 0860 223 222 for free nutritional advice.

Information supplied by the Heart and Stroke Foundation.

Botox may create wrinkles

2010-05-17T06:07:00.000-07:00

Agence France-Presse
May 17, 2010
First Published: 12:06 IST(17/5/2010)
Last Updated: 12:22 IST(17/5/2010)

BotoxNew research has found that Botox, a toxin that paralyzes facial muscles to reduce lines, can ironically cause more wrinkles.

Published in the Journal of Cosmetic Dermatology on May 11, the study suggests that in order to compensate for the paralyzed muscles when trying to recreate facial expressions, other muscle groups come into play, causing lines in un-treated places.

One of these side effects are the well-known 'bunny lines' across the nose, seen on stars such as Kylie Minogue.

Dr David Becker, assistant professor of dermatology at Weill Cornell Medical College in New York and quoted in the study, already warned of unwanted effects of Botox seven years ago when he told the BBC: "(In the case of Botox being injected between the eyebrows), following treatment, muscles in the upper nose, middle eyebrow and eyelid may try to recreate the expression of a scowl. Repetitions of this action cause new wrinkles."

Becker also stressed, however, that in general, the treatment was largely regarded as safe and effective and that any new lines would be less prominent than the ones treated in the first place. According to some medical sites, 'bunny lines' can be prevented by injecting small amounts of Botox into the nose.

Jury Awards $15 Million Against Maker of Botox; Mark & Associates, P.C. and McGinnis, Lochridge & Kilgore, L.L.P. Continue to Evaluate Cases on Behalf of Botox Victims -- AGN

2010-05-17T06:04:00.000-07:00

Oklahoma City Doctor Suffered Botulism Poisoning After Receiving Anti-Wrinkle Injections in 2006

UNIONDALE, N.Y. and AUSTIN, Texas, May 14, 2010 (GlobeNewswire via COMTEX) -- Mark & Associates, P.C. and McGinnis, Lochridge & Kilgore, L.L.P. are pleased to announce a $15 million verdict against Allergan Inc. /quotes/comstock/13*!agn/quotes/nls/agn (AGN 61.06, -1.51, -2.41%) after a jury found the company was negligent for failing to provide sufficient warnings about potential Botox side effects. The law firms are currently representing numerous clients who have been injured as a result of Botox injections. For more information about this verdict and Botox side effects, please visit www.BotoxLegalRights.com.

Ray Chester, partner of McGinnis, Lochridge & Kilgore, L.L.P. and lead trial counsel in the case, represented Dr. Sharla Helton in her lawsuit against Allergen alleging that Botox injections in 2006 led to severe and disabling side effects. Dr. Helton, an obstetrician and gynecologist, suffered botulism poisoning after receiving Botox injections, and was forced to sell her medical practice and step down as medical director of Lakeside Women's Hospital in Oklahoma City due to botulism and debilitating pain.

Botox is the trade name for botulinum toxin, type A, which has been described by the Journal of the American Medical Association as "the most poisonous substance known." JAMA, February 28, 2001, 285: 1059-1070. Botox, especially at high doses, can migrate out of the injected muscles and cause severe injuries which constitute, or at least mimic the symptoms of, botulism.

"We are convinced there are a great number of Botox victims that have not yet associated their symptoms and illnesses with their use of Botox. We hope this verdict gives them the courage to come forward and hold Allergan responsible for their corporate misconduct," said Ray Chester. "It is simply unacceptable for a drug manufacturer to withhold vital safety information from the public."

Jason Mark of Mark & Associates, P.C., who has been part of the Botox litigation team since its inception, commented, "This verdict rightly punishes a corporation who clearly put profits ahead of safety. The American public will continue to hold greedy corporations responsible when they put profit margins ahead of safety."

The firms' next Botox trial will be the case of a 70-year-old nurse who died in 2008 after she received Botox injections to ease her neck pain. That trial is scheduled to begin in Santa Ana, California in September.

McGinnis, Lochridge & Kilgore, L.L.P. was founded in 1927 in Texas with strong interests in government and politics. With offices in Austin and Houston, the firm represents individuals, companies and public institutions in more than 20 focused practice areas and industries. More information is available at www.mcginnislaw.com.

Mark & Associates, P.C. has offices in Boston, Massachusetts and Long Island, New York. The firm aggressively represents victims of defective products, dangerous pharmaceuticals and medical devices and serious accidents. More information on Mark & Associates, P.C. is available at www.youhaverights.com.

This news release was distributed by GlobeNewswire, www.globenewswire.com

SOURCE: Mark & Associates, P.C.

Docs Using Botox On Stroke Victims

2010-05-14T19:18:00.001-07:00

Everyone has heard of using Botox to smooth out wrinkles, but doctors said they are currently using it for stroke victims.

Botox was only recently approved for muscle spasticity. It works by blocking signals into certain muscles that are counteracting proper movement, such as for a stroke victim who suffers from paralysis, doctors said.

But experts said while Botox helps some people, it may not be useful for all stroke victims.

"People who have either a heavy paralysis or even more than two limbs involved -- those people are less likely to benefit," said neurosurgeon Dr. Jonathan Brisman.

The effectiveness of the Botox could diminish as early as three weeks, at which point the patient would have to have more injections, doctors said.

Scientists find why tamoxifen fails some breast cancers (BBC News)

2010-05-10T05:34:00.000-07:00

UK scientists say they have discovered why some women fail respond to breast cancer treatment, and it is a gene error they believe they can fix.

UK scientists say they have discovered why some women fail respond to breast cancer treatment, and it is a gene error they believe they can fix.

Tamoxifen is given to most women diagnosed with breast cancer to prevent the cancer returning.

But not all women respond to the drug - experts estimate a third get no benefit.

The work in the journal Cancer Research suggests the problem is too much of a gene called FGFR1.

This discovery could lead to new treatments for these women as scientists "switch off" the action of FGFR1, enabling Tamoxifen to work.

The team of scientists in the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research have already shown this is possible in the lab.

They introduced a drug which "switched off" the action of FGFR1.

Once FGFR1 was stopped, hormone-based treatments like Tamoxifen could get back to work in destroying cancer cells, they found.

The researchers believe this could ultimately help thousands of women each year.

They say one in 10 breast cancer patients has too much of the FGFR1 gene.

Dr Nick Turner, who led the research, said: "Understanding how this gene can cause Tamoxifen resistance reveals a new drug target for treating breast cancers in patients who would otherwise have a poor outcome.

"There are a number of drugs in development that stop FGFR1 working, and clinical studies are investigating whether these drugs work against cancers with too many copies of this gene.

"The next step is to set up a clinical trial to see whether a drug that blocks the action of this gene can counteract hormone therapy resistance in breast cancer patients.

"If these trials confirm our lab work we could be on the verge of a potentially exciting new treatment for breast cancer."

Dr Lesley Walker of Cancer Research UK, the charity which helped fund the work, said: "Cracking the problem of resistance to treatments such as Tamoxifen would be a major advance in treating breast cancer."

Breast cancer is the most common cancer in the UK affecting more than 45,500 women each year.

Tamoxifen blocks the female sex hormone oestrogen that fuels the growth of some breast tumours.
Original article>>>

Breast cancer gene clue discovery. By Helen Briggs

2010-05-10T05:30:00.000-07:00

Five genetic clues to why some women have a family history of breast cancer have been identified by UK researchers.

By Helen Briggs
Health reporter, BBC News

It brings to 18 the number of common genetic variations linked to a small increased risk of breast cancer.

The Cambridge University-led research, published in Nature Genetics, could see targeted screening and treatment of women more likely to get breast cancer.

It is thought about one in 20 of all breast cancers are down to inherited faults in known genes.

Breast cancer is the most common cancer in the UK with more than 45,500 new cases diagnosed each year.

The precise reasons why a woman develops the disease are still unknown.

However, inherited, environmental and lifestyle factors are all thought to play a role.

There isn't anything we can do about the genes we inherit, we do know that you can reduce your risk of breast cancer by maintaining a healthy weight, limiting alcohol consumption and exercising regularly

Dr Caroline Hacker, Breakthrough Breast Cancer
In the largest project of its kind and funded by Cancer Research UK, the researchers scanned the entire genetic code of around 4,000 British patients with a family history of breast cancer.

They then studied the DNA of another 24,000 women, with and without breast cancer.

The researchers found five "spots" on the human genome linked to a family history of breast cancer. Another 13 have already been located.

Scientists also know about two high risk genes which are more likely to be defective in someone with breast cancer, known as BRCA1 and BRCA2.

Genetic profiling

Dr Douglas Easton of the University of Cambridge, is lead author of the study.

He told the BBC: "We know for sure that these gene variations are associated with risk.

Breast cancer risk factors
Breast cancer risk factors are related to lifestyle, life choices and the environment, or inherited
Established risk factors include age, alcohol, genetics, HRT, pregnancy, the contraceptive pill and weight
Possible risk factors include diet and stress
Source: Breakthrough breast cancer
"It is not the whole picture but it will contribute ultimately to genetic profiling of risk.

"It also contributes to our understanding of why the disease develops and will lead to a better understanding of the biology of the disease."

Women with a strong family history of breast cancer are already given early screening for signs of tumours.

They are also entitled to genetic tests if they have a close relative with breast cancer.

The 18 genetic changes linked to breast cancer are not currently tested for. They are thought to account for around 8% of inherited cases of breast cancer.

Dr Caroline Hacker, policy manager at Breakthrough Breast Cancer, said: "This could lead to new genetic tests which may help identify women who have an increased risk of breast cancer due to inherited faults in genes.

"Hereditary breast cancer is rare and only around one in 20 of all breast cancers are due to inherited faults in breast cancer genes.

"Although there isn't anything we can do about the genes we inherit, we do know that you can reduce your risk of breast cancer by maintaining a healthy weight, limiting alcohol consumption and exercising regularly."

Dr Helen George, head of science information at Cancer Research UK, said: "This research takes us a step closer to developing a powerful genetic test for the disease.

"Such a test could help doctors identify women who have an increased breast cancer risk so that they can make informed decisions about how to take steps to reduce their chance of developing the disease."

Original article>>>>

Diabetes Nerve Pain May Worsen at Night

2010-05-09T06:45:00.000-07:00

People With Diabetic Peripheral Neuropathy Report Worst Pain, Study Finds
By Charlene Laino
WebMD Health News
Reviewed by Laura J. Martin, MD

May 7, 2010 (Baltimore) -- People with diabetes-related nerve damage may experience worse pain in the evening hours, preliminary research suggests.

If confirmed in larger studies, the findings suggest that people with diabetic peripheral neuropathy might need more pain medication late at night.

Peripheral neuropathy is a type of nerve damage associated with type 2 diabetes most often characterized by pain, tingling, and numbness in the hands and feet.

"It could be that patients need more [pain] medication at night or that if they are taking a once-a-day medication, it should be taken in the evening," says Brett Stacey, MD, medical director of the Comprehensive Pain Center at Oregon Health & Science University in Portland.

But it’s too early to make recommendations on the basis of this study, he tells WebMD.

The new findings were presented at the annual meeting of the American Pain Society.
Diabetes Nerve Damage: More Pain at Night

Previous research has shown that people with rheumatoid arthritis often experience worse pain when they wake up than at other times of the day; people with osteoarthritis have worse pain at night.

To begin to investigate whether the pain of diabetic peripheral neuropathy also has a daily pattern, researchers recruited 647 people who reported they'd been diagnosed with the condition.

For seven days, participants kept a diary recording the intensity of their pain every three hours, starting at 8 a.m. They were asked to rate their pain on a 10-point scale, where 10 equals the worst pain imaginable.

The average age of the participants was 54, and 58% were female. Nearly all (92%) were taking prescription or over-the-counter pain medication.

Results showed that average pain scores were highest at 11 p.m. and 8 p.m., when they were 4.65 and 4.53 points, respectively. They dropped to their daily low at 11 a.m., when they averaged 4.21 points.

The association between worse pain and evening hours remained after factors such as age, gender, and other health conditions were taken into account.

Still, the difference between the lowest and highest pain scores was too small to draw any firm conclusions, researchers say.
Diabetes Pain Study: "Hypothesis Generating"

The study has other limitations too, including the fact that participants were recruited via email and that they rated their own pain.

"It's hypothesis-generating," says Michael Clark, PhD, a pain specialist at the Haley VA Medical Center in Tampa, Fla.

Studies like this "tell us whether a hypothesis is worth pursuing," Clark tells WebMD.

"With pain management, we're trying to get away from treating patients based on averages, asking instead when do patients function best and when do they function worst," he says.

The new study was funded by GlaxoSmithKline, for whom Stacey serves as a consultant.
Original article >>>

Prostate cancer diagnosis and treatment: Questions and concerns. By ANDY LAGOMARSINO

2010-05-07T15:02:00.000-07:00

Prostate cancer, the second leading cause of cancer death in American men, does not lend itself to "one size fits all" diagnosis and treatment, according to a local urologist. The disease's lack of early symptoms, combined with an imperfect marker to detect the disease, can contribute to delayed diagnosis. The decision about whether to treat the cancer is no less clear-cut when factoring in the health and age of the patient, family history, longevity and the growth rate of the disease.

"There have been questions raised within the medical community about whether we are over-screening," said Gregg E. Zimmerman, M.D., of Morris Urology, a division of Garden State Urology, and physician program coordinator of robotic surgery at Saint Clare's Hospital. He is one of the few fellowship-trained urologic oncologists in northern Jersey with expertise in robotic surgery.

"There is no harm in screening," said Zimmerman. "The better question is: When should we be treating the disease?" The answers are controversial in the medical community and often confusing for patients. Doctor and patient must look at all factors for each individual case to help the patient arrive at the decision that is right for him.

The Difficulty in Diagnosis: An Asymptomatic Disease and an Imperfect Marker

The prostate gland is found in the male reproductive system. About the size of a walnut, it is located below the bladder and in front of the rectum. It surrounds the urethra, the tube that connects the bladder and penis. The prostate has two functions: It controls the rate at which urine flows out of the bladder, and it secretes a whitish fluid that is fed into the urethra during ejaculation. The fluid gives the ejaculate its whitish appearance and also helps the movement of sperm.

It is estimated that one in six men will develop prostate cancer in their lifetime. The National Cancer Institute notes that there are 192,280 new cases of prostate cancer in the United States annually, with 27,360 men dying from the disease.

One difficulty in diagnosis is that prostate cancer is largely asymptomatic during the early stages. It is not unusual for a patient to be diagnosed with prostate cancer during this time and still "feel fine." In advanced cases, there may be symptoms such as difficulty urinating, urine retention, bone pain, weakness and weight loss. There may also be blood in the urine or semen, discomfort in the pelvic area and swelling in the legs.

The primary screening method involves a blood test called a prostate specific antigen, which measures the level of a protein produced by the prostate, and a digital rectal exam to evaluate for abnormalities. The PSA level is used as a tumor marker because the level typically rises in men when prostate cancer is present. A DRE may reveal a nodule on the prostate. If the PSA level is elevated and/or the DRE is abnormal, a prostate biopsy may be recommended.

A "normal" PSA reading historically has been considered to be between 0 and 4 ng/mL. However, as Zimmerman notes, men with PSA levels in this range can still have prostate cancer.

"Although PSA levels below 4 ng/mL are considered a normal range by the medical community, there is no real ‘normal' range," explained Zimmerman. "The PSA marker is the best we have, but it's not perfect. The PSA velocity, or how that number changes over time, is a more accurate indicator. For example, a patient with a PSA of 6 consistently over a number of years may not be cause for concern. However, if a patient has a PSA that jumped from 0.5 to 1 and then 2, it could indicate a problem, even though the numbers are in ‘normal' range."

While PSA is very sensitive and thus useful in detecting prostate cancer, it also can rise for other reasons. Common causes of PSA elevations include inflammation, such as in prostatitis; urinary tract infections; or an enlarged prostate called benign prostatic hyperplasia, which is common in men over 50. Even seemingly innocuous events such as a bumpy car ride or an ejaculation can cause the level to rise.

The Decision to Treat and the Options Available

Fortunately, prostate cancer is typically a slow-growing disease. There are often many treatment options for patients with prostate cancer. Options include continued monitoring or active surveillance, surgical removal of the prostate, radiation, and cryoablation - a freezing technique. The decision to treat often depends on grade (how aggressive the cancer is), stage (where the cancer is), patient age and life expectancy, presence of other medical problems and a patient's personal preference.

Prostate Cancer Surgery Options

One common way to treat prostate cancer is with surgical removal of the entire prostate. The open radical prostatectomy has been the surgery of choice for many years. In recent years, the minimally invasive robot-assisted laparoscopic radical prostatectomy was introduced and has since become the gold standard treatment for prostate cancer.

"There has been a shift in the paradigm for treatment of prostate cancer, from the open radical prostatectomy to minimally invasive robotic prostatectomy," said Zimmerman.

* Open Radical Prostatectomy. This traditional form of surgery requires a large, open midline incision. It is a major surgical procedure with a hospital stay of three to five days. Patients wear a catheter following surgery for two or three weeks and typically return to work in approximately six weeks.
* da Vinci Robot-Assisted Laparoscopic Radical Prostatectomy. This procedure allows better control, extreme precision, and a greater range of movement than is possible for a surgeon operating with his or her own hands inside the body. This is a technically more advanced procedure that requires additional training and skill. Benefits for the patient include a shorter hospital stay (typically overnight), smaller incisions, less blood loss, less pain and a quicker return to normal activity. Patients wear a catheter for about a week following surgery and may return to work within two weeks.

After surgical removal of the prostate, PSA levels should become undetectable, as long as the cancer was organ-confined (had not spread outside the prostate).

Questions to Ask Your Doctor

Annual screening for prostate cancer is typically recommended for some men beginning at age 50. High-risk patients, including African-American men and those with a family history of the disease, should begin screening at age 40. Men concerned about prostate cancer should ask the following questions of their primary caregiver or urologist:

* Is PSA a reliable marker for the detection of prostate cancer?
* What are my options if prostate cancer is suspected?
* What are the personal factors that should be considered for treatment?
* Does prostate cancer need to be treated in all cases? In my case?
* What are all the treatment options and the respective risks and benefits?
* Can urinary continence and control and sexual function be affected by treatment?

Patient Example: 57-Year-Old Oak Ridge Man

At age 57, Joseph Riggs was a healthy, active resident of Oak Ridge, N.J. He made it a point to get annual checkups, eat right and exercise regularly. It was during an annual physical that he discovered his PSA reading had jumped from 0.6 to 1.6 in just the past year. Although it was well within "normal" range, the elevation gave Zimmerman reason to pause, and he educated Riggs about his options. These included follow-up with PSA testing and rectal examinations at shorter intervals of three or six months, or the more aggressive approach: a prostate biopsy.

Riggs chose to be aggressive. The biopsy came back positive, indicating cancer. Risks and benefits were all discussed, and Riggs elected to undergo a robot-assisted laparoscopic radical prostatectomy performed by Zimmerman. He went in on a Thursday morning and walked out of the hospital on Friday. He wore a catheter for a week. The day after it was removed, he was able to resume his regular exercise program.

"I probably could have gone back to work except for the catheter," said Riggs. "There was very little pain and almost no aftereffects."

Riggs continues to have normal urinary and sexual function. A year later, he remains cancer-free.

— ANDY LAGOMARSINO, NEWJERSEYNEWSROOM.COM
Original article>>>

Diabetes Test Results May Be Deceptive in Black Children. By Randy Dotinga

2010-05-07T15:00:00.000-07:00

Study finds racial disparities in hemoglobin A1c screenings

Black children with type 1 diabetes score higher than whites with similar blood glucose levels on a critical test, potentially leading their physicians to give them the wrong treatment, a new study says.

The test "can be deceptive in African-American children with diabetes, misleading their doctors into believing that glucose levels are higher than they really are," research team member Dr. Stuart A. Chalew, professor of pediatrics at Louisiana State University Health Sciences Center, said in a news release from the school.

If doctors don't take both the test and self-monitored blood sugar levels into account, "they are likely to unintentionally provoke increased episodes of life-threatening hypoglycemia [low blood sugar] in African-American patients," Chalew said.

Chalew and colleagues tracked 276 children with type 1 diabetes for six years at Children's Hospital of New Orleans. The average age was 12.5 years and they had had diabetes for about five years, on average.

Researchers looked at results of the hemoglobin A1c screening test, which is an indicator of blood sugar levels over the previous two or three months. They also tracked blood sugar levels from glucose tests that the participants gave themselves for at least a month.

The researchers found racial disparities in the screening test results. "Besides the risk of over-treating with insulin and provoking hypoglycemia, the data also suggest that there is a need for alternate therapies to reduce diabetes complications other than insulin and other glucose-lowering agents," Chalew said.

The study is published in the May issue of the journal Diabetes Care.

More information

To learn more about kids and diabetes, see kidshealth.org.

-- Randy Dotinga

SOURCE: Louisiana State University Health Sciences Center, news release, May 7, 2010

Original article>>>

Cancers from Environment 'Grossly Underestimated' By EMILY WALKER

2010-05-06T10:42:00.000-07:00

Environmental carcinogens are responsible for a far greater number of cancers than previously believed -- a fact that suggests eradicating these environmental threats should be a priority for President Obama -- according to the report of a presidential advisory panel.

"The Panel was particularly concerned to find that the true burden of environmentally induced cancer has been grossly underestimated," wrote the authors of the report, "Reducing Environmental Cancer Risk: What We Can Do Now."

"The panel urges you most strongly to use the power of your office to remove the carcinogens and other toxins from our food, water, and air that needlessly increase health care costs, cripple our Nation's productivity, and devastate American lives," the report's authors wrote in a letter to President Obama.

The President's Cancer Panel was established by the National Cancer Act of 1971, when then President Richard Nixon declared war on cancer. The panel is required to submit an annual report to the president describing the status of the "war" and identifying both progress and barriers to continued advances.

The singling out of environmental causes for cancer in this year's report is considered a major -- and some said welcome -- departure from previous reports, according to a number cancer specialists contacted by ABC News and MedPage Today.

"For the past 30 years ... there has been systematic effort to minimize the importance of environmental factors in carcinogenesis," said Dr. Philip Landrigan, director of the Children's Environmental Health Center at Mount Sinai School of Medicine in New York City.

"There has been disproportionate emphasis on lifestyle factors and insufficient attention paid to discovering and controlling environmental exposures," he said. "This report marks a sea change."

Dr. Jennifer Lowry, a medical toxicologist at Children's Mercy Hospitals and Clinics in Kansas City, Mo., said the report finally lends a "voice that could be heard that the environment does play an important role in the health of all people of every age."

