Simple Psych Prep Improves Test Results

If you feel anxious before taking an important test, writing about your test anxieties for 10 minutes immediately before the exam improves your test results by 10 to 15%, according to a new study.

The study, published last week in Science by researchers at the University of Chicago,  tracked test taking performance over 3 different experiments.

In the first experiment, the researchers tracked 20 college students, divided in two groups, one of which was told to write for 10 minutes on how they felt about the test they were about to take, while the other was told to do nothing during that time. Compared to a previous reference test, the students who sat quietly did worse by 12%, while those who wrote about test anxiety improved their scores by 5%.

In the second experiment, the researchers had 47 college students take the same kind of test, but divided the subjects into three groups, where the third group was asked to write about unrelated subjects for 10 minutes. The scores for the students in the non-writing group and in the group writing about unrelated subjects dropped by 7%, while those for the students writing about test anxiety rose by 4%.

The third experiment tracked a total of 105 9th grade high school students, in two groups, one year apart. Six weeks before a final exam, the researchers surveyed students' anxiety levels. Then, right before the exam, they divided the students in two groups, one of which was asked to write for 10 minutes about their feelings about the test, while the other was asked to think quietly about unrelated topics. In the non-writing group, the subjects with the highest anxiety performed worst. However, in the writing group, the subjects with the highest anxiety performed as well as those will low anxiety. The student with low anxiety performed similarly in both groups.

The study conclusion: if you have significant test anxiety, taking 10 minutes to write about your test taking feelings before the test might significantly improve your test results. The study's main author, Professor Sian Beilock, believes that the method clears the subjects' working memory of latent anxiety and allows their brain to work more efficiently.


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Study Abstract in Science

Big Breakfasts Make You Fatter?

Big breakfasts may not cause you to decrease your overall caloric intake, but may contribute to a higher daily total caloric intake, according to a new study.

The new study, published this week in Nutrition Journal by researchers from the Else-Kroner-Fresenius Center of Nutritional Medicine in Munich, asked 380 participants to keep a precise diary of everything they ate for a period of 10 to 14 days. A "big breakfast" was defined as having 400 calories more than a "small breakfast" (sic). The conclusion? "The results of the study showed that people ate the same at lunch and dinner, regardless of what they had for breakfast," says Dr. Volker Schusdziarra, main author of the study. Big breakfast eaters ended up consuming 400 calories more per day, and a big breakfast did not appear to decrease caloric intake later in the day.

This study appears to contradict the results of a 2008 study, which showed that dieters eating big breakfasts lost more weight. Why the discrepancy? The researchers for the present study point out that the previous study looked at the ratio of breakfast calories vs. total calories, but did not investigate the relationship between breakfast calories and total caloric intake. When we look at the data, however, we also notice that the present study looked at 10 to 14 days' worth of data, analyzing caloric intake only, where the previous study looked at more than 8 months of data, and correlated it with weight gain. The conclusion of the present study do not, therefore, automatically contradict those of the 2008 study. Nutrition experts continue advising people that breakfast is an important part of the daily diet, and that skipping breakfast may lead to further weight gain.

What should you make of this study? Clearly, eating a larger breakfast will not make you eat less during the day.  You should watch your food intake at breakfast as you do at every other meal. But eating more of your daily calories at breakfast, everything else being equal, may still be a winning diet strategy, according to the 2008 study referenced above.

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Study Abstract in Nutrition Journal

New, Low-Risk, Test for Downs Syndrome

A new blood test could radically lower the pregnancy risk of testing for a fetus' Downs Syndrome, according to a new study.

The new study, published this week by researchers from The Chinese University of Hong Kong in the British Medical Journal, tested the accuracy of a new blood test to detect Downs Syndrome on 753 subjects, of which 86 were found to carry a fetus with Downs Syndrome. The new blood test had no false negatives (i.e. it did not show a negative result when the fetus actually had Downs Syndrome), and 3.1% incidence of false positives (i.e. it diagnosed Downs Syndrome in 3.4% of the subjects when that was not really the case). Today, the actual test procedures for Downs Syndrome carry a 1 to 2% risk of miscarriage. The new test relies on a state-of-the-art DNA technique called multiplexed massively parallel DNA sequencing, and requires only a blood test for the mother. It would dramatically reduce the risk of miscarriage, when compared to traditional techniques.

Downs Syndrome is the most common genetic abnormality in fetuses. The risk of a fetus carrying Downs Syndrome is approximately 0.1% for the general population, but goes up very fast with the mother's age, to reach almost 1% for a 40-year old mother. Downs Syndrome means severe genetic retardation for the child, and 90% of the mothers typically elect to terminate their pregnancy when the diagnostic is made. As the diagnostic is more likely when it becomes harder for the mother to experience pregnancy -due to age,- many parents now have to make very difficult choices between the wish to know if the fetus carries Downs Syndrome, and the risk of miscarriage that the present tests carry.

The new test will radically alter the risk proposition. It takes advantage of the fact that the fetus' DNA can be found in the mother's blood, and requires only a very low risk blood test for the mother. If the test is negative, since it has shown no false negatives so far, no more testing is needed. If the test is positive, meaning in only 1-2% of the cases, to absolutely ascertain the presence of Downs Syndrome, the standard test procedure, which carries higher risk, is required. The risk is therefore decreased, for the general population, by 98%, since only positive blood test results require the riskier traditional test.

Traditional tests with a high certainly of results for Downs Syndrome today require invasive procedures. The most common is amniosynthesis, and involves piercing the amniotic sac with a needle to pick up a sample of amniotic fluid. The other test, chorionic villus sampling, also invasive, requires a small piece of the placenta for testing. Both tests carry a 0.5% to 2% risk of miscarriage.