The report is actually a synthesis of testimony from more than two dozen experts in cancer, chemicals and environmental toxins.

Based on that testimony and research compiled over the last two years, report authors Dr. LaSalle Leffall, Jr., of Howard University and Vivian Smith, professor emerita at the University of Texas M.D. Anderson Cancer Center, concluded that the government has failed to prevent unnecessary exposures to carcinogens. The challenge for the Obama administration, they wrote, is to intensify research efforts into environmental toxins.

"With the growing body of evidence linking environmental exposures to cancer, the public is becoming increasingly aware of the unacceptable burden of cancer resulting from environmental and occupational exposures that could have been prevented through appropriate national action," Leffal and Smith wrote in the letter to the president.

Among the potential exposures cited in the report were pesticides, fertilizers, pharmaceutical byproducts in the water supply, household chemicals and tanning beds. Emissions from cars, trucks and planes add to the toxic mix, the authors wrote.

But the authors said there was no evidence connecting the use of cell phones to increased cancer risk.

While Americans are exposed to thousands of chemicals each year, only several hundred of those chemicals have been safety tested, Leffal and Smith said.

The study of environmental factors and their effect on cancer has been giving short shrift compared to studying lifestyle factors and genetic and molecular causes of cancer, the authors claimed.

But paging through the lengthy report, it was difficult to find solid science to back that strong statement.

"At this time, we do not know how much environmental exposures influence cancer risk and related immune and endocrine dysfunction," Leffal and Smith wrote.

In an interview, Leffal said he hoped the report, if nothing else, would raise awareness that chemicals and other environmental toxins may be causing cancer and that more studies are needed.

"We think based on what we know, when you look at all the data, it just appears to us that there are areas where its been greatly under-reported," Lefall said. "We don't know 100 percent, but that's why we believe we need to do more research."

The National Toxicology Program, part of the Department of Health and Human Services, does list some chemicals such as benzene and formaldehyde and some substances including tobacco as carcinogenic, but environmental factors, such air pollutants and naturally-occurring chemicals, are less well-understood.

Public awareness about some compounds, such as bisphenol A (BPA), has increased in the past year as a handful of studies and report linked the ubiquitous chemical -- widely used in plastics such as baby bottles and other drink containers -- to metabolic disorders, heart disease and male sexual dysfunction.

Also, the U.S. Food and Drug Administration recently announced it would review safety data on another common chemical, triclosan, which is used in antibacterial soaps and washes, toothpastes and cosmetics, after lab tests on animals were concerning.

In the report, Leffal and Smith recommended that physicians routinely ask about their current workplace and living environment as a routine part of collecting patient history.

They also recommended:

Conducting a thorough assessment of workplace exposures and cancer risks;

Creating a more coordinated and transparent system for enforcing environmental health standards;

Increasing funding for federal research into occupational and environmental epidemiologic cancer research;

The Environmental Protection Agency should lower its current maximum standard for radon exposure, and the public should be better informed about the risks of radon;

Providing better care to military personal who were exposed to nuclear fallout.

Radiation exposure has long been recognized as a cancer risk, but this latest report from the President's Cancer Panel claims that patients and healthcare professionals are not completely aware of radiation exposure from imaging techniques such as computed tomograpy (CT) scans -- a radiation exposure that might be increasing with the use of whole body scans and virtual colonoscopy.

And while the report issued a call for increased emphasis on dialing down the radiation exposure with CT, the government may actually be out in front on this issue; the FDA recently proposed new safety requirements for manufacturers of CT scanners and fluoroscopic devices. Those new requirements are designed to reduce unnecessary radiation from medical imaging.

Original article>>>>>>

Lack of sleep linked to early death: study

2010-05-05T10:13:00.000-07:00

LONDON (AFP) - People who get less than six hours sleep per night have an increased risk of dying prematurely, researchers said on Wednesday.

Those who slumbered for less than that amount of time were 12 percent more likely to die early, though researchers also found a link between sleeping more than nine hours and premature death.

"If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol," Francesco Cappuccio, who led research on the subject at Britain's University of Warwick, told AFP.

The study, conducted with the Federico II University in Naples, Italy, aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.

"We think that the relation between little sleep and illness is due to a series of hormonal and metabolical mechanisms," Cappuccio said.

The findings of the study were published in the Sleep journal.

Cappuccio believes the duration of sleep is a public health issue and should be considered as a behavioural risk factor by doctors.

"Society pushes us to sleep less and less," Cappuccio said, adding that about 20 percent of the population in the United States and Britain sleeps less than five hours.

Sleeping less than six hours is "more common amongst full-time workers, suggesting that it may be due to societal pressures for longer working hours and more shift work"

The study also found a link between sleeping more than nine hours per night and premature death, but Cappuccio said oversleeping is more likely to be an effect of illness, rather than a cause.

"Doctors never ask how much one sleeps, but that could be an indicator that something is wrong," said Cappuccio, who heads the Sleep, Health and Society Programme at the University of Warwick.

Research showed no adverse effects for those sleeping between six and eight hours per day.

Sleep-inducing genetic differences could offer protection against alcohol dependence

2010-05-05T08:23:00.000-07:00

Washington, DC: Genetic differences in alcohol-metabolising enzymes, that make you sleepy when you drink, could significantly alter your risk for developing alcohol dependence (AD), according to a study.

One variant of the alcohol dehydrogenase enzyme, ADH1B*3, is observed almost exclusively in populations with African ancestry and has also been associated with reduced rates of AD.

The study has found that greater levels of sedation in African Americans with ADH1B*3 may explain their lower rates of AD.

"In one study looking at genetic samples from a number of African groups, the ADH1B*3 variant was found in almost every group. Furthermore, prior studies had shown that those with ADH1B*3 had reduced drinking and risk for AD, and this was thought to be due to the different form of ADH enzyme that people with this allele have.

The goal of our study was to see if those with ADH1B*3 had different subjective and physiological response to alcohol compared to those who do not. This would be one explanation for why they drank less than others and they have a different experience from drinking," explained Dr. Denis M. McCarthy, associate professor of psychology at the University of Missouri and corresponding author for the study.

Lara Ray from UCLA said that this focus on minority populations such as African Americans is sorely needed.

"In the pharmacogenomics era, failure to account for genetic differences in various ethnic groups may perpetuate or even expand health disparities. In this study, the authors do a very nice job of addressing unique risk and protective genetic factors for alcoholism in African Americans," she added.

Researchers provided a moderate alcohol dose 0.72 g/kg for males, 0.65 g/kg for femalesto 91 African American adults (52 females, 39 males) aged 21 to 26 years.

All participants were genotyped for ADH1B*3 as well as additional polymorphisms that might contribute to alcohol response.

Results showed that ADH1B*3 was associated with higher levels of sedation, as well as a sharper increase in pulse rate immediately following alcohol consumption.

"The unique part of this study is showing that people with this allele have a different experience when they drink they get more sedated, particularly when their BrAC is high," said McCarthy.

"This would be one explanation for their reduced drinking behaviourpeople are less likely to drink heavily when doing so makes them tired rather than stimulated or disinhibited. It is important for genetic research to go beyond demonstrating that a gene is related to a drinking disorder and instead demonstrating the steps by which the gene can exert its influence on that disorder," he added.

The results of the study will be published in the latest issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Male Obesity Linked to Low Testosterone Levels

2010-05-04T13:43:00.000-07:00

Obesity, a condition linked to heart disease and diabetes, now appears to be associated with another health problem, but one that affects men only – low testosterone levels. A new study conducted by University at Buffalo and published online ahead of print in the journal Diabetes Care, showed that 40 percent of obese participants involved in the Hypogonadism in Males (HIM) study, had lower-than-normal testosterone readings. Results also showed that men with diabetes, whether obese or not, showed lower levels of testosterone than non-diabetic men across all weight categories. Among obese men with diabetes, the percentage of men with lower than normal testosterone readings rose to 50 percent. Testosterone levels decreased significantly in both diabetic and non-diabetic men as BMI increased.

This is the largest analysis of the association between obesity and low testosterone, and the first to compare prevalence of low testosterone with obesity and diabetes separately and together. The study shows that obesity and diabetes may exert independent influences on testosterone concentrations.

How can I get rid of my acne? By Dr. Jennifer Shu, CNN Health

2010-05-04T13:41:00.000-07:00

Living Well Expert
Dr. Jennifer Shu Pediatrician,
Children's Medical Group

"I would like to know how can I get rid of my acne. I have tried many creams but am allergic to Proactiv and benzoyl peroxide. At the moment, I am using tea tree oil, but it still has not been helping very well. Kindly help me please".

Expert answer

Thank you for your question. I know how frustrating it can be to have trouble with your skin. Since I don't know the specific details about your condition, I encourage you to visit your primary care doctor or dermatologist for the best care. In the meantime, I consulted with Dr. Jeffrey Benabio, a dermatologist in San Diego, California, and author of The Dermatology Blog, who shared the following general information about acne:

Acne is common: Nearly everyone has it at some point. It can be difficult to treat. These two facts make acne treatment a billion-dollar industry. Many treatments for acne cause redness, itching and irritation, which make it difficult to continue using them. Unfortunately, the most important factor in treating acne is not which treatment you use, but how faithfully you are using it.

Mild acne can be treated with over-the-counter remedies such as salicylic acid or benzoyl peroxide. Prescription treatments such as oral or topical tretinoin, topical clindamycin, and sometimes oral antibiotics such as doxycycline or minocycline are needed when acne is moderate. Severe acne sometimes does not respond to any treatment except tretinoin (Accutane).

Other acne treatments, such as apricot scrubs or tea tree oil, can help in some mild cases, but they do not work for most people with moderate or severe acne.

All topical acne treatments take 10 to 12 weeks to be effective; that means you have to use them for up to three months before you see good results. Most people do not continue using their treatment long enough to give it time to work.

I hope this information is helpful and wish you the best of luck in finding a treatment that will eventually meet your needs.

Article's source link >>

Sweaty palms, underarms? Botox offers 'magical' help

2010-05-03T03:47:00.000-07:00

Mumbai: While most people manage to find respite from the sweltering heat in the shade, 30-year-old Arvind Kumar (name changed) wouldn’t stop sweating even in his centrally air-conditioned office.

Diagnosed with a condition called hyperhidrosis or excessive sweating in certain parts of the body, like the underarms, face, palms and feet, when he was a teenager, Kumar had tried anti-perspirants, anti-anxiety medication and even iontophoresis, a technique using a small electric charge to deliver a medicine through the skin. But all in vain.

That’s when Kumar went for Botulinum toxin, which he claims has ‘magically’ reduced his problem. Cosmetic surgeons and dermatologists say Kumar is not the only person Botulinum toxin, acknowledged as the most poisonous toxic protein in the world, has brought relief to. “Every summer, the number of people asking for treatment for hyperhidrosis triples,” said
Dr Rashmi Shetty, a dermatologist who runs clinics at Santa Cruz and Breach Candy. Shetty, who has treated 15 people this summer, says they get the highest number of patients during summer and the wedding season.

“A small dose of Botulinum toxin is injected into the skin of the underarm of the patient,” said dermatologist Dr Apratim Goel, of Goel’s Cutis Skin Studio, Grant Road. The treatment costs Rs15,000-30,000 depending on the number of units of Botox used. Its effects last from four months to a year.

The dose prevents the release of a chemical called acetylcholine which carries signals from the sympathetic nervous system to the sweat glands in the underarm to stimulate sweat production.

According to Dr Goel, 70% of her patients are males working in the corporate sector.

“They are very conscious about sweat stains on their underarms,” she said. “Watchmakers, diamond businessmen, jewellers, software professionals, painters, etc, who suffer from the condition, require this treatment as otherwise it would hamper their work,” she added.

“If you are worried about the sweat stains when you lift your arms, have sweaty palms, which moisten your keyboard, and soak the paper on which you write, then you may be suffering from hyperhidrosis,” said Dr Kirti Rane, a dermatologist. He added, “Many a times, this hampers the confidence level of the patient, causing both psychological and physical problems leading to social isolation and emotional trauma.”

In Kumar’s case, his condition hampered his professional growth. “Being a software professional, excessive sweating on my palms and underarms affected me a lot. I could not shake hands with anybody. My shirt had sweat stains even in a fully air-conditioned office,” said Kumar, adding that he could see the effects of the treatment in a week’s time.

Earlier, the treatment for hyperhidrosis included a surgery known as ganglionectomy or a surgical procedure to cause denervation. “This, however, resulted in compensatory hyperhidrosis in other areas. For instance, a successful surgery on the underarms would prevent sweating in the underarms, but the body would compensate by causing excessive sweating in some other area, like the face, palms or feet,” said Dr Shetty. With Botox, however, a simple injection resolves the problem, she said.

Side effects of Botulinum toxin: According to experts, the side-effects of Botulinum toxin may vary according to injection site, dose, frequency of injections, and the expertise of the cosmetic surgeon. According to dermatologist Dr Sharon D’Mello, “Botox has no long-term side effects. Most side-effects are localiSed and temporary, such as pain and tenderness at the injection site.”

However, not everyone who suffers from hyperhydrosis is a candidate for botulinum toxin. “This has to be analysed by a qualified dermatologist, as hyperhidrosis is sometimes caused by thyroid conditions as well, which cannot be treated with the injection,” she added.

SOURCE: DNAINDIA.COM

Eat brown rice to prevent high blood pressure, lower heart attack risk

2010-05-03T03:45:00.000-07:00

S. L. Baker, features writer

The rate of cardiovascular disease is much lower in Japan than in the U.S. and now scientists at the Cardiovascular Research Center and Department of Physiology at Temple University School of Medicine in Philadelphia think they know why. People in Japan eat rice virtually every day and rice -- especially the brown and only partially "polished" varieties -- contains a natural compound that appears to guard against high blood pressure and heart disease.

Brown rice is already well known as a healthy food choice because it's a good source of fiber, B vitamins and other nutrients. But new research just presented by Temple University researcher Satoru Eguchi at the American Physiological Society's Experimental Biology conference held in Anaheim, California, reveals another powerful health benefit. A specific natural compound found in a layer of tissue surrounding grains of brown rice inhibits an endocrine protein known as angiotensin II. In excess, angiotensin II can trigger serious cardiovascular problems.

This is enormously significant news because angiotensin II is a well documented culprit in the development of hypertension and atherosclerosis. Angiotensin II constricts arteries, increases blood pressure and forces the heart to work harder. It also thickens and stiffens the walls of the heart and blood vessels.

Big Pharma has created a huge industry producing angiotensin II receptor blockers (ARBs) -- prescription drugs that lower blood pressure by putting the brakes on angiotensin II. Sold under brand names such as Atacand, Teveten, Avapro and Cozaar, the medications are designed to block angiotensin II, thereby relaxing blood vessels so blood pressure is lowered.

But the side effects of these drugs can be serious and even deadly. They include fetal harm (possibly death) if the drugs are taken during pregnancy, dizziness, blurred vision, fainting, decreased sexual ability, infection, chest pain, swelling, trouble breathing and more.The new discovery about rice indicates brown rice or even half-milled rice could be a natural, side-effect free angiotensin II blocker.

Dr. Eguchi, an associate professor of physiology, and his colleagues investigated the subaleurone layer of Japanese rice. Located between the white center of the grain and the brown fibrous outer layer, this sub-layer of rice is loaded with oligosaccharides (complex carbohydrates known to benefit the digestive system) and dietary fibers. But when brown rice is polished to turn it into white rice, this subaleurone layer is ripped off, taking away some of the nutrients. However, the subaleurone layer is preserved not only in brown rice but also in two types of rice popular in Japan -- half-milled (Haigamai) rice or incompletely-milled (Kinmemai) rice.

The Temple research team, working with conjunction with scientists at the Wakayama Medical University Department of Pathology and the Nagaoka National College of Technology Department of Materials Engineering in Japan, removed subaleurone tissue from Kinmemai rice and ran a variety of lab tests that demonstrated the components of this rice layer inhibited angiotensin II activity in cultured vascular smooth muscle cells. Bottom line: the subaleurone rice layer could offer powerful protection against high blood pressure and atherosclerosis by blocking the endocrine protein that can trigger those conditions.

"Our research suggests that there is a potential ingredient in rice that may be a good starting point for looking into preventive medicine for cardiovascular diseases," Dr. Eguchi said in a media statement. "We hope to present an additional health benefit of consuming half-milled or brown rice (as opposed to white rice) as part of a regular diet."

Johnson & Johnson division recalls 43 OTC medicines for infants and children

2010-05-02T08:13:00.000-07:00

By Lyndsey Layton
Washington Post Staff Writer
Sunday, May 2, 2010

A division of Johnson & Johnson is recalling 43 over-the-counter medicines made for infants and children -- including liquid versions of Tylenol, Motrin, Zyrtec and Benadryl -- after federal regulators identified what they called deficiencies at the company's manufacturing facility.

The voluntary recall, which was announced late Friday by McNeil Consumer Healthcare, affects hundreds of thousands of bottles of medicine in homes and on store shelves throughout the United States and its territories and in nine other countries -- a vast portion of the children's medicine market.

The Food and Drug Administration is advising parents and caregivers to stop using the affected products, although Commissioner Margaret A. Hamburg called the potential for serious health problems resulting from the medications "remote."

FDA inspectors had begun a routine inspection April 19 in the company's Fort Washington, Pa., plant when they noticed "manufacturing deficiencies" that triggered the recall, said Douglas Stearn, a senior FDA official.

Stearn said the plant's manufacturing process was "not in control," a term regulators use to describe flawed procedures that affect the composition of medicine. Federal investigators do not know when the problems at McNeil began, but Stearn said that "this does go back in time" and that "we have to try to figure that out."

While the FDA investigates, McNeil has suspended operations at the facility. In a statement, the company said: "Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles." It said the problems may affect "purity, potency or quality."

Marc Boston, a McNeil spokesman, would not discuss the deficiencies cited by the FDA or say when the manufacturing facility was shut down. The company also declined to disclose the amount of products affected by the recall. In addition to the United States, Puerto Rico and Guam, the medicines were sold in Canada; the Dominican Republic; Dubai, in the United Arab Emirates; Fiji; Guatemala; Jamaica; Panama; Trinidad and Tobago; and Kuwait.
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A complete list of recalled products is on the company's Web site.

McNeil received consumer complaints associated with some of the recalled medicines, but the company's decision to pull them was not made on "the basis of adverse medical events," said Boston, who declined to elaborate.

If a child who has taken any of the recalled medications exhibits any unexpected symptoms, parents or caregivers should contact a doctor, federal officials said. Consumers or health-care providers who experience problems connected to the recalled medicines are asked to contact the FDA.

As of Saturday, the FDA was not aware of any health problems related to the recalled products, said spokeswoman Elaine Gansz Bobo.

Parents and caregivers can use generic versions of the affected medicines; they are not affected by the recall. The FDA cautioned against giving adult versions to infants and children, noting the potential for serious problems.

This is at least the third major recall of Tylenol products by McNeil since 2008.

In January, McNeil recalled 49 types of Tylenol products made for adults and two Tylenol products made for children after consumers complained of a mold-like odor and of temporary and minor nausea, stomach pain, vomiting and diarrhea. The company determined that some of the medicines had been contaminated by trace amounts of a chemical that is sometimes present on shipping and storage material.

In 2008, McNeil recalled 21 types of children's and infants' Tylenol liquid products, saying that although the products met internal standards, an unused portion of one inactive ingredient did not meet all quality standards.

Types of breast cancer

2010-05-02T04:47:00.000-07:00

Breast cancer type is categorized by whether it begins in the ducts or lobules, the organs responsible for breast milk production. Medullary carcinoma accounts for 15% of all breast cancer types. This breast cancer type represents 5% of all diagnosis. IPR015525 Breast cancer type 2 susceptibility protein Header EBIDatabasesInterPro Search Open in usermanual InterPro: ” /> Jump to: InterProScan Databases Documentation FTP site Help Click on the icon for context sensitive help from the user manual. The breast cancer type 2 susceptibility protein (BRCA2) is a breast tumour suppressor with a potential function in the cellular response to DNA damage. Some breast cancer types express one or more of these proteins on their cell surface, while others express none. Media Relations Contacts Online Press Kit Rumors, Myths, and Truths Glossary About the American Cancer Society Breastfeeding, Other Factors May Affect Risk of Breast Cancer TypeAtlanta 2008/08/25 -Factors such as age at menopause as well as a woman?s breastfeeding practices can influence her risk of developing certain types of breast cancer.

The investigators found that reproductive risk factors varied considerably by breast cancer subtype. Their analysis included 1,023 women with breast cancer whose cells express the estrogen and progesterone receptors (called luminal cancers), 39 women with HER2-overexpressing breast cancer, and 78 triple-negative cases (no expression of estrogen, progesterone, or HER2 receptors). The study also included 1,476 women without breast cancer. ? They added that additional studies on the causes of breast cancer subtypes are needed to better understand the biology of the disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information. The study?s results suggest that there are distinct and separate hormonal risk factors associated with different subtypes of breast cancer. Women with what is referred to as “triple-negative” breast cancer are more likely than other women with breast cancer to experience a relapse, a new study by Canadian researchers shows. Despite having a high risk of early recurrence, the study indicates that triple-negative breast cancer patients who remain disease-free for eight years are unlikely to die of breast cancer and may be “cured” of their disease.

Breast Feeding Will Lowers Risk Of Breast Cancer

Breastfeeding for 6 months or longer was associated with a lower risk of luminal cancer as well as triple-negative cancer, a type that can be particularly aggressive and difficult to treat. Understanding the specific type of breast cancer can help you ask better questions and work with your physicians to get the best breast cancer treatments. For more information on the types and stages of breast cancer, watch Beyond the Shock®. Medullary carcinoma accounts for 15% of all breast cancer types. Infiltrating lobular carcinoma is a type of breast cancer that usually appears as a subtle thickening in the upper-outer quadrant of the breast. Making up about 2% of all breast cancer diagnosis, tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. Typically this type of breast cancer is found in women aged 50 and above. Inflammatory breast cancer is a rare and very aggressive type of breast cancer that causes the lymph vessels in the skin of the breast to become blocked.

Breast Cancer Risk

The study’s results suggest that there are distinct and separate hormonal risk factors associated with different subtypes of breast cancer. Amanda Phipps, a predoctoral research associate at the Fred Hutchinson Cancer Research Center in Seattle, and her colleagues conducted a study to better understand the specific risk factors for the subtypes of breast cancer, which are classified by expression of the estrogen receptor, the progesterone receptor, and the HER2 receptor. The investigators found that reproductive risk factors varied considerably by breast cancer subtype. Breastfeeding for 6 months or longer was associated with a lower risk of luminal cancer as well as triple-negative cancer, a type that can be particularly aggressive and difficult to treat. Both late age at menopause and use of estrogen plus progestin hormone therapy were associated with an increased risk of luminal disease. Finally, no differences in risks associated with number of children or the age when a woman first gave birth were observed by subtype. The study authors concluded that their results indicate that “certain reproductive factors may have a greater impact on risk of certain molecular subtypes of disease compared to others. Despite having a high risk of early recurrence, the study indicates that triple-negative breast cancer patients who remain disease-free for eight years are unlikely to die of breast cancer and may be “cured” of their disease. Insulin resistance, hyperinsulinemia, and changes in the signaling of growth hormones and steroid hormones associated with diabetes may affect the risk of breast cancer. Despite many proposed potential pathways, the mechanisms underlying an association between diabetes and breast cancer risk remain unclear, particularly because the 2 diseases share several risk factors, including obesity, a sedentary lifestyle, and possibly intake of saturated fat and refined carbohydrates, that may confound this association. Although the metabolic syndrome is closely related to diabetes and embraces additional components that might influence breast cancer risk, the role of the metabolic syndrome in breast carcinogenesis has not been studied and thus remains unknown.

For more info related to this subject and others please visit Breast Cancer Info

BOTOX Gives Stroke Patient a New Life By PEI-SZE CHENG

2010-05-01T22:02:00.000-07:00

Seven years ago, Sandy Gerber suffered a stroke that paralyzed the entire right side of his body. He couldn’t move his arm, his leg, or even talk. After years of physical therapy, Gerber only regained partial use of his right side. Until he tried using BOTOX to treat his paralysis.

"He gave me the injections, five in the arm, six in the leg,” said Gerber.

Dr. John Kelemen of Island Neurological Associates in Plainview, New York treated Gerber. According to Dr. Kelemen, BOTOX has been used since the 1960’s for therapeutic purposes but it was only recently FDA-approved to treat spasticity, which is what Gerber suffered from. Although it is a deadly toxin, when used correctly for medicinal purposes, medical experts say it has few complications and is safe.

"Botox works when there's muscle over activity,” said Dr. Kelemen. “By blocking signals that are counteracting proper movement."

“After two days, I was able to turn my hand over which I never did for 7 years,” said Gerber. “I was able to take a fork and eat my food. I was able to sign my name."

But according to other medical experts, other stroke patients may not have the same response to BOTOX treatments as Gerber.

Dr. Jonathan Brisman of Winthrop-University Hospital in Mineola said, "For the right person it could be terrific. But not all patients are going to have that kind of tremendous response."

Dr. Brisman said in cases where patients suffer more severe paralysis, BOTOX may not help as much and many times, the perceived success of a treatment could be psychological.

"People who are more open-minded and more likely to respond positively,” Brisman said. “They may view it as good for them."

The effectiveness of the BOTOX could diminish as early as three weeks, at which point Gerber would have to have more injections. But now that he is able to do things he has not been able to for years, Gerber is a true believer.

"I can't be more ecstatic than I am right now,” said Gerber. “To tell everybody that I’m doing this. It took me 7 years but it seems to be working."

Drug Reverses Diabetes-Related Vision Loss

2010-05-01T21:59:00.001-07:00

Lucentis Combined With Laser Better Than Laser Alone, Government Study Finds
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD

April 28, 2010 -- Federal researchers say a new treatment can reverse vision loss in many patients with diabetic macular edema, a leading cause of blindness in people with diabetes.

In a news conference yesterday, researchers announced findings from a government study comparing treatments for swelling of the retina caused by leaking blood vessels in the eye.

Nearly 50% of patients given eye injections of the drug Lucentis along with laser treatments showed improvement in vision after a year of treatment, compared to just over a fourth of patients treated with laser alone.

For several decades, laser has been the standard treatment for diabetic macular edema, or DME, in which fluid builds up near the center of the retina.

“For the first time in 25 years we have definitive proof that a new treatment can lead to better results for the eye health of people with diabetes,” said Neil M. Bressler, MD, who oversaw the study as chairman of the Diabetic Retinopathy Clinical Research Network.

Is Your Type 2 Diabetes Under Control? Get Your Health Score
Lucentis Approved for Macular Degeneration

Lucentis is a genetically engineered drug derived from the cancer drug Avastin, which was the first targeted biologic treatment approved by the FDA.

The newer biologic was approved in June 2006 for the treatment of age-related macular degeneration, which is the leading cause of blindness in the elderly.

Bressler said the clear superiority of Lucentis with laser over laser alone in patients with diabetic macular edema should have an immediate impact on clinical practice, even though the biologic treatment is not approved for this indication.

“We expect the results of this study to have a major impact on how ophthalmologists treat macular edema in people with diabetes,” he says.

The study included 691 diabetic patients with macular edema in one or both eyes.

The patients received either standard laser treatment alone, Lucentis plus laser treatments in different dosing schedules, or the injectable steroid drug Trivaris with standard laser therapy.

Lucentis injections were limited to once a month, but most patients ended up having no more than eight or nine injections over the course of a year.
Few Complications, Better Outcomes

After one year, nearly 50% of the Lucentis-treated patients could read at least two additional lines on an eye chart or letters that were one-third smaller than could be recognized before treatment.

Vision loss, defined as loss of two or more lines on an eye chart, was seen in less than 5% of the patients treated with the biologic drug.

Patients treated with injections of the corticosteroid Trivaris and laser showed no greater improvement in vision than patients treated with laser alone.

These patients did have greater reduction in retina thickness, but they also experienced more treatment-related complications than other study participants.

About 30% developed potentially serious eye pressure requiring medication and 60% developed cataracts.

Few eye-related complications were reported in the Lucentis-treated patients, and these patients appeared to have no greater risk of heart attack or stroke.

Genentech: Long-Term Safety Unknown

The study results were published in the April 27 issue of Ophthalmology.

“These findings provide hope for a new treatment beyond laser for patients with diabetic macular edema, which may improve their chances of (maintaining) healthy vision,” says National Eye Institute (NEI) Clinical Director Frederick Ferris III, MD.

But a spokeswoman for Genentech tells WebMD the company has no plans to seek approval for Lucentis as a treatment for DME until its own phase III studies of the drug are complete.

Findings from two such studies are expected in the first half of 2011.

“While the results from this (newly published) study are very encouraging, we believe it is important to understand the long-term safety and efficacy of this drug and to study it in patients for longer than one year,” Nikki Levy of Genentech says.

It is also not clear if the company’s older and much cheaper biologic drug Avastin would be as effective as Lucentis for the treatment of diabetic macular edema, Ferris said. NEI is conducting a trial comparing Avastin to Lucentis in patients with age-related macular degeneration.

A dose of Lucentis costs about $2,000, compared to $50 to $200 for a dose of Avastin. Levy said the annual cost of Lucentis is about $15,500, assuming seven doses over the course of a year.
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Vaccine for prostate cancer approved by the FDA

2010-05-01T10:45:00.000-07:00

Provenge, a vaccine that uses the immune cells of a patient to internally fight off prostate cancer, has already been approved by the Food and Drug Administration, according to a feature on the U.S. News and World Report.

he vaccine is unique in that its use has been approved for treatment as opposed to prevention. At this time, Provenge is only approved for use in patients whose prostate cancer has spread but have yet to exhibit symptoms or only have minimal symptoms of the disease. Provenge can potentially extend survival in patients with advanced prostate cancer by 4 and a half months, although it is said that there are patients who have lived for more than a year more.

Provenge has been seen to have the ability to extend the survival rate of patients without having the serious side effects that chemotherapy, radiation and hormone therapy brings.

It is clarified, however, that Provenge is not a cure for prostate cancer, as indicated by Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society.

In a news release, Dr. Karen Midthun, acting director of the FDA’s Center for Biologics Evaluation and Research shares: “The availability of Provenge provides a new treatment option for men with advanced prostate cancer, who currently have limited effective therapies available.”

The positive effect that Provenge brings to patients with advanced prostate cancer has led to the hypothesis that it may be possible to use the vaccine in the earlier stages of the disease, where it is hoped that it will prove to be even more effective. It is something, however, that will need to be put to the test through clinical trials. Read more.

Living in a high-crime neighborhood may worsen children's asthma

2010-05-01T00:09:00.000-07:00

Contact: Susan Martin
ssmartin@aap.org
847-434-7877
American Academy of Pediatrics

Health-care professionals should consider child's social environment when treating asthma, researcher says

VANCOUVER, BRITISH COLUMBIA – Exposure to violent crime may exacerbate asthma in children, according to a study to be presented Saturday, May 1 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Emerging research suggests that violence and stress may influence the severity of a child's asthma. To explore this association further, researchers conducted a study of 561 children ages 8-14 years in Chicago who had been diagnosed with asthma by a physician.

Investigators interviewed caregivers to determine their stress level and exposure to violence. They also reviewed data from the Chicago Police Department detailing the incidence of violent crime in the communities where the children lived.

Results showed that 41 percent of the children had moderate or severe asthma, and 59 percent had intermittent or mild asthma. After adjusting for the child's age, gender, family history of asthma and socioeconomic status, children were nearly twice as likely to have moderate/severe asthma if their caregivers reported high levels of stress or if the incidence of violent crime was high in their neighborhood. After adjusting for caregiver stress, a high incidence of violent crime still was associated with more severe asthma in children.

"To our knowledge, this study is the first to evaluate the impact of both perceived and actual violence on childhood asthma," said co-author Ruchi S. Gupta, MD, MPH, a researcher from Children's Memorial Hospital in Chicago. "Based on our findings, it seems that the risk of severe asthma is better predicted by the actual incidence of violent crime in a community rather than violence perceived by the caregiver."

The findings suggest that actual violence may be representative of broader social problems known to impact asthma, such as a poor environment, or may be contributing to asthma severity in a way yet to be explored, said Dr. Gupta, who will be presenting the study findings at the PAS meeting with Elizabeth E. Springston.

"When caring for a child with asthma, physicians must consider the environment in which a child lives," Dr. Gupta said. "As health care professionals, we have an obligation to recognize the social barriers facing our patients in managing their asthma."

Why an STD Test Could Save Your Life

2010-05-01T00:06:00.001-07:00

The word "test" makes most people cringe. Images of grammar school, pop quizzes, and the SATs come to mind.

Yet I've spent this month talking about a different sort of test - one that could help protect your health, and even save your life.

April was STD awareness month: a necessary distinction in a world where one in two sexually active people will get a sexually transmitted disease (STD) by the age of 25 -- and most won't even know it. Yet chances are you've been putting off getting tested for the very same reasons pop quizzes made you anxious -- you're terrified of the results.

Not getting tested for an STD won't mean you don't have one -- it just means if you have one you won't know about it. So do yourself and everyone in your life a favor. Don't let another day go by without getting tested.

Before you convince yourself that you're not at risk, consider the facts. The most recent national estimates suggest that there are approximately 19 million new cases of STIs each year, half of them among 15-24-year-olds, and that 65 million Americans have at least one viral STI, most commonly genital herpes. In New York City, the statistics are even higher. Our AIDS case rate is three times the national average -- making New York the epicenter of the epidemic. Our rates of chlamydia, gonorrhea, and herpes are also far above the national average.

And when you break these numbers down by race or age, the statistics get even scarier. More than 80% of new HIV cases in 2008 were amongst men and women of color. For women, New York City's highest rates of chlamydia and gonorrhea occur in teenage girls, age 15-19. Amongst men, boys aged 15-19 have the second highest rates, trumped only by those aged 20-24.

To be sure, education is important too. New York City still does not require sex ed to be taught in schools -- a fact that's atrocious when you consider that about one in three young people in grades 9-12 are currently sexually active, and nearly one in five report having had four or more sex partners so far in their lifetime. Only two-thirds of New York City's sexually active youth report using condoms at all, and one in five girls did not use any birth control the last time they had sex.

Still, education doesn't replace the need for testing. Many STDs are treatable -- meaning the earlier they are detected, the earlier you can address them and the less serious they will become. A number of STDs are also symptomless -- meaning you could have one right now and not even know it.

STD testing is safe and easy. Getting tested protects your health, and can even save your life. You owe it to yourself -- get yourself tested.

Doctor's Advice - Do I have prostate cancer?

2010-05-01T00:05:00.001-07:00

Q I am a 19-year-old guy who has been having a problem for about a year now. While passing my stool, I sometimes notice there is some blood. It started in April last year, when I was away in Trinidad. The food I was given there was not good for me, as it was totally different to what I was used to at home. The bleeding recurred last August. Each time it lasted about a week. It only happens when I am defecating. Now it is happening again, so I'm somewhat worried about my health. Do you think it could be prostate cancer
?

A No, I do not. First, prostate issues cause problems with the urinary system, not the bowels. Second, prostate cancer does not occur at age 19. According to the Jamaica Cancer Society, nearly all cases occur among the over-45s.

So why are you bleeding?

Well, statistically speaking, the likeliest reason for a young guy to bleed from the bottom is piles.

Piles (also known as haemorrhoids) are varicose veins in the rectum. This means that the veins are 'bulging' and are liable to bleed when under pressure.

Piles are extremely common. Experts think they are at least partly caused by a poor diet.

If you do have piles, don't be scared. Most people who get this condition do not have to undergo surgery. Very often, the disorder can be controlled by medication and diet.

I must stress that there could be other reasons why you have been bleeding. See a doc now. Good luck.

Q I am a 20-year-old woman. About two weeks ago, I had sex with my boyfriend. The condom fell off. He decided that he wanted to go ahead without the condom, but I disagreed. So he stayed inside for only about a minute or less. My period came a couple of days after that. Now I have an awful smelly discharge. What do you think I should do? Is it serious?

A On the night the condom fell off, you were absolutely right to insist that your boyfriend stop. However, it is a pity that he continued for around a minute.

Nevertheless, it does seem you are not pregnant, because you say that your menses arrived.

Now you have an offensive discharge. The first thing that occurs to me is this: When the condom came off, did it by any chance remain inside you? A 'retained' condom is a well-known cause of a smelly discharge.

However, let us assume that you had both found the condom. In that case, the likeliest reason for that offensive discharge is a vaginal infection.

You may well have caught the infection during that brief minute of unprotected sex.

It is absolutely essential that you consult a doctor. She can examine you internally, take test samples from the region of your cervix, and reach a diagnosis.

Until you have seen the doc and been diagnosed, do not have sex.

Q I am a man in my early 20s. Around nine months ago, I was in a relationship with another man. I am not gay, but did it for financial reasons, which I know was wrong. What I am worried about is that I have recently failed a blood examination. So I am now wondering if I have contracted HIV. Do you think it was HIV which caused me to fail? But if I had HIV, would I have been seeing signs of it by now?

A Sorry to hear about your problems. But what I do not understand is this. What do you mean when you say that you 'failed' a blood test?

What blood test was it? And why did you have it done? If it was for HIV, I would have thought that whoever did the test would have told you so.

It seems clear that you should now go back to whoever conducted that blood examination and ask them to explain what sort of test it was. It may just have been a blood count for anaemia. Or possibly it was a 'sickling' test.

In the part of your email which I have not published, you told me precisely what you did with this other guy. I regret to say that this particular activity could have been enough to give you HIV if the other man was infected.

You should take an HIV test. The fact that you have not had any symptoms does not mean you are OK. Get this matter sorted out right away.

Q I'm a 19-year-old female who has had two miscarriages, both at five months. I have a problem with my weight, which is 190 pounds. I want to lose about 30 pounds, but I'm really depressed about everything, including the two miscarriages, and being unemployed. I really need advice on how to start losing weight without getting depressed.

A You have obviously had a bad time lately. Many people do not realise how stressful a miscarriage can be for a woman. To have two in succession is extremely distressing. You don't say whether you are in a sexual relationship at the moment. But if you are, I would suggest that you use a good contraceptive method for a year or so, so that you are not exposed to the strain of a further pregnancy, plus the worry of wondering whether you might miscarry again. It is clear that you are quite depressed, so I urge you to see a doctor as soon as possible. It is likely that she will put you on an antidepressant to help you get through this difficult time. On the point of losing weight, do not attempt to lose it quickly! Very strict dieting would probably make you even more depressed. Instead, a reasonable target would be to lose the 30 pounds over, say, the next two and a half years! That is a target of only one pound per month, which is achievable without making yourself miserable. A sensible free diet sheet is available at www.health24.com/dietnfood/weight.

Q Can one die from a heart attack during sex, as I have heard?

A Such things do occasionally happen in elderly people, particularly if they already have heart trouble. But if you are a young person, you really need not fret about this.

Test might help determine if breast cancer will spread. By Allen Mask, M.D.

2010-04-30T16:00:00.000-07:00

A new test could help women already diagnosed with a certain type of breast cancer determine if their cancer will spread or stay contained.

Diane Gilmore's life changed the day she went in for a routine mammogram, and her doctor found breast cancer.

“It’s like I’m in emergency mode and I got to get this taken care of,” Gilmore said of the diagnosis.

Her doctor recommended a lumpectomy -- the standard treatment for patients who are diagnosed with a non-invasive type of cancer called ductal carcinoma, also known as DCIS.

But there was no way to know for sure if the cancer would come back.

Now scientists say they have found a way to help predict whether a woman with DCIS will develop more invasive tumors later in life.

They say patients with certain characteristics in their breast tissue are at higher risk of more serious cancer within eight years.

Researchers say that one in 10 women diagnosed with DCIS will go on to develop a more invasive form of cancer and many patients could be getting treatment they may not need.

Doctors are hopeful the research means better treatment for all patients.

"It would be wonderful to say to these patients, just a surgical lumpectomy is enough for you, you don't need to do more. And for patients in that high risk group, those are probably the patients who will benefit most from additional treatment,” said. Dr. Freya Schnabel, director of breast surgery at New York University’s Langone Medical Center.

Gilmore is not sure which category she falls into, but she has been cancer-free for nearly eight years.

The test is still in the research phase and is not yet available to the public.

Reporter: Allen Mask, M.D.
Producer: Rick Armstrong

Can Botox ace the pain of tennis elbow?

2010-04-30T07:04:00.000-07:00

A single, carefully placed injection of botulinum toxin (Botox) can improve the pain of tennis elbow, researchers say. However, this treatment can cause temporary loss of movement in the third and fourth fingers, which may be an unacceptable side effect for many people.
What do we know already?

Tennis elbow happens when you damage the tendons in your lower arm, usually by moving your arm in a repetitive way, such as when playing tennis, raking leaves, or painting. It causes pain on the outside of your elbow, which often feels worse when you grasp something or twist your arm.

Tennis elbow usually gets better on its own in a few weeks, once you rest your arm and allow the tendons to heal. But occasionally, the pain lasts much longer, which may stop you playing sport or keep you off work.

Botulinum toxin (Botox) is a substance that relaxes muscles by temporarily paralysing them. It's often injected into facial muscles to reduce wrinkles and frown lines. It's also used for medical conditions such as multiple sclerosis, to relax rigid muscles.

More recently, botulinum toxin has been tried as a treatment for tennis elbow. The aim is to relax the muscles that are putting tension on the tendons, thereby allowing the tendons to heal.

This treatment is often quite specialised, using high-tech equipment to pinpoint where to inject the toxin. Researchers have now developed a simpler method, in which the injection site is based on the length of the patient's forearm. This new technique is easier to perform, but is it effective?

To find out, researchers enlisted 48 people who'd had tennis elbow for more than six months. Half were given a single injection of botulinum toxin, and half were given an injection of salt water (a placebo injection). People rated the intensity of their pain before and after treatment on a 100-point scale.
What does the new study say?

People given botulinum toxin saw improvement in their pain after four weeks. On average, their pain scores dropped by 30 points, compared with 12 points for the placebo group. Pain scores continued to drop during the 16-week study. The botulinum toxin group also had less pain while doing certain movements, such as pinching their thumb and index fingers together while their arm was resting on a table.

Alarmingly, all but one of the people in the botulinum toxin group had difficulty fully extending their third and fourth fingers after treatment. However, by the end of the study, everyone had regained full movement.
How reliable are the findings?

These findings should be fairly reliable. The study was a randomised controlled trial, which is the best type of study for finding out whether a treatment works. It was also a 'double blind' study, which means that neither the researchers nor the participants knew which treatment people had been given. This limits the effect that people's expectations might have on the results.

However, there's a good chance that many of the people in the botulinum toxin group guessed they'd been given the real treatment after losing some movement in their fingers. This knowledge could have influenced how they rated their pain.

The study was also quite small, and looked mostly at women. So, we need larger studies, with both men and women, to confirm these findings.
Where does the study come from?

The study was done by Iranian researchers at the Imam Khomeini Hospital Complex in Tehran. It was funded by the Vice Chancellor of Research at the Tehran University of Medical Sciences, and published in CMAJ, a journal owned by the Canadian Medical Association.
What does this mean for me?

If you've had tennis elbow for several months, you are no doubt eager for relief from your symptoms. Although this new technique of providing botulinum toxin injections appears promising, it's still experimental. The loss of finger movement is a troubling side effect, especially if you frequently do finger-dependent tasks, such as typing. So, although this technique may help with pain, it won't necessarily help you get back to normal straight away.
What should I do now?

If your tennis elbow doesn't seem to be getting better, talk to your GP. Although botulinum toxin injections are not widely available, there are several other treatments that may improve your symptoms, including physiotherapy, exercises, arm braces, and possibly surgery.

Breast cancer database unveiled

2010-04-29T09:54:00.001-07:00

A privately-funded new breast cancer database will lead to a "sea change" in the treatment of the disease in Ireland, a leading specialist has claimed.

The National Breast Cancer Bio Resource will collect tumour samples from around the country into a central research system for the first time.

Researchers will then compare the types of treatments being used on different strains of the cancer to find out which drugs are best suited to which patients.

Professor Arnold Hill, of the Royal College of Surgeons in Ireland (RCSI), said the resource will spark a "sea change" in breast cancer care in Ireland and could eventually make surgery less necessary.

"All the time we are making new inroads into the biology of breast cancer," he said.

"Newer drugs are available, but they need to be explored and evaluated. With this resource we'll be able to speed up that process so that in a number of years time, these treatments will be available to all patients."

Prof Hill said the database will help medics tailor the latest and most suitable drugs to patients a lot quicker.

Initially, three research nurses will be based at designated cancer specialist centres in Cork, Galway and Limerick, where they will collate samples from patients who give their consent.