The new test is technically ready for deployment, but is not commercially ready, and would be expensive today. We expect to see it appear in one to two years in the mainstream, by which time it will be significantly cost reduced. It represents a revolution in testing for Downs Syndrome, which, because of the radical decrease in risk of miscarriage, will clearly become the primary approach to Downs Syndrome testing. When amniosynthesis and chorionic villus sampling are typically restricted today to high risk pregnancies (often those of older mothers), we believe that this new technology will make it possible to test all pregnant women, and may largely eliminate Downs Syndrome altogether in the developed world.

Why are we reporting on a test that is no ready for implementation today? We normally only review commercially available tools and techniques. This test represents a remarkable breakthrough for all pregnant couples - a phase of life common to practically all of us. We believe that it is important to spread awareness of this radically better upcoming choice for pregnant couples.

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Study Abstract in the British Medical Journal

CDC: Older Adults Need Shingles Vaccine

The new shingles vaccine (2006) is effective and reduces the incidence of shingles by 55%, according to a new study. The CDC recommends that older adults age 60 and older to get vaccinated against shingles.

The new study, published this week in the Journal of the American Medical Association, surveyed the use of the vaccine among a population of over 75,000 subjects (Kaiser Permanente members in California) who were vaccinated between Jan 1. 2007 and Dec 31, 2009, against a control group of over 225,000 subjects who were not vaccinated. The study showed that the vaccine decreased the incidence of shingles by 55% across all age groups, the incidence of ophtalmic ophthalmic herpes zoster (eye infection by the virus) by 63 percent, and hospitalization by 65 percent. While these numbers might appear low compared to some childhood vaccines which often have success rates in the 80 to 90% range, they are very good for adult vaccines. There were no side effects recorded.

Shingles, also knows as herpes zoster, is caused by the chickenpox virus. The chickenpox virus, which infects approximately 99% of the population that was not vaccinated against it (i.e. all of us above the age of approximately 30), remains dormant in the body, and can reappear tens of years later, typically when the immune system is depressed by stress or sickness. Shingles typically comes with a rash, can be extremely painful for multiple weeks, reoccur several times, and is followed, 10% to 30% of the time, by postherpetic neuralgia, a painful chronic syndrome which cannot always be treated, and which can significantly affect quality of life. The Mayo Clinic estimates that up to 30% of Americans will get shingles in their lifetime.

The probability of getting shingles goes up significantly after age 50, but research for the shingles vaccine is only available for age 60 and up. As a consequence, the CDC recommendation at this time is for older adults above the age of 60 to get vaccinated against shingles. Merck, the manufacturer of the shingles vaccine (brand name Zostavax), has petitioned the FDA to extend its recommendation to populations 50 years old and above.

What should you do about it? If you know anyone affected by the very painful postherpetic neuralgia, it is very unlikely that you will feel the need to ask the question - you probably are right now in line for a vaccination. Merck has not always been able to provide enough vaccine to satisfy demand, and the vaccine is delicate to handle, as it needs to remain frozen until a few minutes prior to injection. Vaccination rates as of now are low. There is enough vaccine right now in the supply chain, and we suggest you get vaccinated as soon as possible, in case a new shortage occurs again.

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Study Abstract in the Journal of the American Medical Association

Full Text Study in the Journal of the American Medical Association 

CDC: What you need to know about the shingles vaccine

Circumcision Cuts HPV, Cervical Cancer Risk

Circumcision significantly decreases the incidence and transmission rate of the Human Papilloma Virus (HPV), according to a new study.

HPV is probably the most common Sexually Transmitted Disease (STD) in existence, before Herpes (HSV), and is commonly assumed to be present in 1/4 to 3/4 of sexually active adults in the US. Some variants of HPV are the primary cause of cervical cancer, while others are associated with anal, penile, head and neck cancers, and with genital warts. Cervical cancer is the second most common form of cancer among women, and a vaccine now exists to be given to pre-sexually active teens. While many HPV infections eventually resolve themselves, HPV is considered incurable. Because of the remarkable prevalence of HPV, impact on its transmission rate is of particular interest. A new study shows very significant results.

The study, published in the prestigious UK Journal The Lancet this week by researchers from Johns Hopkins University, set up two randomized controlled trials (the highest standard for proof of causality), tracking nearly 1,000 couples in Uganda, over a two-year period. The incidence of new HPV infections was 28% lower for women with circumcised partners compared to those with uncircumcised partners. Previous research has shown 32 to 35% decrease of HPV transmission rates to circumcised male partners, compared to uncircumcised male partners. The results of these studies reinforce those obtained in observational studies in the US.

"Male circumcision has now been shown to decrease HIV, herpes simplex virus-2, and HPV infections and genital ulcer disease in men, and also HPV infection, trichomoniasis, and bacterial vaginosis and genital ulcer disease in their female partners," write the authors of the study."Thus, male circumcision reduces the risk of several sexually transmitted infections in both sexes, and these benefits should guide public health policies for neonatal, adolescent, and adult male circumcision programs." "We believe the cumulative scientific evidence supporting circumcision is now overwhelming." adds co-author Dr. Aaron Tobian.

Circumcision rates in the US have seen a dramatic drop in the last ten years. However, new research published in the past ten years has shown very significant inhibition by circumcision of the transmission of various STDs. Neither the Center for Disease Control (CDC) nor the American Association of Pediatrics (AAP) recommend or discourage the practice at this time. WebMD reports, however, that "both the CDC and the AAP are reportedly considering revisions to their infant circumcision policies in light of the new research."

Should this new study impact your attitude towards circumcision? We believe that published outcomes of randomized clinical trials in the past ten years have brought a high level of scientific proof to the advantages of circumcision in the prevention of STDs, and warrant reviewing the pros and cons of the practice. Endorsement of circumcision by the CDC and/or the AAP would make, our opinion, a decision in favor of circumcision based on medical evidence clear cut. The debate on circumcision, however, includes cultural issues which cannot always be brought down to scientific evidence.