Insurance giant Aviva has donated 450,000 euro - 150,000 euro a year for the next three years - to fund the positions in the RCSI-led initiative., but a Department of Health spokesman confirmed the State will pay nothing towards the initiative.

Health Minister Mary Harney said the State already puts huge resources into research through the Health Research Board and Science Foundation Ireland.

Does breastfeeding protect against asthma?

2010-04-29T01:01:00.001-07:00

NEW YORK (Reuters Health) - Sticking to a strict diet of mom's milk during the first 4 months of life may reduce a child's risk of developing asthma by their eighth birthday, according to a new study.

Health

"Breast milk is the optimal food for infants during the first months of life," lead researcher Dr. Inger Kull of the Karolinska Institute in Stockholm, Sweden, told Reuters Health in an email. "But whether or not breastfeeding reduces the risk of asthma has been debated."

Through her milk, a mother transfers "good" bacteria, antibodies and proteins that can help thwart infection. But the evidence for how breastfeeding might influence the later development of asthma remains confusing, with various studies suggesting protective, neutral and even detrimental effects.

Kull and her colleagues decided to look into the relationship a little differently than previous studies. They followed nearly 4,000 Swedish children over 8 years, noting which received short- or long-term, as well as exclusive or partial, breastfeeding.

The team found that about 12 percent of children who were exclusively breastfed for at least the first 4 months of life developed asthma by age 8, compared with 18 percent of those breastfed for a shorter amount of time.

This translated into a 37 percent lower risk of asthma for those breastfed for 4 months or longer, after adjusting for other risk factors such as maternal smoking and birth weight.

The difference appeared to be driven mostly by allergy-related cases of asthma.

The extended and exclusive diet of breast milk also resulted in better lung function at age 8, the researchers report in the Journal of Allergy and Clinical Immunology.

Of course, not all mothers have the desire or ability to solely breastfeed for their child's first months. For these women, Kull suggests that even partial breastfeeding can somewhat reduce the risk of asthma.

But what about all the other conflicting research? Dr. Malcolm Sears of McMaster University in Ontario, Canada, led one of these studies. His team found that New Zealand children breastfed for more than 4 weeks actually developed more asthma later in childhood.

Sears says one possible explanation for his result is the "hygiene hypothesis" -- the theory that the increasingly germ-free surroundings of modern life are actually contributing to an increase in allergies and asthma.

"If you're absolutely protecting children from everything, and breastfeeding protects them to a certain extent, this may allow the immune system to switch to becoming allergic rather than fighting infections," Sears told Reuters Health.

He also suggested the possibility that while breastfeeding might initially increase the risk of asthma, if a mother keeps at it for a long time, the risk can be reduced again - even to the point where breastfeeding becomes protective. Interestingly, his study used an earlier cut-off between short- and long-term breastfeeding than the Swedish study.

Still, given the inconsistent findings, Sears cautions against using asthma protection as the motivating factor for breastfeeding. "There are 101 good reasons to breastfeed," said Sears. "Whether or not it protects you against asthma, you should choose to breastfeed for all the other good reasons."

FDA Could Approve New Cancer Vaccine

2010-04-29T00:54:00.001-07:00

Reported byChristine Webb

ORLANDO -- The science behind the vaccine could also have applications for other kinds of cancers.

Doctors say the vaccine Provenge would be used for patients who already have prostate cancer, and would use the body's immune system to fight prostate cancer, stimulating the immune system to fight those cancer cells.

Doctors would remove patients' own white blood cells, treat them so they respond to the cancerous tumors, then they would put the treated cells back into patients' blood.

The treated white blood cells then look for and destroy those cancer cells.

We asked Dr. Julio Hajdenberg at the M. D. Anderson Cancer Center Orlando what he thought about the possibility of this new vaccine and what it could mean.

"It would be a good breakthrough. A first of its kind if it gets approved, and hopefully open the door for other vaccines," Dr. Hajdenberg said.

According to early clinical trials, men with advanced prostate cancer who took Provenge lived 4½ months longer. Some men gained an extra two or three years of life after the treatment.

Dr. Hajdenberg said it's important to point out Provenge would not be a cure, nor would it replace traditional treatments.

But it would be another option. And it could be still years away.

The worst side effects reported so far have been a few fevers and chills.

M. D. Anderson Orlando is not part of the clinical trials yet.

FDA approves first-of-its-kind asthma procedure

2010-04-29T00:52:00.001-07:00

WASHINGTON

The Food and Drug Administration has approved a novel procedure from a small medical technology firm that uses extreme heat to treat asthma.

The approval decision, announced late Tuesday, makes Asthmatx's Alair System the first non-drug asthma treatment to win federal approval.

The procedure, called bronchial thermoplasty, uses radiofrequency energy to burn away lung tissue that makes it difficult to breath and causes coughing spasms and wheezing. The heat is delivered via a catheter that emits radio waves, similar to microwaves used to cook food. The procedure would be performed by respiratory specialists known as pulmonologists over the course of three, half-hour sessions.

The FDA approved the device for patients 18 and older who cannot adequately control their asthma with prescription medications. While roughly 20 million people in the U.S. suffer from asthma, thermoplasty would only be appropriate for about 2 million adults with severe asthma who don't get relief from existing drugs, according to Asthmatx.

The FDA approved the technology under the condition that Asthmatx track patients for five years to monitor their long-term health.

The Alair System is the Sunnyvale, Calif.-based company's sole product. Asthmatx is privately-held.

Obesity, smoking may raise blood clot risk

2010-04-28T22:33:00.000-07:00

NEW YORK (Reuters Health) - Obesity and smoking may each raise a person's risk of potentially dangerous blood clots in the veins, but certain other suspected risk factors seem to have no impact, a new study finds.

The study, reported in the journal Circulation, investigated risk factors for venous thromboembolism -- blood clots in the veins, usually affecting the legs. If one of these clots travels to the lungs, creating what is called a pulmonary embolism, it can prove fatal.

Some studies have suggested that venous thromboembolism, or VTE, has largely the same risk factors as heart disease does, such as high cholesterol, diabetes, high blood pressure and smoking.

But most of those risk factors have not consistently been linked to VTE. Obesity has stood as the only condition strongly linked to both VTE and cardiovascular disease -- including heart disease and peripheral artery disease, a hardening and narrowing of the arteries supplying the legs.

In the new study, researchers found that among nearly 19,000 Danish adults followed for 20 years, those who were obese or heavy smokers had an increased risk of developing VTE (a clot in a deep vein or a pulmonary embolism).

Compared with non-smokers, those who smoked 25 cigarettes a day or more had a 52 percent greater risk. Meanwhile, obese adults were 65 percent more likely than the thinnest men and women to develop VTE, while severe obesity was linked to a doubling in the risk.

"The main message for the public from our study is that losing weight and quitting smoking are likely to not only reduce the risk of coronary heart disease and peripheral artery disease, but also of venous thromboembolism," lead researcher Dr. Anders G. Holst, of University Hospital Rigshospitalet in Copenhagen, told Reuters Health in an email.

On the other hand, the study found no evidence that diabetes, exercise levels, high cholesterol or high triglycerides (another type of blood fat) were linked to an elevated VTE risk. And while elevated diastolic blood pressure appeared to be a risk factor, a diagnosis of high blood pressure was not. That raises the possibility that the former finding was due to chance, and not a true effect, according to the researchers.

The findings come from a long-term study begun in 1976, looking at heart disease risk factors among adults age 20 and older living in Copenhagen.

Of 18,954 study participants followed for 20 years, 969 had at least one VTE during that time. Obesity and current smoking remained linked to higher risks even after the researchers accounted for age, sex and other health factors.

The findings suggest that two already-recommended lifestyle changes -- shedding excess pounds and quitting smoking -- are key in lowering VTE risk, according to Holst.

He also noted that the lack of a link between cholesterol and VTE is interesting, as a recent clinical trial of the cholesterol-lowering drug rosuvastatin (Crestor) found a lower risk of VTE among patients using the medication.

The current findings, Holst said, suggest that the benefit did not come from cholesterol-lowering, per se, but from some other effect of statins.

Almost half of US adults have diabetes, hypertension, or hypercholesterolemia. By Michael O'Riordan

2010-04-28T22:31:00.001-07:00

Hyattsville, MD - Nearly half of all adults in the US have one chronic condition associated with an increased risk of cardiovascular disease, according to data from the National Health and Nutrition Examination Survey (NHANES).

The report, from the Centers for Disease Control and Prevention, showed that 45% of individuals 20 years of age and older have hypercholesterolemia, hypertension, or diabetes. Of these, 3% of adults had all three conditions and 13% had two conditions. Hypertension and hypercholesterolemia were present in 9% of adults, and 3% of adults had high blood pressure and diabetes.

"These findings indicate that a high percentage of the population have a condition associated with heart disease, the leading cause of death in the United States," according to Cheryl Fryar (Centers for Disease Control and Prevention, Hyattsville, MD) and colleagues in an April 2010 data brief from the National Center for Health Statistics.

The prevalence of diagnosed or undiagnosed high blood pressure, elevated cholesterol levels, or diabetes varied by ethnicity, with non-Hispanic black individuals more likely than non-Hispanic white and Mexican American individuals to have at least one of these three conditions.

Compared with Mexican Americans, non-Hispanic white individuals were more likely to have only one of these chronic conditions, while non-Hispanic black people were more likely than white individuals and Mexican American individuals, 16.4% vs 12.8% and 12.7%, respectively, to have two comorbid conditions. In total, 4.6% of non-Hispanic black people have hypertension, hypercholesterolemia, and diabetes.

"These results emphasize the need for research to identify the reasons for the race/ethnicity differences and to identify factors that could be modified to mitigate the race/ethnicity differences," according to the researchers.

The data also showed that approximately 8% of adults have undiagnosed hypertension, 3% have undiagnosed diabetes, and another 8% have undiagnosed hypercholesterolemia. In more than 15% of all US adults, one or more of these conditions is undiagnosed. The proportion of undiagnosed hypertension, elevated cholesterol levels, and diabetes was similar across racial/ethnic groups.

HERPES RATE HIGHER AMONG BLACK WOMEN

2010-04-28T22:17:00.000-07:00

U.S. herpes rates remain high - CDC

1 in 6 Americans infected with herpes

By JoAnne Allen

WASHINGTON, March 9 (Reuters) - About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said on Tuesday.

Black women had the highest rate of infection at 48 percent and women were nearly twice likely as men to be infected, according to an analysis by the U.S. Centers for Disease Control and Prevention.

About 21 percent of women were infected with genital herpes, compared to only 11.5 percent of men, while 39 percent of blacks were infected compared to about 12 percent for whites, the CDC said.

There is no cure for genital herpes, or herpes simplex virus type 2 (HSV-2), which can cause recurrent and painful genital sores and also increases the likelihood of acquiring and transmitting the AIDS virus. It is related to herpes simplex virus 1, or oral herpes, which causes cold sores.

Several drugs are available to treat herpes symptoms and outbreaks, including acyclovir, which is available generically or under the Zovirax brand name, and valacyclovir, known generically as Valtrex -- both made by GlaxoSmithKline PLC (GSK.L). Ganciclovir, sold as Zirgan, is made by privately-held Sirion Therapeutics, Inc.

The CDC estimates that more than 80 percent of people with genital herpes do not know they are infected.

"The message is herpes is quite common. The symptoms can be often very innocuous," Dr. John Douglas of the CDC said in a teleconference.

"Because herpes is so prevalent it becomes ... a really important reason to use condoms on a consistent and correct basis with all of your partners," Douglas said.

Douglas said the increased rate of infection in blacks is not do to increased risk behavior but likely due to biological factors that make women more susceptible as well as the higher rate of infection within black communities.

The CDC estimates that there are 19 million new sexually transmitted disease infections every year in the United States, costing the health care system about $16 billion annually.

Enzymes key to regulating blood pressure

2010-04-28T22:14:00.001-07:00

ANAHEIM, Calif., April 28 (UPI) -- U.S. researchers found racial differences in enzymes key to regulating blood pressure.

Study leader Dr. TanYa Gwathmey of Wake Forest University Baptist Medical Center looked at the activity of enzymes associated with two peptides -- called angiotensins -- that help regulate blood pressure.

One enzyme helped produce the angiotensin that helped the body retain salt and water and to constrict blood vessels -- characteristics promoting high blood pressure. However, the riskier angiotensin could be converted by another enzyme to a more protective angiotensin that helped let the body release water and open blood vessels -- lowering blood pressure.

Gwathmey and colleagues studied enzyme levels in African-American boys and girls and Caucasian girls -- all having normal blood pressure. The African-American boys had more of the enzyme contributing to high blood pressure and the African-American girls had less of the enzyme protecting against high blood pressure.

"What is really interesting to me is that we are seeing changes in angiotensin metabolism before blood pressure changes," Gwathmey said in a statement. "This could become a useful tool for predicting high pressure and potential therapeutic treatment before hypertension actually sets in."

The findings were presented at the annual Experimental Biology conference in Anaheim, Calif.

Dr Botox is jailed

2010-04-28T22:11:00.000-07:00

A bogus plastic surgeon nicknamed ‘Dr Botox’ has been jailed for two months after being caught carrying out operations without a licence.

Steven Moos (pictured) was sentenced yesterday at Dubai Court of First Instance, which also ordered that he be deported once his jail term is finished.

This means the 40-year-old American is likely to be sent back to the US, where he is facing further charges.

Moos, who used to operate on women at his plush villa in Al Barsha, had been charged with impersonating another surgeon and practising without a licence. He was arrested following a complaint from leading plastic surgeon Stephen B Hopping, a consultant at the American Academy of Cosmetic Surgery Hospital in Dubai, after Moos started using Hopping’s name.

Two women also went to the police and complained they had been left disfigured.

Moos, who earlier this month told 7DAYS from his prison cell his patients “knew the risks”, could have been jailed for up to five years for his crimes. And one of his patients told 7DAYS that she wished the courts had been tougher.

The 37-year-old, who had botched breast enlargement and liposuction, said: “A sentence of two months is not enough. It has been terrible for me.”

She said she hoped the US locks him up again once he is kicked out of the UAE.

The father of four was a doctor in the States but was struck off in 2004 and fled the country to escape charges of supplying illegal drugs. He is wanted by the FBI.

Grapes Reduce Risk Factors for Heart Disease and Diabetes, Animal Study Shows

2010-04-28T22:01:00.000-07:00

SOURCE: SCIENCE DAILY
READ ARTICLE ON THEIR WEBSITE >>>>

Could eating grapes slow what's for many Americans a downhill sequence of high blood pressure and insulin resistance leading to heart disease and type 2 diabetes?

Scientists at the University of Michigan Health System are teasing out clues to the effect of grapes in reducing risk factors related to cardiovascular disease and metabolic syndrome. The effect is thought to be due to phytochemicals -- naturally occurring antioxidants -- that grapes contain.

Findings from a new animal study will be presented April 26 at the Experimental Biology convention in Anaheim, Calif., and show encouraging results of a grape-enriched diet preventing risk factors for metabolic syndrome, a condition affecting an estimated 50 million Americans and is often a precursor to type 2 diabetes.

Researchers studied the effect of regular table grapes (a blend of green, red and black grapes) that were mixed into a powdered form and integrated into the diets of laboratory rats as part of a high-fat, American style diet. All of the rats used were from a research breed that is prone to being overweight.

They performed many comparisons between the rats consuming a grape-enriched diet and the control rats receiving no grape powder. Researchers added calories and sugars to the control group to balance the extra calories and sugars gained from getting the grape powder.

After three months, the rats that received the grape-enriched diet had lower blood pressure, better heart function, and reduced indicators of inflammation in the heart and the blood than rats who received no grape powder. Rats also had lower triglycerides and improved glucose tolerance.

The effects were seen even though the grape-fed animals had no change in body weight.

In all, researchers say the study demonstrates that a grape-enriched diet can have broad effects on the development of heart disease and metabolic syndrome and the risk factors that go along with it.

"The possible reasoning behind the lessening of metabolic syndrome is that the phytochemicals were active in protecting the heart cells from the damaging effects of metabolic syndrome. In the rats, inflammation of the heart and heart function was maintained far better," says Steven Bolling, M.D., heart surgeon at the U-M Cardiovascular Center and head of the U-M Cardioprotection Research Laboratory.

The researchers also looked for signs of inflammation, oxidative damage and other molecular indicators of cardiac stress. Again, the rats who consumed the grape powder had lower levels of these markers than rats who did not receive grapes.

There is no well-accepted way to diagnose metabolic syndrome which is really a cluster of characteristics: excess belly fat (for men, a waist measuring 40 inches or more and for women, a waist measuring 35 inches or more); high triglycerides which can lead to plague build-up in the artery walls; high blood pressure; reduced glucose tolerance; and elevated c-reactive protein, a marker for inflammation in the body.

Those with metabolic syndrome are at higher risk for cardiovascular disease and type 2 diabetes.

But the U-M study suggests that it may be possible that grape consumption can change the downhill sequence that leads to heart disease by prolonging the time between when symptoms begin to occur and a time of diagnosis.

"Reducing these risk factors may delay the onset of diabetes or heart disease, or lessen the severity of the diseases," says E. Mitchell Seymour, Ph.D., lead researcher and manager of the U-M Cardioprotection Research Laboratory. "Ultimately it may lessen the health burden of these increasingly common conditions."

Rats were fed the same weight of food each day, with powered grapes making up 3 percent of the diet. Although the current study was supported in part by the California Table Grape Commission, which also supplied the grape powder, the researchers note that the commission played no role in the study's design, conduct, analysis or preparation of the presentation.

Research on grapes and other fruits containing high levels of antioxidant phytochemicals continues to show promise. U-M will further its research this summer when it begins a clinical trial to test the impact of grape product consumption on heart risk factors.

"Although there's not a particular direct correlation between this study and what humans should do, it's very interesting to postulate that a diet higher in phytochemical-rich fruits, such as grapes, may benefit humans," Bolling says.

Bolling says that people who want to lower their blood pressure, reduce their risk of diabetes or help with weakened hearts retain as much pumping power as possible should follow some tried-and-true advice to eat a healthy diet low in saturated fat, trans fat and cholesterol, achieve a desirable weight and increase physical activity.

Colon cancer test could save thousands in Britain. By MARIA CHENG

2010-04-28T11:01:00.000-07:00

LONDON -- A five-minute colon cancer test could reduce the number of deaths from the disease by about 40 percent, a new study says.

British researchers followed more than 170,000 people for about 11 years. Of those, more than 40,000 had a "flexi-scope" test, an exam that removes polyps, small growths that could become cancerous.

The test involves having a pen-sized tube inserted into the colon so doctors can identify and remove small polyps. Researchers used the test on people in their 50s. In the U.K., government-funded colon cancer screening doesn't start until age 60.

Researchers compared those results to more than 113,000 people who were not screened. They found the flexi-scope test reduced peoples' chances of getting colon cancer by one third. It also cut their chances of dying by 43 percent. Researchers said the test needed to be done just once in a person's lifetime.

The results were published online Wednesday in the medical journal, Lancet. It was paid for by Britain's Medical Research Council, National Health Service Research & Development, Cancer Research UK and KeyMed.

Experts said the findings could make some authorities reconsider how they look for colon cancer. Worldwide, the disease causes 1 million cases and 600,000 deaths every year.

In Britain, people aged 60 to 74 are tested every other year with a fecal blood test. In the U.S., colonoscopies - 20-minute scans of the entire colon that require sedation - are common, even though no trials have proved they work for cancer screening. Use of the flexi-scope test has plummeted in the U.S. because colonoscopies are perceived as being better.

To find polyps or to detect cancer early, the American Cancer Society recommends several options for people over 50: a flexi-scope test, double-contrast barium enema or virtual colonoscopy every five years or a colonoscopy every 10 years.

"It's not for me to tell governments what to do," said Dr. Wendy Atkin, a professor of surgery and cancer at Imperial College London, who led the research. "But this is a very big effect, with a very quick and a very cheap test."

Atkin said the test only needed to be done once because polyps that grow in the bowel appear before age 60 - so any potentially cancerous growths should be caught if the test is done on people in their fifties. But the test only works on the lower bowel, so other exams, like the fecal blood test, would still be necessary.

Dr. David Ransohoff of the departments of medicine and epidemiology, University of North Carolina at Chapel Hill, North Carolina, said the Lancet findings might make doctors rethink whether the less-invasive flexi-scope test to scan the lower bowel, plus a highly sensitive fecal blood test to scan the upper bowel, could be better than a colonoscopy. Ransohoff was not linked to the study and wrote an accompanying commentary in the Lancet.

Ransohoff said the finding the test only needed to be done once in a person's lifetime was "striking" and further follow-up was necessary to see just how long this protective effect lasts.

Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, said the study results would not change their colon cancer screening guidelines.

"We have long included (flexi-scope) tests as one of our preferred tests to prevent disease," he said. "I would hope clinicians look at this information and recognize there is some value in this test."

Wrinkle wary 20-somethings turn to Botox

2010-04-28T09:06:00.001-07:00

BOTOX, the popular wrinkle-fixer for over-40s, is the new must-do for Queenslanders as young as 20.

Derived from botulism toxin, Botox is injected under the skin and paralyses facial muscles, smoothing lines and wrinkles.

Gold Coast personal assistant Terri-Anne Chapman, 21, said she wanted to stop lines before they appeared.

"I'm 21 so I don't have wrinkles – I treat it as a preventative so when I do get older I don't have really bad lines," she said.

The Varsity Lakes resident first had Botox between her eyes when she was 20 and has had it three times since.

"I had a slight frown-line in between my eyes, which most people couldn't see unless I pointed it out, but it bothered me," she said.

She said the treatments lasted just under six months.

"Botox is very common on the Gold Coast – a lot of my girlfriends have it done regularly," she said.

"Taking care of yourself and helping prevent any early ageing signs is important to a lot of people."

The average cost of Botox per area is about $300 and people usually have one or two areas treated at a time.

Cosmetic king Napoleon Perdis this week urged more women to look after themselves from a younger age – and that included using Botox.

He said injectables and cosmetic enhancements were "going to become a part of life".

"I think people should avoid complete surgery because you kind of let everything droop and you pick it all up and it looks unnatural," he said.

"But if you start maintaining it from a little bit younger, you're not going to have these (problems)."

Cosmetic doctor Mario Soteriou, of Cosmetic Image Clinics in Brisbane, said Botox was increasingly common for women in their 20s.

"When Botox was first released, it was about getting rid of a line . . . now it's more about preventing," he said.

"Lines occur over time because of muscle movement, but by relaxing those muscles you remove the potential for those lines."

Dr Soteriou said he had three women this week say "my mother has a line here and I don't want it".

"After treatment they become more positive – they benefit both emotionally and physically," he said.

But dermatologist and owner of The Skin Centre on the Gold Coast, Michael Freeman, said young women did not need Botox because their skin was elastic.

He said Botox was not unhealthy, but warned if women paralysed muscles in one area, more lines could appear in another.

Dr Freeman said the most popular spot for Botox was above the nose, but most people could train themselves out of using those muscles and therefore it would not be necessary.

Study suggests link between R-rated movies and underage drinking By Emma Rose Johnson

2010-04-28T09:04:00.001-07:00

Children who watch R-rated films are more likely to start drinking alcohol at an early age, according to researchers at Dartmouth Medical School in Hanover, N.H.

Researchers at the Department of Pediatrics and Norris Cotton Cancer Center at Dartmouth Medical School questioned almost 3,600 middle-school students in 15 New England schools, and followed up with them 13 to 26 months later. During that time, only 3 percent of children who said their parents never allowed them to watch R-rated films also said they had started drinking alcohol. Comparatively, 13 percent of those who had responded that their parents sometimes allowed them to watch R-rated films said they had started drinking, as well as 25 percent of those who said their parents always let them watch R-rated films.

“The research to date suggests that keeping kids from R-rated movies can help keep them from drinking, smoking and doing a lot of other things that parents don’t want them to do,” Dr. James D. Sargent, a pediatrics professor at Dartmouth Medical and an author of the study, told Bloomberg Businessweek.

The findings were published in the May issue of the Journal of Studies on Alcohol and Drugs. The article’s introduction stated prior research has linked various forms of entertainment, including R-rated, or “restricted”, films to personality and behavioral changes in youth, including aggression, sexual behavior and tobacco use.

“We think seeing the adult content actually changes their personality.” Sargent said. The study’s introduction also discusses the consequences of those personality changes: those who start using alcohol earlier are five times more likely to develop adult alcoholism, with a subsequent increase in alcohol-related injury and death.

Sargent told Bloomberg depictions of alcohol consumption occur in about 90 percent of R-rated films, which might be one reason adolescents who watch R-rated films are more drawn to drinking. The Motion Picture Association of America ratings board issues film ratings for all films distributed in the US, bans children under the age of 17 watching an R-rated film in theaters without supervision. But in the end it is parental judgment that dictates what a child will or will not be able to watch.

“We think this is a very important aspect of parenting, and one that is often overlooked,” Sargent said.
Emma Johnson is a Blast Magazine critic whose work has appeared in The Boston Globe

Prostate cancer runs in families

2010-04-27T07:10:00.000-07:00

HEIDELBERG, Germany, April 26 (UPI) -- A man who has direct relatives -- father and brothers -- with prostate cancer has a higher risk of getting prostate cancer too, researchers in Germany said.

Kari Hemminki of the German Cancer Research Center and colleagues analyzed data from the Swedish National Family Cancer on 26,651 prostate cancer patients -- of which, 5,623 cases had family history of lung cancer.

The study, published in the journal European Urology, found men age 65 and older with three brothers with prostate cancer have a risk that is 23 times higher than that of the control group -- men without affected family members.

Men ages 65- to 74 years, whose father had prostate cancer but no brothers, had a risk increased by 1.8 times, the study said.

"Our results provide a good guidance for doctors. If a man has several affected relatives who may even have been diagnosed at a young age, then his personal risk is substantially increased," Hemminki said in a statement.

"In this case, a family doctor should urgently recommend having an early detection examination."

SEX ASSAULT CASE: THE PEOPLE v. GILBERT JUAREZ

2010-04-27T07:06:00.000-07:00

THE PEOPLE, Plaintiff and Respondent,
v.
GILBERT JUAREZ, Defendant and Appellant.
In re GILBERT JUAREZ, on Habeas Corpus.

Nos. B211487, B214808

Court of Appeals of California, Second District, Division One.

Filed April 26, 2010.

Kenneth H. Lewis and Stephen G. Rodriguez for Defendant, Appellant and Petitioner.

Edmund G. Brown, Jr., Attorney General, Dane R. Gillette, Chief Assistant Attorney General, Pamela C. Hamanaka, Senior Assistant Attorney General, James William Bilderback II, Supervising Deputy Attorney General, and Roberta L. Davis, Deputy Attorney General, for Plaintiff and Respondent.
NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

JOHNSON, J.

A jury convicted Gilbert Juarez of committing a lewd act upon a child under 14 years of age, with enhancements for infliction of great bodily injury, substantial sexual conduct with the victim, and personal infliction of great bodily injury on the victim. Juarez argues that the trial court (1) erred in admitting some evidence and excluding other evidence, (2) should have excluded the victim's parents from the courtroom, and (3) made errors in its instructions to the jury. He also argues that the verdict was not supported by substantial evidence. In both Juarez's appeal and his consolidated petition for writ of habeas corpus, Juarez argues that his trial counsel provided ineffective assistance. We affirm the judgment and deny the petition for habeas corpus.
FACTS AND PROCEDURAL BACKGROUND

An information filed May 16, 2007 charged Juarez with one count of committing a lewd act upon a child under the age of 14 years, in violation of Penal Code section 288, subdivision (a).[ 1 ] The information also alleged enhancements: that Juarez inflicted great bodily injury on the victim, under section 12022.8; that he personally inflicted the great bodily injury, under section 12022.7, subdivision (a); that he engaged in substantial sexual conduct with the victim, under section 1203.066, subdivision (a)(8); and that under section 667.61, subdivisions (a), (b), and (e), he personally inflicted great bodily injury on the victim in the commission of the offense, in violation of sections 12022.53, 12022.7, or 12022.8.

Juarez pleaded not guilty and denied the special allegations. After trial, a jury convicted Juarez on January 18, 2008 and found all the special allegations to be true. The court sentenced Juarez to 15 years to life on the substantive count, under section 667.61, subdivision (b). Juarez timely appealed and filed a related habeas corpus petition, which we consider concurrently with his appeal.
I. Prosecution evidence
A. Dawn M.

The prosecution's first witness was Dawn M., the mother of victim Erin M.[ 2 ] Erin M. was born in August 1997, and was 10 years old at the time of trial. Juarez was a good friend of Dawn M. and her husband. Erin M. was in special education classes in school for speech and language, and had some issues with her fine motor skills, for which she received therapy. When Erin M. was younger, she had problems with her short-term memory, but "we just don't have that problem with her anymore."

Dawn M.'s family met Juarez's family through mutual friends, Richard and Katherine Fidermutz. Dawn M. and her husband John M. had asked Juarez to be godfather to Erin M.'s older sister, Krysta M., who was 14 at the time of trial. Juarez had two children, Megan and E.J.; Krysta M. was best friends with Megan. Erin M. and Krysta M. often spent the night with Megan and E.J., and the last time Erin M. slept over was in April 2006. Krysta M. did not go, and Erin M. stayed at Juarez's house from April 10, 2006 to April 15, 2006, her spring break from school.

The Saturday after Erin M. came home from the visit, she complained to Dawn M. that "she was hurting down below." Dawn M. told her to take a warm bath, and when Erin M. came back in she was crying. Dawn M. put a towel down on Erin M.'s bed, had her lie on it, and could see that "she was covered in blisters" on her vaginal area and her thighs. Dawn M. asked her "if anybody had touched her there, and she just said, Gil licked me there. And I said, what? And then she told me again—I must have asked her probably 10 times, and finally she took her tongue and she stuck her tongue out and started acting out what he did to her." The only "Gil" that Dawn M. or Erin M. knew was Juarez.

Dawn M., who was hysterical, called Katherine Fidermutz, who was away in Big Bear. It was evening, and Dawn M. decided to wait until the next day to go to the doctor so that Katherine could come with her, but when Katherine was not back the next morning, Dawn M. took Erin M. to Kaiser Urgent Care. A doctor took a culture of Erin M.'s blisters, and told Dawn M. to wait for the results. On April 26, however, Dawn M. took Erin M. to a pediatrician, because the blisters were severe and were not clearing up.

The pediatrician, Dr. Carol Welles, pulled the culture results, and asked Dawn M. if anyone in her family had cold sores. Dawn M. said no. In Dawn M.'s presence, Dr. Welles asked Erin M. if anybody had done anything to her, and Erin M. said "Gil licked her down there." Dr. Welles told Dawn M. that Erin M. had herpes simplex 1, the common cold sore. No one in Dawn M.'s family had cold sores, she did not know anyone who did, and Erin M. had never had a cold sore. Dr. Welles called the police, and a sexual assault response nurse questioned Erin M. in Dawn M.'s presence. Erin M. showed the nurse what had happened using a stuffed animal, and also identified where she had been licked on a drawing of a girl.

Since then, Erin had not had cold sores on her genital area, although she had had some on her mouth. Dr. Welles had put her on an oral medication. None of the outbreaks were as severe as the first.

Dawn M. was very angry and hurt, because she had trusted Juarez so much and because Erin M. had to live with it. Dawn M.'s mother, Erin M.'s grandmother, had died the previous January. Around the time that Erin M. had spent the night at Juarez's home she had been having nightmares, climbing into bed with her parents, and refusing to go over to the Juarez home. At the time, Dawn M. thought Erin M.'s behavior was related to the death of Erin M.'s grandmother. She encouraged Erin M. to go over because Juarez would buy tickets to Disneyland and it was expensive. Before Erin M. told her about the abuse, Dawn M. considered Juarez her very good friend.

On cross-examination, Dawn M. testified that Krysta M. enjoyed going over to the Juarez's home and had never complained about inappropriate touching. Dawn M. had never been tested for herpes and no one in her family had had cold sores. Erin M. had had "itchy tongue" which was treated with mouthwash. The doctors believed it was a food allergy. Defense counsel read into the record Dawn M.'s preliminary hearing testimony that around the time of Erin M.'s grandmother's death, Erin M. "would put her hands down her pants and she was trying to itch or scratch or something," although Dawn M. also testified that Erin M. never scratched her vaginal area. Dawn M. had waited until the next day to take Erin M. to the hospital because she needed support. She denied that she took Erin M. and Krysta M. over to the Fidermutz home that night and left them there to spend the night.

On redirect, Dawn M. testified that the Department of Children and Family Services (DCFS) had been called to her home when Erin M. was born in August 2000, and that after interviewing Krysta, the Department determined there was no merit to an allegation that Dawn M. had slapped Krysta M. in the mouth. There was no further contact with child services. Dawn M. had not called the police immediately because she first wanted to find out the medical cause of the blisters, and she did not want to make an unfounded allegation. The "itchy tongue" Erin M. had complained about had gone away when Erin M. had stopped eating citrus. Erin M. was taking some oral medication for the herpes which decreased the severity of outbreaks.
B. Erin M.

Erin M., the victim, was the next witness. She testified that the defendant's name was "Gil," and that she couldn't think of anyone else named Gil. She used to play with Juarez's daughter E.J., spent time at Juarez's home, and would go places with the family. Erin M. remembered spending the night at Juarez's house in April last year, but she had not been there since because "he went to my bed and licked my bottom," pointing to her vaginal area. She had had on a shirt, but no pants or underwear.

When Erin M. slept at Juarez's house, she would sleep in E.J.'s bed, and E.J. would sleep with Juarez and his wife. Megan would be in the room with Erin M., and she was there the night that Juarez licked Erin M., although Megan was asleep. Erin M. slept at the Juarez house with her underwear off, although at home she kept it on. Erin M. said she first told her mother, then the doctor, and then the police, about what had happened. She had also talked to a nurse at Northridge. Erin M. knew the difference between the truth and lies. She was sure that Juarez had licked her. No one else had ever done that to her.

On cross-examination, Erin M. stated that she had trouble remembering things. At the Juarez house, she would sleep in a trundle bed next to Megan, and Megan was sleeping there that night. The house was small. Music was playing on a radio in the room that night. She did not remember whether she had had rashes on her body before. Erin M. thought she stayed with her mother the night her sores were discovered, although she wasn't sure. Defense counsel read into the record Erin M.'s statement at the preliminary hearing that the door to the room was open. When asked, "This happened to you, this licking?" Erin M. answered "Yes." The lights were off, and the door was open. She did not remember any other times this had happened, although she thought she told the police that it had happened more than once.

On redirect examination, Erin M. testified that she had trouble remembering things that happened long ago, and might think something happened but not remember everything about it. She remembered being in the bath, that it hurt, that she got out of the bath to tell her mom something was wrong, and that she told her mom that Gil licked her. Megan was in her own bed, which was right next to the bed occupied by Erin M. Erin M. remembered that she was mad when Juarez did it, that it hurt, and that it happened more than one time, "a lot of times."
C. Mary Ann Lague

The next prosecution witness was Mary Ann Lague, a sexual assault nurse examiner at Northridge. She saw Erin M. on May 25, 2006. After talking to the parents and the police, she interviewed Erin M. alone, but a television monitor in the room allowed the police to observe the interview. While Lague was talking to Erin M., she took some notes and checked boxes on a form, writing a narrative right after the exam.

When she asked Erin M. why she was there, Erin M. replied "I came because a man licked my private." Erin M. said the man was Gil. Erin M. told Lague that she had been in bed, wearing a t-shirt and no underwear (which is not what she usually did at home), when Gil came in, pushed her legs apart, and "licked her private." Erin M. had said Megan was asleep in the room, that it had happened many times, and that she had not wanted to go that time because she knew it would happen again. Erin M. circled the genital area of a drawing of a gingerbread woman, and said "Gil had licked her there, her mom had put medicine there, and the doctor had taken a test there." Erin M. demonstrated on a teddy bear. Lague then did a physical examination, during which Erin M. pointed to her clitoris as where she had been licked. Lague testified that there was redness on Erin M.'s labia but no lesions or sores. There was no DNA test that could tell you who had infected a child with herpes. A child who was sexually molested might show sexualized behavior, have nightmares, or become emotional or withdrawn. An eight-year-old would not know that anyone would lick the vagina or the clitoris.

On cross-examination, Lague testified that she interviewed Erin M. without Dawn M. in the room, with only a child advocate present. Lague had also interviewed Juarez's daughter E.J., who was five at the time, and stated that it was a "red flag" that while E.J. denied having been touched by her father, she also said that she would not be able to talk about that if anyone had touched her. On redirect, Lague stated that E.J. told her that when Erin M. came to her house, Juarez "helped them in the shower and he washed them all over and also in their private parts and it felt really nice," indicating her labia and clitoris during a physical exam performed by another examiner. E.J. also stated that she did not wear underwear to bed.
D. Carol Welles, M.D.

Carol Welles, M.D., testified that she was a pediatrician at Woodland Hills Kaiser Permanente. On April 26, 2006, Dr. Welles saw Erin M., who came in because of irritation in the vaginal area, which was burning and hurting. Cultures had been taken in urgent care a few nights earlier, and Erin M. and her mother wanted to get the results. Erin M. was well-groomed. Dr. Welles performed a physical exam of Erin M.'s vaginal area and found multiple very small "vesicles or . . . little blisters" in clusters, which made Dr. Welles suspect herpes. Dr. Welles looked up Erin M.'s test results on the computer and found that it was herpes simplex virus type 1.

Dr. Welles had not seen Erin M. before, and asked her whether she had been "bothered in that area, and she disclosed that she had been, and I remember that quite vividly." Erin M. told her "her godfather had touched her in that area." Dr. Welles put out her hand to stop Dawn M. from showing how upset she was, and asked Erin M. to "tell me about it." Erin M. told Dr. Welles that her godfather, Juarez, "would put his mouth against her vagina or vaginal area." Erin M. did not use those words but showed Dr. Welles her vaginal area. Dr. Welles asked where this happened, and Erin M. continued that it happened at Juarez's house when she was babysat, and said "at nighttime, that he would come into her room and that he would remove her underwear and that he put his mouth against her vaginal area." They both had clothes on, and nothing was placed inside her body. Dr. Welles thought "it was very clear from this eight-year-old girl's voice that this was—this was a history that I couldn't ignore, and it was very impressive coming from that age a person, who I would not have assumed to have had the experience to have seen such an act."

Dr. Welles testified that as a pediatrician she treated infections and lesions, including herpes. There were two kinds of herpes, herpes simplex virus 1 ("type 1") which was found in the mouth, to "which most of us have been exposed in our lifetime and most of us would test positive perhaps." Herpes "type 2" is traditionally found in the genital area, although it can be found in the oral area as well. The virus could be easily spread by touch or secretions. The virus could be shed even in the absence of active lesions. Skin-to-skin contact could transmit the virus, for example if the mouth of a person with a cold sore touched another person's mouth, and the virus could be transmitted to chapped or irritated skin. A person could also touch his or her own cold sore and give themselves herpes on another part of their body. A young person touching him or herself "a lot" could self-inoculate, although another person with an oral sore could also inoculate that person, and Dr. Welles did not know which was more common. For self-inoculation, even without a current active lesion, someone would have had to have had a cold sore in the past. The first outbreak of type 1 herpes was usually very uncomfortable, "not dissimilar to what I saw with Erin." Dr. Welles thought that the sores she saw on Erin M. were similar to a first-time outbreak. If someone self-inoculated type 1 to another part of their body, such as the genitals, that would not be a first outbreak. Dr. Welles stated it was "clear to me that that was Erin's first outbreak, and her mother also denied that she had had anything like this before."

The incubation period from exposure to outbreak was somewhere between 2 and 20 days. The outbreak that Dr. Welles saw on Erin M. was consistent with exposure between April 10 and April 15, 2006. The virus lives in the nerve root, never leaves the person's body, and can become reactivated during certain times. Once infected, a person can spread the virus to others, including to a baby delivered vaginally.

Dr. Welles had reviewed all of Erin M.'s medical records, and saw that a few years earlier in 2004 Erin M. had a white lesion on her tongue, which was cultured and tested negative for herpes simplex. Dr. Welles believed that what she saw was Erin M.'s first outbreak.

On cross-examination, Dr. Welles stated she did not have specific expertise in herpes. She did not know that a person could have type 1 herpes all his or her life and not have an outbreak. She did not have a lot of experience seeing herpes in the genital area of children. She had relied in part on Dawn M.'s statement that Erin M. had not had a previous outbreak. She had tried to stop Dawn M. from sobbing while Erin M. was discussing what had happened. Dr. Welles believed it was "fair to say that the majority of Americans have herpes 1 . . . and they have that for their entire lives." The virus could be transmitted by kissing, mouthing and touching. Type 1 could also be transmitted by touching your mouth and then touching something else, or "self-inoculation," which would be much more possible if there were an active lesion, although that was not absolutely necessary. She agreed that if someone touched their mouth and touched their genitals, and if they were not clean, "they can get herpes down there."

Dr. Welles testified that herpes type 1 and herpes type 2 looked the same and could be distinguished in the laboratory. She agreed that DNA testing could identify the strain of the virus, and that if the strain were the same between two persons, it would be a powerful indication of who the donor was. She did not know whether it would be possible to determine from where the virus came.

On redirect, Dr. Welles testified that the DNA test would show the DNA of the virus, not the donor. No test could show who had given the virus to Erin M. A test could analyze the DNA of the particular strain of the virus, which would narrow it down, but would not show the transmitter of the virus. The DNA strand could be isolated during the first outbreak. Erin M. had subsequent cold sores, and Dr. Welles treated her with the same medication she used for the genital lesions. It was not common to see herpes of any type on the genitals of an eight-year-old child. Dr. Welles generally did not see self-inoculation.

On recross, Dr. Welles stated that poor hygiene could increase the possibility of self-inoculation. She had not discussed with Erin M. or her mother any learning disabilities. She had never seen a cold sore heal in one day.
E. Krysta M.

Krysta M., Erin M.'s older sister, testified that Juarez was her godfather, and that she frequently spent the night over at Juarez's home. The Juarezes told Krysta M. and Erin M. that they could not wear underwear with their pajamas. Erin M. wore a big shirt to bed with no underwear underneath. Krysta M. had never seen a cold sore on Erin M.'s mouth before April 2006. Erin M. did not have a problem with hygiene. Krysta M. had seen the outbreak on Erin M. the day it was discovered and said it looked like a bad case of chickenpox all over the genital area; her mom was upset and crying. She remembered talking that night about what Erin M. said, "that Gil had licked her in the genital area." Krysta M. did not think anyone had tried to implant that idea in Erin M. Juarez had been a close family friend, Krysta M. never heard anyone "bad-mouthing" him, and Erin M. was not a liar.

On cross-examination, she stated that Juarez had never touched her inappropriately. She was close friends with Juarez's daughter Megan. Krysta M. confirmed that she had told the police that Juarez never came into the bathroom while she was bathing. She would give her underwear to the Juarezes at night, they would wash it and other items of her clothing, and give it back to her in the morning. Krysta M. slept in the second trundle bed; the house was very small, and a door from the bedroom leading into the living room was kept open. The Juarezes bedroom was just across the hall. Krysta M. had her first menstrual cycle while at the Juarezes, and Juarez had explained to her what it was with Megan present, using educational videos. The M.'s had boarders in their home. Erin M. had some speech and memory problems when she was younger, but her memory now was good. Krysta M. saw cold sores on Erin M. after the first outbreak, but had never seen Erin M. have hygiene problems. Dawn M. was very upset when Erin M.'s sores were discovered. Krysta M. was sure she and Erin M. had not spent the night at the Fidermutz house that night. Her grandmother had died a few months before and this was an emotional period for the family. Krysta M. had never been tested for herpes, and had never seen a cold sore on her family or on the boarders.

On redirect, Krysta M. stated that she slept in the same bedroom with Megan, who was a pretty heavy sleeper. They could put toilet paper over Megan and she wouldn't wake up. She had never seen cold sores on Erin M. before the genital outbreak. Erin M. did not scratch herself in the genital area. Before Krysta M. got her first menstrual period, she and Dawn M. had gone to a mother-daughter event at the elementary school explaining it. Krysta M. brought extra underwear when she stayed over at the Juarez's house, and was not sure why there was a rule not to wear underwear. The Juarez girls also did not wear underwear.
F. Stipulations

The parties stipulated that Juarez had herpes simplex type 1 and type 2, and that he had both viruses at the time the offenses allegedly occurred. Further, the parties stipulated that Erin M. had herpes simplex type 1 on her genital area.
II. Defense case
A. Katie Fidermutz

Katie Fidermutz (Katie), who was fifteen, testified that Juarez was her "uncle" by friendship, and that she had also been close friends with the M.'s. Krysta M. was her best friend. On April 22, 2006, Dawn M. brought Krysta M. and Erin M. over to the house; Katie and her brothers were there; her parents were out of town. Dawn M. was crying and hysterical but not crazy, stating over and over "I can't believe he would touch my daughter like that. We trusted him." Katie was shocked. After a half hour, Dawn M. left and Erin M. and Krysta M. spent the night. After Dawn M. left, Erin M. walked around and repeated "I can't believe he would touch me." Dawn M. picked up Erin M. the next day. Katie testified that Erin M. rarely took showers and would always touch her private areas, saying that it hurt and itched, and that she never brushed her teeth. Erin M. also had a bad memory.