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Abstract of the study in The Lancet

Autism-Vaccine Link Study Reported a Fraud

The famous 1998 Wakefield study, documenting for the first time the possibility of a link between autism and vaccines, was faked, according to a new report.

In 1998, Dr. Andrew Wakefield, along with 12 other coauthors, published in the prestigious UK medical journal The Lancet an epochal study documenting a possible link between autism and vaccines through 12 cases. The study was taken up by large groups of understandably anxious parents. It spawned a strong anti-vaccine movement in the US, Canada and the UK, which has resulted in significantly lower vaccination rates, along with increased epidemic rates and childhood deaths.

Unfortunately, the research for the Wakefield study could never be duplicated, and no other mainstream study so far has been able to show a link between autism and vaccines - the few that tried have been strongly criticized for small sample size and methology flaws. In fact, the cause of autism is still largely unknown today. The Wakefield study was highly controversial. Eventually, 10 of the co-authors withdrew their names from the study, and The Lancet itself retracted the original article. Last year, after the longest and most expensive investigation ever, the UK General Medical Council called Dr. Andrew Wakefield "irresponsible" and "dishonest", and recommended that his license to practice medicine in the UK be revoked.

It now appears that the original Wakefield study was not only careless, but also fraudulent. The prestigious British Medical Journal, rival to The Lancet, published this week an investigative report by journalist Brian Deer, reviewing the actual data used by the Wakefield study. The conclusions:

• Patients' selection had not been random but cherry-picked by anti-vaccine campaigners, who recruited the cases
• Study's summary of the case descriptions for every single case (all 12 patients) is contradicted by medical records or by parents' interviews
• Several patients were documented as having symptoms appearing within days of an MMR vaccination, when actual records or interviews show the appearance of symptoms months later - a critical piece of evidence for a causal link
• Study listed 9 patients with a diagnosis of regressive autism, where only one of the them was actually clearly diagnosed with the condition
• Study showed 12 patients are being "previously [to vaccination] normal" when 5 of the already showed symptoms prior to vaccination
• For 9 patients, normal colonic analysis results were changed to "non-specific colitis" after a "research review"
• Most of the parents were looking for financial compensation from vaccine manufacturers

Dr. Wakefield also neglected to mention that he had been recruited as a consultant two years prior to the study publication by an attorney (Richard Barr, from Norfolk, UK) preparing a large scale lawsuit against vaccine manufacturers (for which he was paid more than $600,000 plus expenses for his work), and that, eight months prior to publication, he also had patents out for an alternative measles vaccine, from which he stood to benefit if regular vaccines had been discredited.

The British Medical Journal concludes, in an editorial, that:

• Dr. Wakefield was responsible for the fraudulent representations;
• it is not possible to believe that Dr. Wakefield was simply wrong and incompetent, because misrepresentations are too gross, and all point in the same direction.

Dr. Wakefield denies the conclusions of the reports, and accuses journalist Brian Deer to be paid by vaccine companies.  Brian Deer lists his funding as being from the Sunday Times, UK Channel 4, and the British Medical Journal. He recently appeared on the show American Morning and said that that his motivation was journalistic, while that of Dr. Wakefield was "to make money." Brian Deer's report is the first in a series. We look forward to reading the others.

How should you deal with the consequences from that report? The vaccine hypothesis in the recent rise of autism has frightened many parents. It relied heavily upon an assumption of conspiracy between vaccine companies, public health authorities and doctors associations, and its most significant piece of research, however shaky, was the Wakefield study. With the vaccine hypothesis shattered, we believe that it is essential at this time to protect our children from the known dangers of epidemics.  Check with your family doctor if your children have overdue vaccinations.

Want to read more about it? Try Science Blogs, WebMD Brian Deer Interview, WebMD FAQ, Time Magazine, CNN 1, CNN 2, US News, Seth Mnookin.com, Wall Street Journal, NewYork Times, MNN, CBS/  BNET, Washington Post, MedPage Today, AP, Consumerist, Slate, LA Times, Forbes, Mother Jones, New York Magazine, CNN Blog, Globe and Mail, The Age,  New Scientist,  PointofLaw,  Left Brain/Right Brain UK 1, Left Brain/Right Brain UK 2, Left Brain/Right Brain UK 3, Nature, The Australian, NPR. 

Unfortunately, even after this thorough debunking, many parents who believe in the Wakefield study do not appear to be changing their mind: Montreal Gazette, Age of Autism 1, Age of Autism 2, CNN. 

British Medical Journal: How the case against the MMR vaccine was fixed

British Medical Journal Editorial

British Medical Journal Blog

Babies Fatter from Cow Milk Formula?

Babies fed standard cow milk formula may grow fatter than those fed hypo-allergenic formula, according to a recent study.

The study, published this week in the journal Pediatrics by researchers from the Monell Chemical Senses Center, in Philadelphia, followed a blind clinical trial of 64 newborns. Infants were randomly assigned to two groups, one of which was fed traditional cow milk formula  (the most common type), while the other was fed hypo-allergenic formula. After 7 months, the weight of babies in the first group averaged two pounds over that of babies in the second group. Both formulas have the same amount of calories, and weight differences could not be attributed to length differences.This early difference in weight may predispose infants fed cow milk formula to obesity: "Numerous studies have shown that rapid rates of growth during first year are linked to obesity, metabolic syndrome [and] mortality" says Julie Mannella, Ph.D., principal author of the study.