On cross-examination, Katie testified that her parents did not allow her to talk to the police and that she had not told an investigator that the M.'s had come to her house that night. She had talked to the Juarez family about testifying between one and five times. Katie had not stayed over at the Juarez house for about a year in April 2006. She repeated that Erin M. continually touched herself, in private and in public, so that anyone would notice.

On redirect, Katie testified that Juarez was never inappropriate and she had told her parents that. She stated that defense counsel had emphasized to her the importance of telling the truth.
B. Katherine Fidermutz

Katherine Fidermutz (Katherine), Katie's mother, testified that she was close to Juarez and had been close to Dawn M. She often babysat Erin M. She and her husband were in Big Bear when Dawn M. called on Saturday, April 22, 2006. Dawn M. was hysterical, saying, "Erin had said Gil licked her privates." Dawn M. was a very emotional person, and had taken the death of her mother very hard. Katherine was shocked, and told Dawn M. to take Erin M. to the doctor. Dawn M. wanted Katherine to go with her, and said she would wait for Katherine to return. Dawn M. called back and asked if she could drop off the girls at Katherine's house. Katherine said okay, then called Katie and asked her if Juarez ever did anything inappropriate. Katie said no. Katherine never told Dawn M. to wait until she returned to take Erin M. to the doctor. She returned late that Sunday night.

Katherine stated that Erin M. was "very slow," and had poor short-term memory. Erin M. was dependent on Dawn's approval. Her hygiene was not good, and she would "scratch her private a lot because her panties were dirty." Erin M. would cup her mouth when she was nervous. In September 2005, Katherine took Erin M. to a Dr. Nichols for sores in her mouth. She believed Juarez was an honest man. He was a "germophobe. . . . All the time in his pockets, he has the sanitizer things. My kids complain he makes you wash your hands all the time."

On cross-examination, Katherine testified she did not babysit Erin M. as much after August of 2005. When shown records from when she took Erin M. to the doctor for her tongue, she did not remember that Erin M. was tested and it came back negative. She stated that Erin M. had had cold sores before the visit, something she did not mention before. She though Dawn M. might have misunderstood what Erin M. said. On Sunday, when she returned from Big Bear, she and her husband went over to the Juarezes' and her husband told them what Dawn M. had said. She was there to protect Colleen Juarez, her best friend. Katherine also stated that Erin M. would have been reluctant to accuse Juarez.

On redirect, Katherine said her children also had cold sores in the past. She went to Colleen Juarez to give her emotional support. She had not wanted to testify, and had been subpoenaed by the defense.

On recross, Katherine said she was friends with Dawn M. "on a different level." Her husband had reported Dawn M. to DCFS when Erin M. was being born. On redirect, Katherine stated that Krysta M. had given her information, and she had contacted Erin M.'s aunt Pat.
C. Steven (Steven) and Jeff Fidermutz (Jeff)

Steven, who was 24, stated that he had been called down to testify from Oregon. Juarez was a family friend. Dawn M. came over on April 22, 2006, and dropped off Erin M. and Krysta M. He was there with his two brothers, two of their friends, and his sister Katie. Dawn M. was crying and said that Juarez had touched Erin M. Erin M., after her mother left, repeated "I can't believe Gil would touch me." The two girls spent the night. Dawn M. picked Erin M. up the next day to take her to the hospital. He thought it was "weird" that someone would drop off their child in that situation, especially in a house with four boys. He had not spoken to anyone from the defense before testifying. He had talked to Colleen Juarez and told her what he remembered while sitting outside the courtroom that morning. Juarez was a very close friend, the best friend of Steven's father. He had talked to his mother and father about his testimony. On redirect, Steven stated that defense counsel had told him to tell the truth.

Jeff, who was 19, testified that Juarez was his godfather. He also remembered Dawn M. coming over that late evening, hysterical and saying "Gil had touched little Erin." Erin M. and Krysta M. had spent the night. He had recently discussed the events of that day with his family, and with Colleen Juarez. He had never seen Erin M. with a cold sore, or with a hand down her pants. He had watched Dawn M.'s testimony before he was called as a witness. Jeff had talked to his sister Katie about the testimony. He wanted Juarez to be acquitted, and after watching testimony, he decided that he had information about which he wanted to testify. He had not known that Dawn M. would say that she did not bring the children over to his house.
D. Beverly Staples

Staples testified that Juarez was a friend of her son and his wife, and that Erin M.'s father John M. was her best friend's brother. In April and May 2006, Staples worked as an assistant in special education. She tutored Erin M. twice a week in April and May. She did not observe any hygiene problems or scratching at the mouth. When Erin M. was five or six, however, Staples observed her touching her private area and then putting her hand up to her face. Although she helped Erin M. with her reading, Erin M. would memorize the words for the next time: "She had a pretty good memory, that one." Staples also thought she had some short-term memory problems. Once Erin M. started crying hysterically when Staples said no to her. In April and May, Staples never saw Erin M. with any cold sores or inflammation in her mouth.

On cross-examination, Staples stated that her son's best friend was Richard Fidermutz. In April and May 2006 she observed Erin M. to be a very sweet girl who seemed to be honest. Staples never noticed anything inappropriate or unusual about Erin M.'s hygiene, nor did she ever notice a cold sore. Staples had some training in communicable diseases of children under 10, and she would have noted and reported a cold sore or any lesion. When she had seen Erin M. putting her hands on her private area, it was over her clothing. Erin M. could be emotional and antsy.

On redirect, Staples testified that she was amazed how upset Erin M. became on the day she cried when Staples said no.
E. Colleen Juarez (Colleen)

Juarez's wife Colleen testified after the defense introduced into evidence a layout and seventeen photographs of the Juarez home. Colleen Juarez testified that they had been married for 17 years, and that she worked for Los Angeles City Attorney's office as a legal secretary. Colleen had known the M.'s for ten or eleven years, and Juarez was Krysta M.'s godfather. She had had cold sores on her lip, as recently as about two months ago. She had never had genital herpes and her prior outbreak was four or five years ago. The only time she had seen Juarez with a cold sore was in January 2001, when he started working at Disneyland and had a photograph taken for his identification card. She had not had cold sores outside of the two times she mentioned. Her children had never had cold sores. Colleen had tested positive for herpes type 1 and negative for herpes type 2.

When both Krysta M. and Erin M. came to spend the night, Krysta M. would sleep on the trundle bed in the bedroom with Megan and Erin M. would sleep in the living room on the couch. Colleen was shown the layout and the photographs of the house. The house and the girls' bedroom, where Megan had the daybed with the trundle bed and E.J. had her own bed, were very crowded. The master bedroom opened into the living room.

After the incident in April 2006, Colleen's daughters tested negative for herpes type 1 and type 2, and had a gynecological exam which showed nothing unusual. The house was about 600 square feet, crowded and cozy. During sexual activity, she and Juarez would close the door to the master bedroom. The children's bedroom door did not close. Colleen was a light sleeper who heard everything. She would not get up if she heard Megan walking around or Juarez coming home late from work, she would go back to sleep.

Juarez was "kind of obsessive" about germs. He continually asked the children if they had washed their hands, and carried antibacterial liquid, spray, and wipes. The family regarded it as a joke.

Colleen testified that Dawn M. was very emotional while her mother was dying. Erin M. couldn't read, and would memorize everything, would not brush her teeth, and had a problem dressing herself. The kids at school teased her because of her speech problem, and she had some short-term memory loss. She did not properly clean herself after going to the bathroom and did not wash her hands. Erin M. would put her hands in her mouth because her tongue itched, and then put her hands into her pants and scratch herself, saying that it itched. There was no set policy that the girls could not wear underwear when they slept over, and they would show up with dirty clothing which the Juarezes would wash.

The trundle bed was old and noisy. Colleen's work schedule was 8:30 a.m. to 5:30 p.m., and Juarez worked from 2:00 p.m. or 4 p.m. until 12:00 p.m. or 2:00 a.m. During April 10 to 15, 2006, when Erin M. stayed at the Juarez home, Juarez was off work on some of the days, staying home with the girls, and taking them to Disneyland with him on one day. If Juarez was home at the girls' bedtime, he would read them a story, talk with them, and turn out the lights. Colleen Juarez could hear him reading the story and hear the kids laughing. He would sit on Megan's or E.J.'s bed. Colleen Juarez had said in a police report that Juarez would lie down with the girls every night, but that was wrong. He would sit on the edge of the bed.

Katherine Fidermutz had called Colleen the night Katherine came home from Big Bear, and she and her husband came over and told Colleen the allegations. Colleen was devastated. Colleen called Juarez and told him that "they're saying that you were inappropriate with Erin," and when Juarez started to cry she told him to come home early so they could talk.

Colleen had seen white sores and blisters inside Erin M.'s mouth two or three times. Erin M. had a sore on her mouth that week. Colleen had commented on it and the M.'s told her it was nothing to worry about; she had not been told there was a food allergy.

Colleen testified it was "easy" to hear things coming from her children's room, and the door was always open. She would hear Juarez coming home and would wait for him in bed. During the April 15-20 time period, she and Juarez had sexual intercourse and engaged in oral sex. Colleen never had an outbreak during that period. She loved her husband but would not lie to protect him. She was very angry that day.

On cross-examination, Colleen testified that she would never want to believe that the molestation allegation could be true. She was intimately familiar with the case, and had reviewed the police reports, had read the preliminary hearing transcripts and transcripts of the trial testimony. She had talked to Juarez about the case, and had discussed strategy.

When the police first contacted Colleen, she did not mention ever having seen a cold sore on Erin M., although she knew that Erin M. had been diagnosed with herpes on her genitals. Colleen knew she herself had had a cold sore, but did not know it was called herpes. She never mentioned, because she was not asked, that Erin M. had cold sores just days before the allegations, or that Erin M. had hygiene problems. When she realized that cold sores on Erin M. were relevant, she called Juarez's counsel.

Colleen also testified that she did not remember reports indicating that both of her daughters had unusual vaginal discharge at the time of their gynecological examinations. She was concerned about the testimony by the sexual assault nurse that there were some "red flags" during the examination of her daughter E.J. Colleen had asked her daughters if they had ever been touched inappropriately, with Juarez present. She believed her daughters would have told her of any inappropriate behavior even with Juarez there, and that Juarez would tell her if the allegations were true, even though she would take the children and leave.

Juarez was closer to Erin M. than was Colleen. After reading to the children he would sometimes stay in the room until Erin M. fell asleep, which could take up to 45 minutes. Erin M. referred to Juarez as "My Gil." He made sure Erin M. got into the bathtub, although he did not actually bathe her.

Colleen testified that her daughters slept with no underwear; she had been raised that way but would not tell anyone else not to wear underwear. Juarez was a germophobe but would orally copulate her; she took a shower beforehand. Their home had been featured on the TV show "Clean Sweep," which did an entire episode called "Caught in a Mouse Trap" cleaning their living room, dining room, and kitchen. Colleen testified that they were on the show for "clutter," not for "living in a pigsty." She was Krysta M.'s godmother, and Juarez was Krysta M.'s godfather. She and Juarez met the family when Krysta M. and Megan were around 2. The Juarezes helped when Erin M.'s grandmother passed away. She was not aware of any reason why Dawn M. would make something up about Juarez.

On redirect, Colleen testified that she was not angry at Erin M. but at Dawn M. Erin M. strived to please Dawn M., and Colleen held Dawn M. responsible for the prosecution of Juarez. Dawn M. was not a good mother and should have taken better care of Erin M. and should not have been so emotional around her. After she spoke with the police, Colleen's children were taken to a foster home.

On recross, Colleen testified that she had scheduled her daughters for the required examination on the morning after DCFS took the children to be examined. She admitted that she had told the girls that "Erin [M.] had made up a lie," telling them that Erin M. had gone to the doctor twice before she determined something was wrong, and that they would be interviewed by DCFS, who would ask them questions about their private parts. It did not occur to her that the girls' answers might be affected, and she thought even her five-year old (E.J.) would think for herself. She had never heard Dawn M. lie, but blamed her for the prosecution.

On further redirect, Colleen stated that it would be "insane" for Juarez to have committed the alleged molestation in their house, because of the great potential that he would be discovered. The house is small, "you can hear everything that happens," and it would mean the loss of his family if he were discovered. The light from the living room came into the girls' bedroom and the entire house.

On further cross-examination, Colleen stated that a child with a speech impediment and memory problems might be at greater risk of molestation, but "a child is going to get the message across," although not all children necessarily disclose abuse.
F. Gilbert Juarez

Juarez testified that he worked as a security officer at Disneyland, and that his first and only outbreak of herpes was when he had his picture taken in 2001. Juarez was unaware it was called herpes, thinking that the name only related to genital sores. He did not know he had herpes type 2 until he was tested. He had never had an outbreak of genital herpes. He testified that Erin M. had begged to stay at his house during the time in question, and that he had taken the girls to Disneyland one day. Nothing unusual occurred. He had never touched Erin M. or any other female in an inappropriate manner.

Juarez was very close to Erin M. and tried to help her with her speech impediment and her memory problem. She was unkempt and would often stick her hands in her mouth to scratch her tongue, and had little pustules in her mouth and on her tongue. Juarez associated these with cold sores and told Dawn M. about it. She smelled unclean.

As the "at-home dad," Juarez did the laundry and general housecleaning. The "Clean Sweep" show reorganized their home, calling the episode "Caught in a Mouse Trap" because of the Disney items in the rooms. It was in 2000 or 2002.

Juarez testified that he knew when he was tested that if he did not test voluntarily, he could be forced to test. At the time of the alleged molestation, he weighed 235 pounds and had no cold sore. Erin M. had a small pimple on her lower right lip that he thought was a cold sore. He testified that the house was so tiny you could hear a sneeze at one end from the other end. He thought the crime was "horrific . . . a terrible, terrible crime." The possibility of discovery, given the house, was very great.

At the time of Krysta M.'s baptism, the M.s accused Juarez of calling DCFS to report that Krysta had been abused by her grandfather, although Juarez had not made the call. This caused a rift between the families.

On cross-examination, Juarez testified that it was not really possible to move around the house without making any noise. He had heard all the testimony and seen all the documents in the case, and had been able to talk to the defense witnesses. He stated that nothing he said could convict him because he did not do it. His most important goal was to avoid conviction, but he was telling the truth, and would never even think of doing what the charge accused.
G. Stanley Bierman, M.D.

The defense had retained Dr. Bierman, a dermatologist who specialized in sexually transmitted diseases and had seen between 1,000 and 2,000 cases involving herpes type 1 and type 2. Herpes type 1 was blistered lesions above the waist; type 2 was below the waist, although type 1 could appear in the genital area whether by oral sex or by autoinoculation. After initial exposure to herpes type 1, a person would develop blisters in the mouth, sometimes an fever, and malaise. The virus then became latent, would reactivate after a variable period of time, and again would produce blisters on the lip. This period of latency and outbreak then would repeat. The subsequent outbreaks were less intense. In many cases, people with the virus had never had an outbreak and did not know they had herpes when they tested positive. Herpes type 2 produces blistered lesions on the genitalia.

Herpes type 1 could be transmitted to the genital area by saliva. It was possible that a person with no symptoms of herpes type 1 could nevertheless be shedding the virus into the salivary glands, so that if saliva got on the hands it could then be transferred to the genital area. Dr. Bierman had seen patients who had self-inoculated themselves with type 1 herpes in the genital area.

Dr. Bierman had reviewed Erin M.'s medical records. On September 13, 2004, a rash on Erin M.'s tongue was tentatively diagnosed as herpes (he presumed type 1). A culture was taken, and after testing, the result was negative for herpes.

It was not possible to do a DNA test on someone with herpes to determine the donor, nor was it possible to determine whether an outbreak was a first or subsequent outbreak. Given the medical records prior to September 13, 2004, Dr. Bierman testified that there was a reasonable possibility that Erin M. had herpes type 1. Autoinoculation by someone with herpes type 1 would be more likely than poor hygiene.

On cross-examination, Dr. Bierman stated that the virus "maybe" remains in the body for life. The most common form of transmission for herpes type 1 was oral sex. The virus could be transferred through the mucous membranes in the mouth or in the interior of the female genitalia. The incubation of the virus would be five to seven days before cold sores would appear. The Center for Disease Control estimated the incubation period as within two weeks. Dr. Bierman agreed that "if a person was exposed to herpes simplex 1 by having been orally copulated, say, on the 15th of April, [it would] be consistent with the incubation period that you've described for them to have cold sores on the 22nd of April."

Dr. Bierman agreed that the first (primary) outbreak of herpes generally was the most severe. After a primary outbreak of herpes type 1 on the genital area, red marks remaining three or four weeks later were consistent with a first outbreak. Someone who had had a lip cold sore was far less likely to have a genital outbreak of herpes type 1 or type 2, because of the development of antibodies. Further, an outbreak of herpes type 1 in the genital area was generally a primary outbreak. A false negative for herpes type 1 was more likely if the culture tested was taken after the blister had popped, crusted, and begun to heal. If a culture was taken by popping a blister, if there is herpes type 1, it will generally show up in the culture. Also, someone whose first episode is on their lip will generally have future outbreaks in the same location. Self-inoculation only accounted for .3 percent of all transmission of herpes, and usually occurred during the first outbreak. A child who self-inoculated from the lip to the genitalia could develop "herpetic whitlow," a blister lesion on the finger.

An outbreak of herpes on the genitalia, whether type 1 or type 2, put the person at an increased risk for HIV and encephalitis, and perhaps for cervical cancer. A woman with genital herpes could transmit it to a newborn delivered vaginally. In general, herpes was a substantial disease for a child. Dr. Bierman treated very few children. A case of genital herpes, either type 1 or type 2, was a red flag for child abuse in a child older than three. Dr. Bierman's specialty was dermatology, not infectious disease. He had not examined Erin M., and had relied on the medical records he was given by the defense.

Papules were raised red areas that could be caused by trauma, an irritation, or sensitivity to food. If the papules were caused by herpes, vesicles would later appear. Herpes papules or vesicles would cause pain, rather than itching. Dr. Bierman agreed that the only appearance of vesicles in Erin M.'s medical records was in April 2006 in the genital area. The tongue was a less likely location for a herpes type 1 blister than other areas in the mouth or lips. Asked whether "it is consistent that someone who was exposed to [type 1 herpes] via oral sex between April 10 and April 15th would then come down with the vesicles on April 22nd," Dr. Bierman responded, "It's within the time frame." Self-inoculation in a child was rare, it was rare to have a genital outbreak if an oral outbreak already had occurred, a first outbreak might leave red marks a month later, and autoinoculation generally occurs during the first outbreak.

Dr. Bierman was aware that Erin M. said "Gil licked me," and showed age-inappropriate sexual knowledge. All these facts were consistent with the April 22 outbreak being the first and primary outbreak of herpes type 1.

On redirect, Dr. Bierman testified that he had never come across a case where herpes 1 in the vaginal area was transferred to the mouth. False negatives for genital herpes occurred 50 percent of the time. Dr. Bierman maintained his opinion that there was a reasonable possibility that Erin M. had herpes prior to April 26, 2006. He did not believe she could have self-inoculated from the genital outbreak to her mouth. He thought that the records showed that Erin M. had a herpetic whitlow on her finger on April 26, 2006, which he believed showed "autoinoculation transference from mouth to finger to genital."

On further cross-examination, Dr. Bierman stated that he did not remember his earlier testimony that he would not expect to see herpetic whitlow. He admitted that he had to testify that Erin M. had self-inoculated to say there was transmission of the virus in any way other than oral sex. He admitted that out of two possible explanations, "the most reasonable explanation for this child having oral herpes on her genitals is that she was orally copulated like she said between April 10 and April 15."

On further redirect, Dr. Bierman again testified that an alternate explanation was self-inoculation by Erin M. On further cross-examination, he once more stated that the best explanation for the outbreak was that Erin M. contracted herpes type 1 on her genitals through oral copulation during the period from April 10 to 15.
III. Closing arguments

The prosecution pointed out that Erin M.'s testimony that "Gil licked me" was consistent from her first statement to Dawn M. to her statements to every other person and her testimony in court. That simple statement explained all the facts of the case: the outbreak of herpes and the lack of evidence that Erin M. had had cold sores before April 2006. Both Erin M. and Dawn M. were credible witnesses with no reasons to lie. In contrast, Juarez's witnesses only came up with their testimony about Erin M.'s poor hygiene and earlier cold sores after talking to the police and after the appointment of an expert tasked with finding any other explanation for the type 1 herpes on Erin M.'s genitals. Even the defense expert admitted that the most reasonable explanation for the outbreak was oral copulation by Juarez between April 10 and April 15, 2006.

Defense counsel emphasized that the jury needed to find Juarez guilty beyond a reasonable doubt, "a certainty, a conviction in your own mind and heart that you are absolutely correct in your decision." Erin M. was disabled, her mother Dawn M. was highly emotional, and a lack of basic understanding about herpes type 1 and type 2 pervaded the case. "Sexual deviancy knows no bounds in reference to morality. It could be a priest, a corporate executive, a teacher. It could be anyone. There's no question about that. That's why there's no character witnesses here, because that's irrelevant." Nevertheless, the small house and the chance of getting caught made the crime scene important. The prosecution did not present any expert witnesses to contradict Dr. Bierman. Juarez should have been tested immediately after Erin M.'s outbreak was discovered to see if he was shedding the virus. A test for antibodies should have been done on Erin M. to determine if it was her first outbreak.

Erin M.'s disabilities were obvious during her testimony, during which she did not go into detail. Erin M. had also been pressured on the stand. "You're not dealing with a normal young girl who can be very bright, who can sometimes be very decisive and strong."

Dawn M.'s emotionality during Dr. Welles' examination was inappropriate, and Dawn M. lied about taking Erin M. over to the Fidermutzs' house instead of immediately going to the doctor. It made no difference to the case that Dawn M. waited, but her denial had an impact on her credibility. "It's the same reason I think she's in this courtroom many times making faces as the witnesses testify. She doesn't want to look bad."