Most common baby formulas, such as Similac or Enfamil, are based on cow milk. Hypo-allergenic (protein hydrolysate) formulas, such as Nutramigen or Alimentum, are also based on cow milk, but the proteins in the formula have been processed to be less likely to generate allergic reactions. Babies fed formula typically gain more weight than breastfed babies, although weight gain for babies fed hypo-allergenic formula in the study was similar to that of breastfed babies. Hypo-allergenic formula is significantly more expensive than regular formula. Medical authorities strongly recommend breastfeeding as a preferable alternative to formula feeding.

Should you switch to hypo-allergenic formula? The sample size in the study was small, and the cause of the discrepancy in weight gain was not clear. The principal investigator, Julie Manella, when asked, believes that is would be premature to switch on the basis of the study alone. However, suspicion of lactose intolerance would be a good reason to switch despite the price difference.

Research for the study was funded by the U.S. National Institute of Child Health and Human Development.

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Study Abstract in Pediatrics

Daily Aspirin Lowers Death Risk From Cancer

Daily long term use of aspirin significantly lowers the risk of death from a variety of cancers, according to a new study. This effect is stronger when use has been for longer periods of time, increases with age, and is independent of gender and dose.

The study, published yesterday by researchers from Oxford University in the prestigious British journal The Lancet, aggregated the results of eight randomized clinical trials (the highest level of proof), gathering over 25,000 subjects who were followed from between 5 years and 20 years after trial inception. Subjects who had taken aspirin showed a lower risk of overall cancer death by 21%, compared to members of the control group. Risk of lung cancer death went down by 30%, esophageal cancer by 60%, colorectal cancer by 40%, prostate cancer by 10%, and gastrointestinal cancer by 35%. 

The protective effect depended upon the length of daily use and upon the type of cancer. It started at 5 years for oesophageal, pancreatic, brain, and lung cancer, but needed 10 years for colorectal and stomach cancer, and 15 years for prostate cancer. The protective effect increased with duration of use. After 5 years of use, risk of death from any kind of cancer had decreased by 34%. The protective effect was shown to extend up to 20 years after trial inception, when risk of death for solid cancers was lower by 20%, and for gastrointestinal cancer by 35%. The effect was independent of dose, although most trials used low doses around 75mg -baby aspirin dose in the UK, vs 81mg in the US.

The authors of the study had already published a first article in the same journal in October, showing very significant effect for low daily doses of aspirin on the prevention of colon cancer. This additional study greatly generalizes the first one. This is the first time that prevention has been proven to work against cancer. This study, and the one that precedes it, are particularly compelling because they consist in randomized clinical trials, which are the gold standard of proof for statistical causality evaluation.

Some experts, however, caution the public not to put too much into the present study at this stage, and point out two primary limitations. The eight trials used by the study were not looking at cancer, but at heart disease and stroke prevention, and it is only through post hoc (i.e. after the fact) analysis that data processing showed the effect on cancer. There is danger in post hoc analysis because the study was not designed to specifically prove effect on cancer, and other factors may have influenced the results. “If you suddenly go back 20 years later and look at the data, it’s tempting to say the result is because of the drug,” says Dr. Derek Raghavan, chairman of the Taussig Cancer Institute at the Cleveland Clinic. to the Cleveland Plain Dealer. Another weakness of the study is that the subject sample is mostly composed of men.

Should  you start taking daily doses of aspirin? Some experts advise against it at this stage, because of potential dangers resulting from aspirin use, which include hemorrhagic stroke and gastrointestinal bleeding.  "Until these [further] analyses have been done, I think it's very premature to try and advise people. There's a reason statisticians say 'beware the post-hoc analysis,' "says Dr. Raghavan. "There's really no reason for people to rush off to the doctor and say 'Should I be on aspirin?'" "I definitely think we wouldn't want to make any treatment decisions based on this study," says Dr. Raymond DuBois, provost of the M.D. Anderson Cancer Center at the University of Texas.

While the authors of the study did not recommend a change in patients guidelines, the main author, Dr. Peter Rothwell, did mention that medical guidelines "may be updated on the back of these results."  It is interesting to note that Dr. Rothwell, who is 46, decided to start using daily aspirin himself after seeing early study results: "It was looking as though there was something going on, and I thought it was a sufficiently large benefit to be worth doing something about." He adds:"the increased risk of bleeding is about 1 in 1,000 per year, while the decreased risk of cancer is 2,3, or 4 per 1,000 per year." Dr. Rothwell suggested that a daily aspirin regimen is "worth thinking about" if you have a family history of early cancer, that the sensible time to start would be around age 45, and that the regimen should continue for 25 to 30 years, then stop, as bleeding risk goes up very significantly around age 75.  Dr. Peter Elwood of the University of Cardiff, concurs: "There's a small risk of any of us having a gastric bleed... But when you inspect the data…you find that the mortality from the bleed is not increased. In other words, aspirin seems to be increasing the less-serious bleeds." Dr. Ed Kim, lung cancer expert at the M.D. Anderson Cancer Center, says that he will "strongly consider" taking daily aspirin himself, but that he would not automatically recommend this regimen to a patient without discussing the risks along with the benefits. 

What to do in front of seemingly contradictory advice? We find this study very significant. If you are middle-aged and in good health, we advise you to take the first opportunity to talk to your family doctor and discuss a daily aspirin regimen.


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Study Abstract

Daily Aspirin Lowers Colon Cancer Risk

A low daily dose of aspirin taken for the long term lowers the risk of colon cancer by 25%, according to a new study.


The study, published last week my a multinational team of researchers in the prestigious UK journal The Lancet, followed the outcomes of five randomized trials in the UK, Sweden and the Netherlands for a period of 20 years. Over the follow-up period, after taking low doses (75mg per day) of aspirin for about 6 years, subjects had a 24% lower likelihood to be diagnosed with colon cancer, and a 35% lower likelihood to die of the disease. The use of aspirin was particularly beneficial against upper (proximal) colon cancers, which are typically not caught by colonoscopy or sigmoidoscopy. There was no advantage for larger doses than baby aspirin.

The study was particularly powerful because it had a wide patient sample (over 14,000) over three countries, and because, based on randomized trial, it was able to establish causality between the treatment and the effect.

A commentary in the same issue of the journal proposes that the daily use of a low dose of aspirin become a standard suggestion by family doctors. "Anyone with any risk factors such as a family history (of colon cancer) or a previous polyp should definitely take aspirin," said Peter Rothwell,  professor at the University of Oxford, and one of the study's authors. Professor Rothwell believes that the study also "tips the balance" for anyone considering aspirin to prevent heart attacks and strokes.

Some experts cautioned patients not to start taking daily aspirin doses without consulting a doctor first, as it may cause lesions and bleeding in the stomach and intestines when taken over long periods. Low doses of aspirin in the study were 75mg, while baby aspirin doses in the US are 81 mg.

Another study about aspirin, published almost simultaneously with this one, appeared to show aspirin to have a major effect on prostate cancer treatment survival, possibly reducing death rates by 60%, with an 80% mortality reduction from high risk prostate cancers. A different study, also almost simultaneous, reported that aspirin reduces complication from heart surgery when administered immediately preceding the procedure.

Want to read more about it? Try WebMD, the New York Times, USA Today, the Washington Post, or Medscape.

The study in The Lancet

The commentary in The Lancet

AHA Releases New CPR guidelines

After multiple years of evidence that chest compressions alone are statistically at least as efficient as, if not more than traditional CPR, the American Heart Association (AHA) has updated its CPR guidelines.


The new guidelines put much stronger emphasis on chest compressions, and on the urgency to call emergency services. They separate the case of untrained bystanders from emergency personnel and bystanders trained in CPR. Untrained bystanders are encouraged to deliver compression-only CPR (sometimes called CCR). Trained lay-persons and emergency personnel are requested to start with chest compressions, then to clear the airway, then to alternate between 2 breaths and 30 compressions. The new acronym for trained responders is C-A-B: Compression - Airway - Breathing. The guidelines emphasize that chest compressions should be as uninterrupted as possible, and that the patient not be over-ventilated (too much breathing).

The Red Cross, the largest training organization in CPR, has not adopted the AHA recommendations yet.

The new guidelines are somewhat controversial. The past 5 years have seen many studies show the statistical superiority of CCR over traditional CPR. Some voices complain that the new AHA guidelines do not go far enough: "Why do the Guidelines state that, 'Rescuers should avoid stopping chest compressions and avoid excess ventilations' and yet not advocate chest-compression-only CPR?" asks Dr. Gordon Ewy, of Sarver Heart Center at the University of Arizona, a pioneer of CCR, "the 'Guidelines' have lost or are in danger of losing their credibility."

There is general agreement that, for cardiac arrests only, CCR is superior to CPR. For cardiac arrest following drowning, drug overdose, or for children where cardiac arrest is typically consecutive to breathing problems, the use of breaths is generally believed to be valuable or necessary. The controversy focuses on what the general recommendation for CPR should be, and what untrained bystanders should be directed to do in the general case. In general, however, less than one third of all patients undergoing cardiac arrest outside of a hospital setting get any form of CPR, so any progress on the frequency of administration of CPR or CCR would be better.

We postponed the publication of this post to be able to point at good presentations from the AHA on its new guidelines. Unfortunately, one full week after the publication of the new guidelines, the AHA pages on CPR are still a mess, and provide pitiful clarity on the new process. Surprisingly, the AHA does not make it easy to find out what good CPR is... So, not being able to point you at a very clear summary of the new guidelines from the AHA, we give you our own summary of the new process below.


For untrained bystanders, the process is:
1. Call 911, or ask someone to do it for you
2. If the victim does not respond, roll him (or her) on his back.
3. Immediately start administering chest compressions, at least 100 per minute (on the rhythm of Staying Alive, by the Bee Gees), to a depth of 2" for adults and 1.5" for children. Allow full chest recoil after each compression before the next. Keep on administering chest compressions without interruption.

For trained lay-persons, the process is:
1. Call 911, or ask someone to do it for you
2. If the victim does not respond, roll him (or her) on his back.
3. Immediately start administering 30 chest compressions, on a rhythm of at least 100 per minute (on the rhythm of Staying Alive, by the Bee Gees), to a depth of 2" for adults and 1.5" for children. Allow full chest recoil after each compression before the next.
4. Open the airway with a head tilt and chin lift
5. Quickly administer two 1-second breaths with a tight seal
6. Go back to uninterrupted cycles of 30 chest compressions followed by 2 breaths. Minimize interruptions to the chest compressions, and do not over-ventilate the patient.


Want to read more about it? Try the Washington Post,  BBC,WebMD, Chicago Sun Times, CNN, Time Magazine, CBS, USA Today, Business Week HealthDay, KCRG or MedPage Today. You might also want to read our previous post on the state-of-the-art of CPR and CCR.

YouTube new AHA Guidelines

Highlights - New AHA Guidelines (PDF)

Circulation Abstracts - New AHA Guidelines

AHA New C-A-B Graphic (PDF)

AHA 2010 Guidelines FAQs (PDF)

Industry Progress on BPA Phase-Out

Responding to major consumer concerns over the use of Bisphenol A (BPA), many large corporations, including ConAgra and General Mills, have made faster progress than expected in phasing BPA out of their product portfolio, according to a recent report.

BPA is an organic compound frequently used in plastic baby products and food packaging. Scientific evidence has raised the concern of significant development danger in human consumption of food or liquids in contact with BPA containers, without proving danger in clinical trials or cohort studies.