Dr. Welles was not an expert. Dr. Bierman's testimony was intended to educate the jury about the appropriate tests, and although self-inoculation was rarer, it was possible. One of the doctors thought Erin M. had herpes, and although the culture was negative, false negatives happened 50 percent of the time. There were powerful, reasonable alternatives to the prosecution's theory that Juarez gave Erin M. herpes.

Colleen Juarez and Juarez had testified about their normal lives and their family. The house was small and the trundle bed too squeaky for Juarez to avoid detection. There was no evidence that Juarez was unstable, overly emotional, used drugs or drank, or made offensive remarks. Dawn M., however, lied about taking her daughters over to the Fidermutzs' house, and had "remained in this courtroom the entire time, because there's a strong indication that she has a powerful, undeniable influence over her daughter." Counsel urged the jury to think independently and to think about reasonable doubt, and "hopefully this nightmare of Mr. Juarez will come to an end."

In rebuttal, the prosecution told the jury to focus on the testimony. Erin M.'s testimony was direct evidence of what happened. The sexual assault nurse's testimony was that there were red flags regarding Juarez's daughter E.J. Dr. Welles was an independent witness, a doctor who did her job. And even if Dawn M. was "the worst mom on earth. . . . How does that make the defendant not guilty?" "[W]hat evidence is there that she coached Erin to say this, that she had a motive to coach Erin to say this, that she had the knowledge to coach Erin to say this?" Katherine Fidermutz's interest was to protect Colleen and Juarez. Erin M.'s disabilities did not make her story less credible, but they did make her "prey to men like Gilbert Juarez." She remembered what had happened to her and had been consistent down the line. As to Dr. Bierman's testimony about a 50 percent false negative test rate, "that 50 percent false-negative rate is for HSV-2, not HSV-1." He was not an unbiased expert. Erin M.'s itchy mouth in 2004 was a food allergy to citrus. The first outbreak was the genital outbreak, and although there was no proof that Juarez was shedding, "that doesn't mean he didn't orally copulate the child." Staples was the only defense witness that had no motive, and she volunteered that she did not notice bad hygiene or a cold sore.

As to Colleen, "you heard a lot of times that Colleen lives in a 600-square-foot house. That ain't where Colleen Juarez lives. Colleen is living somewhere called denial." Colleen asked her children about any abuse in front of Juarez, told them that someone else made up a lie about Juarez, and warned them that someone was going to ask them about abuse, "and that's how you make sure that your kids don't tell." A husband would not admit to this behavior especially when they know the ramifications.

The defense had brought in pictures and a diagram of the tiny house, but "you don't have to be smart to be a felon. . . . [T]he kind of men that commit this crime, it's a compulsion. . . . So you groom a child. You find a child that you're less likely to have reporting, the child who is less likely to be believed. . . . [Y]ou molest them even in close quarters. People take risks all the time, stupid risks." Erin M.'s testimony and the medical evidence proved the crime beyond a reasonable doubt.
IV. Jury deliberations and verdict

After instructions, the jury began deliberating at 9:16 a.m. on January 18, 2009, and at 4:05 p.m. returned a verdict of guilty on count 1 and all the enhancements.

The court denied Juarez's motion for a new trial on October 10, 2009. The court sentenced Juarez to fifteen years to life in prison, with 297 days of good time, fines, and a security assessment.
DISCUSSION
I. The testimony of the sexual assault nurse, Mary Ann Lague

On his direct appeal, Juarez argues that the portions of Lague's testimony in which she repeated Erin M.'s statements that Juarez had molested her, should have been excluded as hearsay. Juarez's counsel objected on hearsay grounds, and the court admitted the statements as past recollection recorded under Evidence Code section 1237.

Evidence Code section 1237 provides: "(a) Evidence of a statement previously made by a witness is not made inadmissible by the hearsay rule if the statement would have been admissible if made by him while testifying, the statement concerns a matter as to which the witness has insufficient present recollection to enable him to testify fully and accurately, and the statement is contained in a writing which: [¶] (1) Was made at a time when the fact recorded in the writing actually occurred or was fresh in the witness' memory; [¶] (2) Was made (i) by the witness himself or under his direction or (ii) by some other person for the purpose of recording the witness' statement at the time it was made; [¶] (3) Is offered after the witness testifies that the statement he made was a true statement of such fact; and [¶] (4) Is offered after the writing is authenticated as an accurate record of the statement." Juarez argues on appeal that the exception does not apply, because the facts of the oral copulation recorded in the writing were no longer fresh in Erin M.'s memory, because Lague examined Erin M. over a month after the abuse allegedly occurred and a month after Dawn M. discovered the sores on Erin M.'s genitals.

The hearsay exception pursuant to section 1237 does not apply, because Erin M. had sufficient "present recollection to enable [her] to testify fully and accurately" about the oral copulation. Erin M. testified from her recollection at trial. The admission of her statements to Lague under section 1237 was harmless error, given Erin M.'s detailed trial testimony. Even if Lague's testimony had been excluded, Erin M. testified at trial that Juarez had licked her genital area, and there was ample supporting evidence that she had contracted herpes type 1 from Juarez as a result. The case did not hinge on Lague's testimony, and it is not reasonably probable that the exclusion of Lague's testimony would have resulted in Juarez's acquittal. (See People v. Parks (1971) 4 Cal.3d 955, 961.)
II. Exclusion of Colleen Juarez's lay opinion testimony

Juarez argues that the trial court erred in refusing to allow Colleen to testify that because the house was so small, she would have been aware that Juarez was performing oral sex on Erin M. in the girls' bedroom. During Colleen's testimony, defense counsel asked her "Do you have an opinion based upon the smallness of the house and your experience with the noise whether, if something like that would happen, you would become aware of it?" Colleen answered "yes." The prosecution objected that the question "calls for speculation," and the court agreed and struck the testimony.

When a witness is not testifying as an expert, "his testimony in the form of an opinion is limited to such an opinion as is permitted by law, including but not limited to an opinion that is: [¶] (a) Rationally based on the perception of the witness, and [¶] (b) Helpful to a clear understanding of her testimony." (Evid. Code § 800.) Evidence Code section 702 states that a witness' testimony "concerning a particular matter is inadmissible unless he has personal knowledge of the matter." Evidence based on speculation "is irrelevant because it has no tendency in reason to resolve questions in dispute." (People v. Chatman (2006) 38 Cal.4th 344, 382.)

"We review for an abuse of discretion a trial court's ruling that a question calls for speculation from a witness." (People v. Thornton (2007) 41 Cal.4th 391, 429.) The question called for Colleen to give her opinion about whether she would have been aware of Juarez performing oral sex on Erin M. in the girls' bedroom. The entire defense case was that Juarez had not performed oral sex on Erin M.; Colleen therefore would not have personal knowledge of what sounds such an event would create. Further, for her to have become aware that "something like that" was happening, Colleen would have had to investigate, requiring her to testify that not only would she have perceived something, but she would have gone to see what was going on.

A lay witness may testify to an opinion about something the lay witness actually perceived, and a lay opinion is helpful "when the matters observed by the witness may be too complex or subtle to enable the witness accurately to convey them without resorting to the use of conclusory descriptions." (Osborn v. Mission Ready Mix (1990) 224 Cal.App.3d 104, 112.) Colleen, however, had not observed anything about which she could express a helpful lay opinion. The question was whether she had an opinion that she would have observed (and investigated) sounds that Juarez was performing oral sex on Erin M. in the girls' bedroom. She had never actually perceived such an act, and so her lay opinion about whether she would have heard it, and would have become aware of what was happening, would have been speculation. The trial court did not abuse its discretion in excluding the testimony as speculative. (See People v. Thornton, supra, 41 Cal.4th at p. 429 ["Under that deferential standard, we cannot second-guess the court's ruling that asking the witness whether she thought the two vehicle occupants were acting as if they knew each other was speculative."].)

In addition, even if the trial court erred in excluding the testimony, the error was harmless. Colleen testified at length about the close quarters in the house. She testified that the house was small, that she would close the door to the master bedroom when she and Juarez engaged in sexual activity, that she was a light sleeper who heard everything, that she could hear sounds coming from the girls' bedroom, and that it would be "insane" for Juarez to commit the molestation in the girls' bedroom because the house was so small and "[y]ou can hear everything that happens." The defense theory that Juarez could not have evaded detection in the small house was thoroughly presented in her testimony (as well as in Juarez's testimony and the photographs and diagram introduced into evidence), and the excluded opinion testimony would not have added much except speculation. The evidence of Juarez's guilt was strong, and the defense made as much as it could of the size of Juarez's house and the possibility of discovery. It is not reasonably possible that allowing the excluded opinion testimony would have changed the result.
III. Testimony regarding why Juarez's daughter E.J. would not be a witness

During Juarez's testimony, his counsel asked him "Has there been a decision by you and your wife with reference to calling as witnesses your two children? [¶] . . . [¶] Well, let's just start with little [E.J.] Has there been a decision not to call her as a witness?" Juarez answered "That is correct," and his counsel asked "And is that based upon a recent medical problem?" The prosecution objected "Your honor, there would be an objection as to why a witness is not being called. If a witness is unavailable, a witness is unavailable." The trial court sustained the objection.[ 3 ]

A witness is unavailable under Evidence Code section 240, subdivision (a)(3) if the witness is "unable to attend or to testify at the hearing because of then existing physical or mental illness or infirmity." The question posed by Juarez's counsel necessarily asked for a hearsay response, as Juarez would have had to testify regarding the contents of an out-of-court conversation with Colleen, and would have offered the contents for its truth. The testimony was properly excluded as inadmissible hearsay.

Further, the trial court never ruled that E.J. was unavailable as a witness, and no hearing was held regarding her availability. There is no determination in the record whether she was actually unavailable and on what ground, so Juarez has not shown that the excluded testimony would be relevant. Although the prosecutor did ask, during cross-examination of Colleen, whether she was aware "that the people of the State of California cannot compel the youngest child to come testify", without evidence in the record that there was another reason for her nonappearance, Juarez cannot complain that he was precluded from presenting that alternative explanation.

Even if it was error to exclude the testimony about E.J., it was harmless. Juarez claims that E.J.'s testimony would presumably have been "exculpatory," meant to rebut Lague's testimony that her examination had raised "red flags" regarding possible molestation. It was not E.J.'s supposedly exculpatory testimony that was excluded, however, but an explanation for her absence that had no foundation in the record. Allowing Juarez to testify that E.J. was ill would not have tended to exonerate him regarding his molestation of Erin M., especially given the strong evidence of guilt. It is not reasonably probable that Juarez would have been acquitted had he been allowed to testify that his younger daughter was not testifying due to illness.
VI. The presence of Erin M.'s parents in the courtroom

Juarez argues that it was error for the trial court to allow Erin M.'s parents to remain in the courtroom after Erin M.'s and Dawn M.'s testimony had concluded. There was no error.

After Dawn M. testified, she remained in the court room as a support person for Erin M. during her testimony. John M., Erin M.'s father, was not present.

The next day of trial, outside the presence of the jury, the prosecutor informed the court that there was a standing motion to exclude, and that defense counsel objected to the continued presence of Dawn M. in the courtroom. The prosecutor stated: "It's my position she's already testified in the matter and she should be allowed to remain." Defense counsel argued: "There would be a strong opposition. She may be called back in reference to this matter. We have significant impeachment witnesses that would indicate that she fabricated certain things in reference to this case. At least three witnesses will be testifying in reference to that." Defense counsel indicated that Erin M.'s father could also be a potential witness, and the prosecutor stated that she had placed his name on the witness list "just because his name might come up," but he had not been interviewed and she did not intend to call him. Defense counsel continued to argue that John M. might be called as a rebuttal witness, and because Erin M. was no longer on the stand, it was inappropriate for either parent to be in the room because they might be called back.

The prosecutor responded: "Well, your honor, if he's already asked her the questions which he plans to impeach her on, there's no reason for her to be recalled. She's already been confronted." The trial court stated: "I would agree. I don't see a reason for her to be excluded because the bottom line is even if she's recalled, she's going to be told what the statement was in court by someone that said something different than her to get a response. [¶] You've got your testimony on the record. She is the victim's mother. I can understand her wanting to be present for the case." The court asked the prosecutor to advise Dawn M. that when defense witnesses were testifying, "[t]here is to be no emotional reaction from anyone in the audience." The father had not been interviewed, and the court saw no reason to exclude him. Krysta M., Dawn M. and John M.'s other juvenile daughter, testified that day.

During a break after the prosecution rested, defense counsel pointed out that Dawn M. and Krysta M. had already testified, and the defense intended to put on an impeachment defense: "If they are going to remain, that is the risk the attorney takes." The court responded: "If they are going to testify again, it is going to be by the People. Let's not anticipate the problem. The jury saw they sat in the courtroom during the testimony."

Defense counsel advised the court that Erin M.'s father was in the courtroom before the second day of the defense case, and stated: "I'm asking, in an abundance of caution, because there has been testimony that he was present at certain time periods that may be very critical, that he not be permitted to stay." The prosecution repeated "I have no intention of calling him as a witness." The court ruled that John M. could stay in the courtroom. Dawn M. was not recalled, and John M. was not called to testify.

We review the trial court's ruling on the motion to exclude witnesses for an abuse of discretion. (People v. Griffin (2004) 33 Cal.4th 536, 574.) Under Evidence Code section 777, "the court may exclude from the courtroom any witness not at the time under examination so that such witness cannot hear the testimony of other witnesses." "The purpose of the order [excluding witnesses] is to prevent tailored testimony and aid in the detection of less than candid testimony." (People v. Valdez (1986) 177 Cal.App.3d 680, 687.)

Juarez does not explain how the decision to allow John M. and Dawn M. to stay was an abuse of discretion. Dawn M. had already testified, and had been questioned on the issues for which the defense presented impeachment testimony. Further, John M. was not interviewed by the prosecution or the defense, and was not on the defense witness list. We see no abuse of discretion in the trial court's denial of the motion to exclude Dawn M. and John M. from the courtroom.

Further, even if the trial court erred, the error was harmless, because Juarez has shown no prejudice from the presence of Dawn M. and John M. in the courtroom. The defense did not recall Dawn M., and Juarez does not claim the defense would have recalled her had she not remained in the courtroom. Juarez's argument that John M.'s value to the defense was "compromised" is belied by the defense's failure to indicate any interest in his testimony; the defense never interviewed John M. or put him on the witness list, and John M. never testified for the prosecution. If the defense had decided to recall Dawn M. or call John M. as a witness, counsel could have questioned them regarding any effect their presence in the courtroom may have had on their testimony.
V. Jury instructions

The jury was instructed: "It is alleged that the crime occurred on or between April 10, 2006 and April 17, 2006. The People are not required to prove that the crime took place exactly on a particular day, but only that it happened reasonably close to that day." Juarez argues this instruction was error, because the instruction should have stated that the last day was April 15, 2006, the last day that Erin M. stayed at the Juarez home. Further, Juarez argues that his defense expert, Dr. Bierman, established that the incubation period for herpes was 5-7 days, and so the exact date of the molestation was important to establish that Erin M.'s outbreak occurred within the incubation period.

Juarez's counsel joined with the prosecution in requesting the instruction. When the trial court asked, "So you want it that `it is alleged a crime occurred on and between April 10, 2006 and April 17, 2006'?," defense counsel responded, "I believe it's more accurate, your honor." The court repeated, "I take it you both want it to be worded "`As alleged a crime occurred on and between April 10, 2006 and April 17, 2006?'" Defense counsel stated, "Yes, your honor," and the trial court stated, "Okay, I'll modify it so that it reads the way you both want." The record shows that defense counsel joined in requesting the instruction and in approving its language and the dates, and "[t]he claims of error are therefore waived" as to the instruction. (People v. Jackson (1996) 13 Cal.4th 1164, 1223.)

We acknowledge that the testimony at trial was that Erin M. stayed at the Juarez home from Monday, April 10, 2006 to Saturday, April 15, 2006, rather than April 17, 2006 as stated in the instruction. Generally, the prosecution is not required to prove the exact date on which the offense occurs, unless "the defense is alibi [so that] the exact time of commission becomes critically relevant to the maintenance of the defense." (People v. Richardson (2008) 43 Cal.4th 959, 1027.) Juarez did not raise an alibi defense. Nevertheless, the date of the offense was important, as it established the time of Erin M.'s exposure to the herpes virus. Dawn M. discovered the blisters on Erin M.'s genitals on April 22, the following Saturday. Katherine testified that Dawn M. called her on April 22, upset and crying about her discovery. Dawn M. took Erin M. to urgent care the next day and had Erin M. tested. The following Wednesday, April 26, Erin M. saw Dr. Welles, who reviewed the test results, and found they were positive for herpes type 1.

There was no dispute at trial that the date that Dawn M. discovered the blisters on Erin M.'s genitals was Saturday, April 22, 2006, or that the dates that Erin M. slept over at the Juarez home were April 10, 2006 through April 15, 2006. The outbreak of the virus on that date is consistent with Dr. Bierman's estimate of a 5-7 day incubation period. Further, the prosecution introduced into evidence, on cross-examination of Dr. Bierman, the CDC's estimate that the first outbreak usually occurred within two weeks of the transmission of the virus. The CDC estimate of an incubation period is consistent with an outbreak on the 22d, whether the offense occurred as early as April 10, 2006 or as late as April 15, 2006. Any error was harmless, because the jury's verdict was consistent with a conclusion that the outbreak on April 22, 2006 was the result of oral copulation by Juarez during the period from April 10, 2006 and April 15, 2006, within the timeframe in the instruction, when undisputed evidence established that Erin M. stayed at the Juarez home.
VI. Substantial evidence

Juarez argues that inconsistencies in Erin M.'s testimony, and medical evidence that Erin M. had a preexisting case of herpes, show that his conviction was not supported by substantial evidence. We disagree. Substantial evidence supports the conviction.

Evidence is sufficient to support a conviction if, after viewing the evidence in the light most favorable to the prosecution, a rational trier of fact could have found the essential elements of the crime beyond a reasonable doubt, and we "`"`presume in support of the judgment the existence of every fact the trier could reasonably deduce from the evidence.'"'" (People v. Mejia (2007) 155 Cal.App.4th 86, 93.) "In deciding the sufficiency of the evidence, a reviewing court resolves neither credibility issues nor evidentiary conflicts. [Citation.] Resolution of conflicts and inconsistencies in the testimony is the exclusive province of the trier of fact. [Citation.] Moreover, unless the testimony is physically impossible or inherently improbable, testimony of a single witness is sufficient to support a conviction. [Citation.]" (People v. Young (2005) 34 Cal.4th 1149, 1181.)
A. Inconsistencies in testimony

Juarez begins by labeling Erin M.'s testimony inconsistent and "unbelievable." To the contrary, the examples Juarez gives do not dilute the strength of Erin M.'s testimony that Juarez orally copulated her. Juarez labels as "a shocking admission" Erin M's answer "[n]ot really" in response to defense counsel's question, "[W]e're talking about the time he was in the bedroom. Do you remember this?" The trial transcript shows, however, that defense counsel was not asking Erin M. about whether the molestation occurred, but about whether she remembered her preliminary hearing testimony, during which she had answered, "Right" when asked, "Now, when Gil did this to you, it was a long time, is that right?" Erin M.'s answer related to her testimony at the preliminary history, not the oral copulation. This was not inconsistent with her testimony that Juarez orally copulated her.

Juarez points to this questioning by the prosecution as ambiguous whether Dawn M. had coached Erin M. to say that Juarez molested her: "Q: Did your mom ever say to you, I want you to tell them that Gil did this to you? A: I don't remember. Q: You don't remember her ever saying that? A: No." This exchange was followed, however, by more testimony:

Q. Your mom told you that I want you to come to court?

A. I think so.

Q. Your mom said, I want you to tell the truth?

A. Yeah.

Q. You wouldn't lie just to try to make mom happy, would you?

A. No.

Q. Because you understand that this is really important, right?

A. Yes.

Q. Because we're in court, right?

A. Yes.

Q. And you wouldn't lie to the judge or to all these people in here, would you?

A. No.

Q. And a[re] you absolutely sure about what you remember? Are you sure that Gil licked your privates?

A. Yes.

In context, Erin M. stated simply that she did not remember Dawn M. telling her to accuse Juarez, and because she testified that her mother told her to tell the truth in court, the jury was entitled to conclude that Dawn M. did not coach Erin M.

Juarez complains that Dr. Welles testified that Erin M. told her that her godfather had molested her, although Juarez was not godfather to Erin M., but to Krysta M., her older sister. Dr. Welles's actual testimony was "I asked Erin to tell me about it, and she told me that her godfather, Mr. Juarez, would put his mouth against her vagina or vaginal area." Whether Dr. Welles was confused by what Erin M. told her, or whether Erin M. mistakenly identified Juarez as her godfather to Dr. Welles, this is not an inconsistency that casts doubt on Dr. Welles's testimony or Erin M.'s testimony, given that Erin M. consistently identified Juarez by name as her molester.

Juarez also argues that Erin M. testified that she did not wear underwear when sleeping at the Juarez home, but Dr. Welles testified that Erin M. told her that Juarez "would come into the room and that he would remove her underwear and that he put his mouth against her vaginal area." Erin M. also testified, however, that she did not remember how her "bottoms" came off that night. Erin M. did not testify whether she removed her own underwear that night, and a jury could reasonably infer from her testimony that Juarez removed her underwear when he put her to bed, and then orally copulated her.

All these inconsistencies are either nonexistent or minor, and we do not resolve credibility issues or evidentiary conflicts on appeal. (People v. Young, supra, 34 Cal.4th at p. 1181.) Juarez has not shown that any of the challenged testimony is inherently improbable or physically impossible. (See ibid.)
B. Evidence that Erin M. had a preexisting case of herpes

Juarez argues that "the evidence is clear that she had a preexisting case of herpes 1 infection at the time of the alleged abuse by Gilbert Juarez." This misstates the record and mischaracterizes the testimony at trial.