 
The NGO As You Sow, in collaboration with the green tech investment fund Green Century Capital Management, recently published a report grading industry progress in eliminating the use of BPA, company by company. The report shows that, in part due to investment activism, some major companies have made rapid progress in phasing out BPA, as compared with 2009. BPA is present in many plastic products, in general food and liquid containers, and in metal can liners for food packaging.

In particular, Heinz, ConAgra, and Hain Celestial have started using PBA-free packaging, are committed to eliminating BPA, and have a timeline for getting there. General Mills, Nestle, Sarah Lee and McCormick are all committed to eliminating BPAs, and have engaged in large scale tests to identify alternative packaging. Other companies, such as While Foods, Costco, Kellogg, PepsiCo or Smuckers, are making some progress in moving towards PBA-free packaging, but have not demonstrated total commitment or started engaging in alternative packaging tests.

Laggards in the field, who have not committed to eliminating PBAs, include Coca-Cola, Safeway, Del Monte, Kraft, Unilever, Herschey, and Wal-Mart.

BPAs are an unusual case as an environmental concern, because it has not been proven to be nefarious to human consumption in clinical trials. Yet the scientific concerns surrounding it are such that many in the environmental community believe it should be phased out nonetheless. The FDA has recently expressed concern about BPAs, while Canada on October 13 of this year became the first country to officially declare BPA a toxic substance.

We are of two minds about BPA and the controversy around it. On the one hand, all of us at ConsumerPla.net have gotten rid of all of our BPA containers, in particular for those that were in use with our children. At the same time, we are slightly leery of too much legislation being passed before human consequences are proven for BPA. Clearly, it is important to stop the use of potentially nefarious substances before they have a chance to impact a whole generation of children or more, such as what happened with lead paint. And yet, where do you stop before significantly damaging the tissue of our industrial society? We wish we had an answer to that...

Want to read more about it? Try Fast Company and USA Today.

The 2010 BPA Progress report  (PDF) by As You Sow and Green Century Capital Management

The 2009 BPA Progress Report (PDF) by As You Sow and Green Century Capital Management

Progress Report Summary

Babies No Smarter From Fish Oil Pills

Use of fish oil supplements during pregnancy does not appear to improve the baby's mental development or decrease the incidence of post partum depression, according to a new study.

This new study, published this week in the prestigious Journal of the American Medical Association (JAMA) by researchers of the University of Adelaide in Australia, reports on the results of a well designed randomized double blind trial correlating the use of fish oil supplements during pregnancy with the baby's cognitive development and the mother's risk of post partum depression.

Some studies in the past have found a link between higher intake of fish oil and improved cognitive development for the baby along with less incidence of post partum depression for the mother. None of these studies, however, were truly authoritative: some were observational (post facto analysis), while others used small sample sizes. As a result of these studies, many national and international health agencies have come out with recommendations for pregnant women to take fish oil supplements. The key fish oil component is assumed to be docosahexaenoic acid, or DHA.

This study was the first clinical trial of significant size to actually test the causality link between taking fish oil supplements and assumed health and cognitive benefits. It used a double blind randomized trial approach with a statistically large population of subjects. The researchers followed 2,320 women, who were randomly assigned to take 1,500 mg of fish oil pills or of vegetable oil pills (control group), starting on the 21st week of pregnancy. After giving birth, mothers took standard evaluation test for depression 6 weeks and 6 months after giving birth, while 694 children were evaluated at age 6 months.

The conclusions were disappointing. The children's cognitive, language, motor development and social emotional behavior scores were the same across both groups. Of the women in the trial, 9.67% of those who took DHA supplements developed post partum depression, while 11.02% of those in the trial group did. The conclusions of the authors were that DHA supplements did not influence either the baby's cognitive development, of the mother's risk to develop post partum depression, although there appeared to be some positive influence for women at high risk. The researchers conclude: "The results of [this trial] do not support routine DHA supplementation for pregnant women to reduce depressive symptoms or to improve cognitive or language outcomes in early childhood."

Why is the outcome of this study so unexpected to many? Some experts, such as Dr. Emily Orken of Harvard Medical School, suggest that dosage might be a possibility. Some mention that eating fish may be better than taking supplements. The study authors suggest that previous observational studies have other impacting factors, and that past clinical trials might have used too small population samples. Finally, some, like Dr. William Barth of Massachussetts General Hospital, were skeptical all along: “I wish it were so simple, that there was a pill we could take to make our children smarter.”

The study was considered important enough by the Journal of the American Medical Association to warrant an editorial. This editorial recognizes the value of the study, yet suggest that, for now, recommendations to pregnant women not be changed: "For now, pregnant women should take care to get the recommended intake of 200 mg/d of DHA, either by including low-mercury, high-DHA fish in their diets or by taking a daily n-3 PUFA supplement," write Dr. Emily Orken of Harvard Medical School and Dr. Many Belfort of Children's Hospital in Boston for Editorial Board of JAMA.



Want to read more about it? Try Medical News Today,  Reuters, WebMD,  Food Consumer, International Federation of Gynecology and Obstetrics, The Age, the New York Times, US News, Time Magazine, Medscape, the LA Times, and ABC News.

Study Abstract in JAMA

JAMA editorial excerpt

Vitamin B12 May Lower Alzheimer's Risk

A diet heavy in vitamin B12 may lower your risk of developing Alzheimer's disease.

A study published today in Neurology by researchers from Karolinska Institute in Sweden indicates that subjects who consume higher amounts of Vitamin B12 may be better protected from the development of Alzheimer's disease. The researchers followed 271 patients aged 65 to 79, none of which had dementia at the start of the study, for 7 years. 17 of them developed Alzheimer's disease over the duration of the study. After correcting for gender, weight, blood pressure, age, smoking habits, and educations, the study concluded that higher vitamin B12 concentration in the patient's blood was correlated with a lower risk of Alzheimer's disease. The study also found that higher concentrations of the amino-acid homocysteine was associated with a higher likelihood of developing Alzheimer's disease.