Ample evidence supported the jury's finding that Erin M. contracted herpes type 1 on her genitals when Juarez orally copulated her, rather than from her own preexisting infection. Nothing in the record conclusively established that Erin M. had a preexisting case of herpes type 1 before April 2006. Dawn M. and Krysta M. testified that Erin M. had not had a cold sore before April 2006. Erin M.'s medical records were discussed in detail, and nothing in the records established that Erin M. had herpes before April 2006. In 2004, the rash on Erin M.'s tongue was tested for herpes and the results were negative. Dr. Welles and the defense expert, Dr. Bierman, agreed that it was most likely that the April 2006 genital outbreak was Erin M.'s first outbreak, not a recurrent outbreak. Although the defense attempted to establish that Erin M. had infected her own genital area with herpes type 1 by transferring the virus from her mouth, that defense failed. Even Dr. Bierman concluded "the most reasonable explanation for this child having oral herpes on her genitals is that she was orally copulated like she said she was between April 10 and 15." To the extent there was a conflict in the evidence, the jury was entitled to resolve it, and we will not disturb the jury's conclusion that Erin M. contracted the herpes type 1 virus from Juarez when he orally copulated her.

Substantial evidence supports the jury verdict.
VII. Ineffective assistance of counsel

On direct appeal and in the consolidated petition for writ of habeas corpus, Juarez claims that his trial counsel provided ineffective assistance.

"In order to establish a claim of ineffective assistance of counsel, defendant bears the burden of demonstrating, first, that counsel's performance was deficient because it `fell below an objective standard of reasonableness [¶] . . . under prevailing professional norms.' [Citations.] Unless a defendant establishes the contrary, we shall presume that `counsel's performance fell within the wide range of professional competence and that counsel's actions and inactions can be explained as a matter of sound trial strategy.' [Citation.] If the record `sheds no light on why counsel acted or failed to act in the manner challenged,' an appellate claim of ineffective assistance of counsel must be rejected `unless counsel was asked for an explanation and failed to provide one, or unless there simply could be no satisfactory explanation.' [Citations.]' If a defendant meets the burden of establishing that counsel's performance was deficient, he or she also must show that counsel's deficiencies resulted in prejudice, that is, a `reasonable possibility that, but for counsel's unprofessional errors, the result of the proceeding would have been different.' [Citation.]" (People v. Ledesma (2006) 39 Cal.4th 641, 745-746.) "`[W]e accord great deference to counsel's tactical decisions' [citation], and we have explained that `courts should not second-guess reasonable, if difficult, tactical decisions in the harsh light of hindsight [citation].'" (People v. Weaver (2001) 26 Cal.4th 876, 925-926.)

We address each basis for this claim in turn.
A. Failure to request a jury visit to the Juarez home

Juarez argues that it was fundamental to his defense to establish that it was improbable that he could have orally copulated Erin M. in the house without detection, given the house's layout and size. It was "absolutely vital" that the jury see the house for itself, and so the failure of defense counsel to request a visit was ineffective assistance of counsel.

Section 1119 provides: "When, in the opinion of the court, it is proper that the jury should view the place in which the offense is charged to have been committed, or in which any other material fact occurred, . . . it may order the jury to be conducted in a body, in the custody of the sheriff or marshal . . . to the place . . . ." The trial court has discretion whether or not to grant a motion for a jury view. (People v. Friend (2009) 47 Cal.4th 1, 47.) "`"When the purpose of the view is to test the veracity of a witness's testimony about [his or her] observations, the trial court may properly consider whether the conditions for the jury view will be substantially the same as those under which the witness made the observations, whether there are other means of testing the veracity of the witness's testimony, and practical difficulties in conducting a jury view." (Ibid.)

The purpose of the jury view would be to test the veracity of Erin M.'s testimony that Juarez orally copulated her at night in the girls' bedroom. It is Juarez's burden, in alleging that his counsel was ineffective for failing to request such a view, to demonstrate that the conditions for the jury view at the time of trial in 2009 were "substantially the same" as the conditions in 2006, when the alleged molestation occurred. (See People v. Friend, supra, 47 Cal.4th at p. 47 [no abuse of discretion to deny request for jury view when "it was uncertain how close the conditions the jury would have encountered would have been to those under which [the witness] made his observations four years earlier"].) Juarez does not address whether the conditions in the Juarez home were the same two years later. Further, Erin M. testified that the oral copulation took place at night, and to the extent that visibility is in issue, it would be necessary for the jury to view the house at night to duplicate the conditions of the alleged molestation. (Id. at p. 48 [visibility is affected by both lighting and distance].) Finally, "alternative means of testing [Erin M.'s] credibility were provided at trial by various witnesses" (ibid.), as both Colleen and Juarez testified to the small size of the house and the way noise carried from one end to the other. The record is silent with regard to what, if any, noises the oral copulation would have generated and, if any, how loud the noises would have been.

The defense introduced two diagrams and seventeen photographs of the Juarez home, and examined Colleen at length about the house. This was ample evidence for the jury to assess the scene of the offense. The exhibits and testimony enabled the jury "to draw its own inferences about the probability defendant was capable of committing the crime" without a jury view. (People v. Kraft (2000) 23 Cal.4th 978, 1053.) Juarez has not shown that the trial court would have abused its discretion in failing to order a jury view, had counsel made a motion.

We presume that counsel had a tactical reason for not requesting a view, and because the record sheds no light on why counsel did not, we reject the claim of ineffective assistance on this ground, as there are a variety of satisfactory explanations for why he may not have considered that one was required.
B. Failing to object to Dawn M.'s testimony

Juarez claims that trial counsel was ineffective in failing to object on hearsay grounds to Dawn M.'s testimony that Erin M. told her "Gil licked me there," when Dawn M. saw the outbreak on Dawn M.'s genitals. Juarez argues that it was inadmissible hearsay "offered to prove the truth of the matter stated" under Evidence Code 1200, and that it was inadmissible and highly prejudicial.

During Dawn M.'s testimony, the prosecutor asked her what she did after she saw the condition of Erin M.'s genital area, and Dawn M. responded that Erin M. said, "Gil licked me there." Defense counsel did not object. The prosecutor then asked Dawn M. what she did after she heard this, and Dawn M. testified that she called Katherine Fidermutz, "hysterical," and told Katherine what Erin M. had told her.

Hearsay is "evidence of a statement that was made other than by a witness while testifying at the hearing and that is offered to prove the truth of the matter stated." (Evid. Code §1200, subd. (a)). Hearsay evidence is inadmissible except as provided by law. (Id., subd. (b).)

Juarez argues that the statement was inadmissible hearsay. Respondent argues that the testimony was admissible, because it was not offered for the truth of Erin M.'s accusation that Juarez had molested her, but rather as "foundational evidence to explain Dawn's subsequent conduct." Erin M.'s statement had evidentiary value to explain why Dawn M. called the Fidermutz house, called the Fidermutzes on vacation, and behaved in an emotional way. These were issues at trial, and defense counsel could reasonably have determined that objecting to the admission of the statement on hearsay grounds was not worth the risk of being perceived by the jury as attempting to hide evidence.

Further, Dawn M.'s testimony that Erin M. disclosed the oral copulation to her would have been admissible for the nonhearsay purpose of establishing the fact of, and the circumstances surrounding, Erin M.'s disclosure of the molestation to others. (See People v. Brown (1998) 8 Cal.4th 746, 749-750.) Even if defense counsel had successfully objected, the jury would have heard Dawn M.'s testimony regarding Erin M.'s complaint, with an instruction limiting the testimony to the fact of the disclosure and the circumstances under which it occurred.

"We have long recognized that counsel's decision whether or not to object to inadmissible evidence is a matter of trial tactics. [Citation.] Because we accord great deference to trial counsel's tactical decisions, counsel's failure to object rarely provides a basis for finding incompetence of counsel. [Citations.] Here, nothing in the record suggests defense counsel lacked a rational tactical reason for not objecting to [the] testimony." (People v. Lewis (2001) 25 Cal.4th 610, 661.) Counsel may well have concluded that objection was futile, given that the testimony was arguably admissible to explain Dawn M.'s subsequent conduct, or to show the fact that Erin M. had disclosed the molestation and the circumstances under which the disclosure occurred.

Further, given the cumulative effect of so much testimony that Erin M. identified Juarez as her molester, there is no reasonable possibility that the outcome would have been different if counsel had objected and Dawn M.'s testimony had been excluded as hearsay. Erin M. herself testified that she told her mother that Gil had licked her, and Dr. Welles testified that Erin M. told her the same thing. The failure to object was not ineffective assistance of counsel.
C. Failure to subpoena Dr. Nichols

Juarez argues that trial counsel was ineffective because he failed to subpoena as a witness Doctor Nichols, who he claims believed Erin M. had herpes on her tongue in September 2004, until a test of a culture of the lip came back negative. Trial counsel asked Dr. Bierman, the defense expert, about Dr. Nichols's report, and Dr. Bierman stated that the report showed "a diagnosis entered of HSV, herpes simplex virus." When trial counsel asked if the diagnosis was written out, the prosecution objected on hearsay grounds and argued the evidence was misleading. The court ruled that without the other doctor available for cross-examination by the prosecution, "what can come in is that they did an analysis and it came back negative." Because "the doctor could have been brought in," the court sustained the prosecution's objection.

"On direct appeal, a claim of ineffective assistance of counsel cannot be established by mere speculation regarding the `likely' testimony of potentially available witnesses. [Citation.]." (People v. Medina (1995) 11 Cal.4th 694, 773.) There is no evidence that Dr. Nichols was ready to testify, or that he would necessarily testify that despite the negative test result, he believed Erin M. had herpes on her tongue in 2004. In fact, it is likely that defense counsel saw the pitfall inherent in subpoenaing a doctor to testify that Erin M. had herpes in 2004, when the test results showed otherwise. It is speculation to assume that the testimony would have helped the defense, because it would also have emphasized the negative test results.

Juarez argues that the test might have been a "false negative," but this misstates Dr. Bierman's testimony regarding the occurrence of false negatives. His estimate that false negatives occur in half of the tests was for genital herpes, type 2, whereas Erin M. had been infected with herpes type 1.

It was not ineffective assistance for trial counsel not to subpoena Dr. Nichols.
D. Failing to call Juarez's therapist as a witness

In his habeas petition, Juarez alleges that it was ineffective assistance for trial counsel not to call as a witness Ronald Korn. Juarez states in a declaration that while he was out on bail, he retained Korn as a therapist, whom he visited over 30 times between July 2006 and November 2007, a sixteen-month period. Juarez told his trial counsel that Korn would testify that Juarez "did not have the characteristics of a pedophile or child molester," but trial counsel did not interview Korn "despite my begging him to do so." Juarez also provides a declaration from Korn, in which he describes himself as "licensed in the State of California as a Marriage and Family Therapist" with a master's in clinical psychology from California State University, Los Angeles. Korn states that over 32 visits "I had the opportunity to interview, test, judge and otherwise psychologically examine Mr. Juarez." Although he was prepared to testify at trial, Juarez's trial counsel never contacted him.

Counsel's decision whether to put on a witness is a matter of trial tactics and strategy, which we will generally not second-guess. (People v. Mitcham (1992) 1 Cal.4th 1027, 1059.) A defendant accused of a sex offense may present expert testimony to establish, through such things as personality tests, that he does not have a disposition to commit the crime. (People v. Stoll (1989) 49 Cal.3d 1136, 1153, 1157-1158.) Such expert opinion is character evidence, relevant as circumstantial evidence that a defendant is unlikely to have committed the charged acts. (Id. at p. 1158.) Although Korn's resume does not show any special expertise in treating or evaluating sex offenders or child molesters, his testimony may have been admissible at trial as character evidence. We note, however, that his declaration is vague regarding how he evaluated Juarez, stating merely that he had the opportunity to test and psychologically examine Juarez. It is not clear from the declaration or from his resume what tests he may have performed.

We cannot say, however, that trial counsel was ineffective in failing to present Korn as a witness. Trial counsel may have made a tactical decision not to present additional character evidence regarding Juarez. Without more detailed information about what the basis for Korn's trial testimony would have been, we cannot say whether it would have been admitted or whether it would have been helpful to Juarez's defense. The evidence against Juarez was strong, and the jury "`may temper their acceptance of [a witness's] testimony with a healthy skepticism born of their knowledge that all human beings are fallible.'" (People v. Stoll, supra, 49 Cal.3d at p. 1157.) Given the strength of the evidence against Juarez, it is particularly true here that a jury might tend to disregard character evidence from a therapist who treated Juarez after the alleged molestation. Further, defense counsel may have decided not to present such testimony so as not to prompt the prosecution to present its own evidence regarding the characteristics of child molesters, or to avoid cross-examination which might diminish the weight of the evidence or discredit it altogether. Juarez does not establish that there was no satisfactory explanation for the failure to call Korn as a defense witness, and we decline to second-guess trial counsel's presumed tactical decision.

Further, we repeat that there was strong evidence of Juarez's guilt. It is not reasonably probable that Korn's testimony, judged by the scant information in his declaration, would have resulted in Juarez's acquittal.
E. Failing to object to coaching by Dawn M.

In his habeas petition, Juarez alleges that his trial counsel was ineffective for failing to object when Dawn M. "coached" Erin M. from the courtroom audience during Erin M.'s testimony. Juarez's accompanying declaration states that "I happened to turn towards the audience and saw that Erin [M.]'s mother, Dawn [M.], was `mouthing' answers to her daughter while she was on the stand, and was nodding her head up and down and side to side to prompt her daughter's answers." Juarez states that he advised his trial counsel, who did not object or bring it to the judge's attention. Juarez also includes a declaration from his mother, in which she states that she also observed Dawn M. coaching Erin M.

Defense counsel did, however, address the coaching issue when, during cross-examination, he had the following exchange with Erin M., after Erin M. testified that Dawn M. cried when she discovered the outbreak of blisters on Erin M.'s genitals:

Q. Do you love your mother very much?

A. Yes.

Q. Do you want to please her?

A. Huh?

Q. Do you want to make her happy?

A. Yes.

Q. Is that very important to you?

A. Yes.

Shortly thereafter, counsel continued:

Q. Have you ever told your mother what happened to you, other than that first time?

A. I think.

Q. I notice that you're looking at your mother right now; right?

A. Yeah.

Q. You look at her and then you get a little nervous.

A. Yes.

Q. I'm sorry, go ahead. You don't want to say anything that makes her angry, do you?

A. Huh?

Q. You don't want to make her angry, do you?

A. No.

Q. Why don't you?

A. Because I'm nice to her.

Q. Hummm?

A. I'm nice to her.

This exchange establishes that counsel was aware that Erin M. was looking at Dawn M., and chose to address the issue of coaching gently, in the context of his cross-examination of a ten-year-old testifying to the details of oral copulation. We presume that trial counsel considered it sound trial strategy not to object, but rather to draw the jury's attention to the communication between Erin M. and her mother Dawn M. without attacking Erin M. Juarez argues that if the jury had been aware of the coaching, it would have affected their view of Erin M.'s and Dawn M.'s credibility. The record shows that trial counsel made the jury aware of the coaching, and the jury had the opportunity to decide whether it affected their evaluation of Erin M.'s and Dawn M.'s testimony. It was not ineffective assistance for counsel not to make a formal objection to the alleged coaching.
F. Failure to call character witnesses

In his habeas petition, Juarez also contends that trial counsel was ineffective in failing to call "numerous" character witnesses on his behalf, including three who provided declarations, although he gave trial counsel a list of possible positive character witnesses. One potential witness states that she knew Juarez through the PTA, and that she would have testified that Juarez was an excellent father and family man. Although she contacted his trial attorney to let him know that she was willing to appear as a character witness, she was never contacted. Two other declarations from a member of Juarez's church and from a close friend state that the declarants would have testified on his behalf, although neither contacted Juarez's attorney.

Whether to call a witness is a question of trial strategy, which we do not second-guess, and where (as here) the record does not establish why counsel failed to act, we reject a claim of ineffective assistance "`unless there simply could be no satisfactory explanation.'" (People v. Ledesma, supra, 39 Cal.4th at p. 746.) There are myriad possible satisfactory reasons why counsel did not call the character witnesses, only one of whom had contacted him. The record shows that defense counsel did prepare some character witnesses, and then decided not to present their testimony. There was testimony at trial to Juarez's good character from his wife Colleen and from Katherine Fidermutz. The alleged abuse occurred within a circle of families who were long-time friends; Juarez was even Krysta M.'s godfather. The prosecution's theory was that regardless of his seeming good character, Juarez exploited a position of trust to molest a child who was close to his family and who trusted him. It is not reasonably possible that more character witnesses would have resulted in a jury determination that Juarez was innocent.
G. Defense counsel's "guarantee"

Juarez's final contention in his petition for habeas relief is that his trial counsel guaranteed him that he would win at trial, convincing Juarez not to accept a plea offer. Juarez's declaration states that in negotiations before trial, defense counsel told him not to take any deals and to proceed to trial, because the case against him was weak. The record shows that before the jury was called into the courtroom on the first day of trial, the trial court reiterated the prosecution's offer of a maximum sentence of six years. The court advised Juarez that he was facing a possible life sentence, and he might want to consider the deal, although he did not know if it was a good offer. The prosecution stated that the deal "was actually going to be withdrawn once we were sent out. But if Mr. Juarez has a change of heart before the jury comes in . . ." Juarez's counsel told the court "I have had a lengthy discussion, as the court would expect, about the potential consequences of this matter, numerous times, and he's been aware of the offer. I'll discuss it with him again. . . . But it's his decision."

During a short break, Juarez states, his counsel told him he would "`guarantee we will win this thing! Don't take the deal. She [the D.A.] is offering you this chance, at this late date, which is very unusual at this late time, because she has nothing to convict you. You will be found "not guilty." We have a strong defense.'" Juarez claims that were it not for his counsel's advice and guarantee, he would have taken the plea, because he would not have faced a life sentence.

To establish ineffective assistance of counsel in the context of a defendant's rejection of a proffered plea bargain, a defendant must first establish not that counsel's advice was right or wrong, but that the advice was outside the range of competence demanded of trial counsel. (In re Alvernaz (1992) 2 Cal.4th 924, 937.) "We caution that a defense attorney's simple misjudgment of the strength of the prosecution's case, the chances of acquittal, or the sentence a defendant is likely to receive upon conviction, among other matters involving the exercise of counsel's judgment, will not, without more, give rise to a claim of ineffective assistance." (Ibid.) "`It is all too tempting for a defendant to second-guess counsel's assistance after conviction or adverse sentence.'" (Id. at p. 938, quoting Strickland v. Washington (1984) 466 U.S. 668, 689.) "[A] court should scrutinize closely whether a defendant has established a reasonable probability that, with effective representation, he or she would have accepted the proffered plea bargain." (Ibid.) "[P]ertinent factors to be considered include: whether counsel actually and accurately communicated the offer to the defendant; the advice, if any, given by counsel; the disparity between the terms of the proposed plea bargain and the probable consequences of proceeding to trial, as viewed at the time of the offer; and whether the defendant indicated he or she was amenable to negotiating a plea bargain. In this context, a defendant's self-serving statement—after trial, conviction, and sentence—that with competent advice he or she would have accepted a proffered plea bargain, is insufficient in and of itself to sustain the defendant's burden of proof as to prejudice, and must be corroborated independently by objective evidence. A contrary holding would lead to an unchecked flow of easily fabricated claims." (Ibid.)

Juarez does not state that counsel failed to communicate the offer to him. He complains that counsel gave him the wrong advice. There is nothing in the record, however, to indicate that Juarez ever was amenable to pleading guilty. As a result, his contention that he would have pleaded guilty if counsel had not assured him he would win at trial is exactly the sort of "self-serving statement" which, lacking independent corroboration by objective evidence, is insufficient to establish prejudice for the purpose of a successful claim of ineffective assistance. Juarez maintained his innocence throughout and testified "I am telling you the truth . . . I did not do this. This was something that I would not even think of doing. It's never even crossed my mind." "[A] defendant's trial protestations, under oath, of complete innocence may detract from the credibility of a hindsight claim that a rejected plea bargain would have been accepted had a single variable (sentencing advice) been different." (In re Alvernaz, supra, 2 Cal.4th at p. 940.) We reject Juarez's claim that his counsel's advice on the plea bargain was ineffective assistance.[ 4 ]
DISPOSITION

The judgment is affirmed. The petition for writ of habeas corpus is denied.

We concur:

MALLANO, P. J.

CHANEY, J.
1. All subsequent statutory references are to the Penal Code, unless otherwise indicated.
2. We use last initials to protect the identity of the victim, who was eight years old at the time of the offense and ten years old at the time of trial. We also use initials for Juarez's younger daughter E.J., as there was testimony at trial regarding possible sexual abuse of her as well.
3. The prosecutor apparently believed that E.J. was unavailable because E.J. was a possible victim of sexual assault and therefore could not be compelled to testify. (See Code Civ. Pro. § 1219.) On appeal, however, Juarez states that the reason E.J. did not appear as a witness was because she had been diagnosed with muscular dystrophy, and was too ill to testify. There was no offer of proof at trial regarding such a diagnosis, and we do not consider it on appeal.
4. We note that Juarez's appellate counsel represented Juarez when he filed a new trial motion, which raised all the claims Juarez raises on appeal with the exception of his claim that trial counsel guaranteed him he would be acquitted and convinced him not to plead guilty.

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Brazilian Health Minister Advocates Sex To Thwart High Blood Pressure

2010-04-27T07:01:00.001-07:00

April 27, 2010 (Pen Men at Work): The Minister of Health of Brazil has a rather ingenious therapy for his nation’s crisis of high blood pressure. The therapy that he has suggested is that the people must enact sexual activities frequently. More sex will diminish the menace of high blood pressure.

Health Minister, Jose Temporao, has expounded that the adults should enact a number of physical exercises regularly. These exercises will facilitate to keep their blood pressure down. The Health Minister has voiced that an efficient cardiovascular workout also consists of sexual acts. However, rather appropriately, he has mentioned that sexual activities must be always performed with suitable protection. The Health Minister unfailingly highlighted his Ministry’s persistence on secure sex in order to put a stop to the proliferation of deadly sexual diseases.

The Health Minister has suggested that Brazilians must enact sex up to five times per week. This will be an effective method to thwart unceasing health crises such as hypertension, diabetes, and cardiovascular difficulties. The Health Minister has emphasized that the Brazilians must dance, perform sex, maintain a steady weight, execute bodily exercises and, most importantly, measure their blood pressure regularly.

Gomes Temporao urged the Brazilians to wolf more fruits, vegetables and legumes and to perform exercises, which includes sex. He declared that whatever he had mentioned about sex was not a joke. He seriously believed that sexual acts do reduce blood pressure.

The Health Minister released these observations on Monday. These observations were explicated by him while he was initiating a national movement against high blood pressure in the Brazilian capital of Brasilia.

The Health Ministry of Brazil has proclaimed that 21.5 percent of the Brazilians suffered from high blood pressure in 2006. This percentage, rather alarmingly, soared to 24.4 percent in 2009.