Both the authors of the study and specialists commenting on it agreed on the fact that the study was small, preliminary, and by no means definitive. Previous studies on the links between Vitamin B12 and Alzheimer's diseased have had mixed results.

Want to read more about it? Try Medical News Today, WebMD, Medscape, BBC, Medpage Today, hc2d UK,  CNN, BusinessWeek HealthDay, or MSNBC.

Three Healthy Habits Lower Breast Cancer Risk

Three healthy habits contribute to lowering the risk of breast cancer in post-menopausal women, according to a recent study: engaging in regular physical activity,  maintaining a healthy weight, and consuming alcohol in moderation.




The American Cancer Society has long maintained healthy lifestyle recommendations for cancer prevention, concerning diet, exercise and alcohol consumption:

• maintain a body mass index of 18.5 to under 25
• engage in 30 minutes of vigorous exercise at least 5 days per week (45-60 minute sessions are preferable)
• drink no more than one alcoholic beverage per day

A large retrospective study, published this week in Breast Cancer Research by researchers from the University of Rochester, followed more than 85,000 post-menopausal women for over 5 years, and surveyed how well they followed the American Cancer Society recommendations listed above, where the vigorous exercise requirement was lowered to 20 minutes at least 5 days per week. The conclusion? "Whether or not you have a family history, the risk of breast cancer was lower for women engaged in these three sets of behavior compared to women who were not," says principal author Dr. Robert Gramling.

Indeed, the study shows that adherence to these recommendations resulted in approximately 24% lower incidence of breast cancer for women with no family history of breast cancer, and in approximately 14% lower incidence of breast cancer for women with a family history of breast cancer. Dr. Susan Gapstur, vice president of the epidemiology research program of the American Cancer Society, believes that breast cancer risk reduction might be even more significant if vigorous exercise sessions are increased to 45-60 minutes at least 5 days per week.


Want to read more about it? Try CBC News,  HealthDay, NIH Medline, or HealthLine.

The Study in Breast Cancer Research

Body Mass Index Calculator at the National Heart and Blood Institute

American Cancer Society cancer prevention guidelines

Compression-Only CPR is Better

Using a simpler CPR resuscitation technique which only uses chest compressions saves more lives than traditional CPR, according to a new study.


The study, published by researchers from the Arizona Department of Health Services  in yesterday's edition of the prestigious Journal of the American Medical Association (JAMA), reviewed over 4,400 incidents where patients experienced cardiac arrest outside of a hospital setting, and where only bystanders were available to administer CPR. 849 patients received compression-only CPR, while 666 patients received traditional CPR. The other patients did not receive any CPR. Of the patients who received compression-only CPR, 13.3% survived, while 7.8% of those receiving traditional CPR survived. Only 5.2% of those who received no CPR at all survived. The differential between traditional CPR and compression-only CPR shows a 60% advantage for compression-only CPR.

The compression-only CPR process involves calling emergency services and immediately administering at least 100 compressions per minute to the chest - equivalent to the beat of the song Staying Alive, by the Bee-Gees. No breaths are given, and compressions are not interrupted. The traditional CPR process involves calling emergency services, opening the airway and clearing it, then administering in alternance 30 chest compressions and 2 breaths, where chest compressions are given at a rhythm of approximately 100 compressions per minute.

This conclusion of this study only reinforces findings that have been common to many other recent studies:

• In September, a study published in the journal  BMC Medicine by researchers from the University of Michigan concluded that patients who experience sudden cardiac arrest outside of a hospital setting do as well when treated with compression-only CPR as they do when getting immediate defibrillation. 
• In July, two studies testing compression-only CPR were published in the New England Journal of Medicine. One was conducted in Sweden, and covered more than 1,200 incidents. The other one, conducted in Seattle and in London, covered more than 1,900 incidents. Both studies found that chest compression-only CPR was as effective as traditional CPR when dealing with people experiencing a heart attack.
• In 2009, data from the Arizona Center for Health Services from almost 5,000 incidents over 4 years showed that people treated with compression-only CPR were more likely to survive by a margin of 68% compared to regular CPR.

In 2008, on the heels of several years of studies showing the benefits of compression-only CPR, the American Heart Association published a statement recommending that bystanders not confident or trained in CPR call 911 and immediately start chest compression-only CPR. The statement followed the publication, in 2007, of three large studies, each one of which surveyed the outcomes of thousands of instances of CPR practiced by bystanders. Two large scale studies from Sweden and Japan were published in the journal Circulation, the Swedish study covering nearly 10,000 incidents, and the Japanese study covering 4,900 cases. Another Japanese study was published in the journal The Lancet, and covered more than 4,000 cases. All studies showed that the use of compression-only CPR had no worse, and sometimes much better results than that of traditional CPR.

The American Heart Association is expected to soon announce a significant change to its CPR guidelines.

Want to read more about it? Check Medscape, USA Today, iVillage, San Jose Mercury News, Science Daily, ABC News, CBC News, Wall Street Journal, and NIH Medline.

• For the September 2010 study in BMC Medicine, check NIH Medline and Medical News Today
• For the July 2010 studies in the New England Journal of Medicine, check CBS News and  CNN.
• For the 2009 data from Arizona Center of Health Services, check Science Daily
• For the 2008 AHA statement, try Science Daily, WebMD, and Fox News.
• For the 2007 studies, check Science Daily 1 and Science Daily 2.

10/15/2010 Update: a new study published yesterday in the prestigious UK journal The Lancet confirms further the findings of the studies listed above, by analyzing the results of over 3,000 instances of CPR administered by bystanders guided by emergency dispatchers. Survival rates were 22% higher for compression-only CPR than for traditional CPR. More information in  NIH Medline, MedPage Today or Business Week HealthDay.

Study Abstract in JAMA

AHA Hands Only CPR FAQs

Hands Only CPR How To

Light Drinking in Pregnancy OK?

Drinking up to one to two glasses of alcohol per week during pregnancy does not appear harmful to the baby, according to a new study.

The study, published yesterday in the Journal of Epidemiology and Community Health, by researchers from the University College London, is a retrospective study, which followed more than 11,500 children born between September 2000 and January 2002, using data from the UK Millennium Cohort Study. Mothers were classified as non-drinkers altogether, non-drinkers during pregnancy (but drinkers otherwise), light drinkers during pregnancy (i.e. one to two glasses of alcohol per week), moderate drinkers during pregnancy (3 to 6 glasses per week), and binge or heavy drinkers (7 or more glasses per week) during pregnancy. Mothers were interviewed about their child's behavior at age 3, and children were tested for behavior and cognitive development at age 5.

Children of mothers who were light drinkers during pregnancy were 30% less likely to show behavior problems than children of mothers who stopped drinking during pregnancy. When the study was corrected for socio-economic status and other factors, they effect still showed 23% advantage for children of light drinking mothers. Cognitive development was also higher for children of light drinking mothers, even after fully adjusting the study results for mediating factors. "There appears to be no increased risk of behavioral or intellectual problems in their children [at age 5]," says Dr. Yvonne Kelly, study investigator. In fact, says Dr,. Kelly, ""children born to light drinkers seemed to have fewer behavioral problems and higher cognitive scores than those born to moms who didn't drink during pregnancy."

What are the limitation of the study?

• The study is observational only (cohort study), and cannot prove causality - only a randomized double-blind trial could do that.
• There may be mediating factors that were not taken into account when compensating for other factors in the study.
• Subjects self reported their drinking, which may subject this measure to some self reporting bias.

Nevertheless, the sample was large (more than 11,500 children), and the methodology so far has in general not been criticized by outside experts.  In fact, a similar study published in June 2010 in the British Journal of Obstetrics and Gynecology, and  using 14 years' worth of data from the Western Australian Pregnancy Cohort (Raine) Study, reported similar results, not only for children of light drinkers, but also for children of moderate drinkers during the first trimester of pregnancy. "Children of light and moderate drinkers had less emotional and behavioral problems through childhood and adolescence," said Dr. Monique Robinson, from Telethon Institute for Child Health Research in West Perth, Western Australia, as reported in Reuters. 

These studies are not the only ones reporting no harm from light drinking in pregnancy. As early as 1991, Dr. Joel Alpert and Dr. Barry Zuckerman of the Boston University School of Medicine wrote, in the journal Pediatrics in Review, in an analysis of other studies: "Our conclusion is that there is no measurable or documented risk from this level [two or fewer drinks per day] of drinking during pregnancy."

Experts, however, were quick to point out that this study should not be seen as an invitation to drink. "I do not believe we want to establish a precedent that any level of alcohol consumption is okay, because in truth, we really don't know the long-term effects of even light drinking," commented Dr. Marc Lewis, service chief for Women's Health Services at Henry Ford Hospital in Detroit, Michigan, adding: "We know that in the United States, the leading cause of mental retardation is related to fetal alcohol syndrome." Dr. Timothy Naimi, an alcohol expert with Boston University School of Medicine, criticized the study: “These findings are highly implausible, given that ethanol is the world's leading fetal neurotoxin." "Fetal alcohol syndrome has been described in mothers who had a single episode of binge drinking," commented Dr. Ron Jaekle, professor of clinical obstetrics and gynecology at the University of Cincinnati.

What to conclude of all this? You should talk to your doctor before deciding what your drinking behavior should be during pregnancy. The general recommendation in the US is to fully abstain from drinking during pregnancy. It seems, however, from a preponderance of evidence, that light drinking, consisting of one to two glasses of wine or beer per week during pregnancy, is unlikely to cause any development or behavior problem to the child.

Want to read more about it? Try USA Today,  Medscape, CNN, SFGate,  msnbc, FoxNews, iVillage, Montreal Gazette, Bloomberg, the London Times, Business Week/ HealthDay, National Post, Time Magazine, or WebMD.  

Study Abstract

Medical Imaging Radiation Over-Exposure Update

On September 7, we reported a dramatic story discussing numerous incidents of over-exposure to radiation through routine diagnostic CT scans, documented across 3 hospitals in the US, but probably endemic across most radiology departments in the nation. Since that date, over-exposure to radiation has been discovered in 5 additional hospitals.








Today Governor Schwarzenegger of California signed a bill requiring radiology departments to record radiation from CT scans and report to patients and prescribing doctors in cases of over-exposure. The FDA has also broadened it investigation, and is expected to publish its conclusions soon. Congratulations to the New York Times for breaking this important story.

Original New York Times story

Original ConsumerPla.Net story

Light, Healthy Belgian Waffles: Recipe

Wouldn't it be great if we cook prepare the dishes we like best, yet make them so healthy that they can be a mainstream feature of our diet? In this rare instance, we share a new recipe from our test kitchen: a truly delicious Belgian waffle recipe, that is light, airy, and sweet, yet uses exclusively whole grains, with no refined flour, sugar, or butter. This recipe makes 6 large waffles or 8 waffle boats.



Recipe rating: Easy


Total recipe time: 25 minutes

15 minutes prep (mostly beating egg whites)
10  minutes cooking (making the waffles)

Ingredients

8 ounces regular whole wheat flour (we use Gold Medal in our test kitchen, but other brands would work as well)
1 tablespoon of baking powder
1 bag Stevia or Splenda (may be replaced by one teaspoon of sugar)
1/2 teaspoon of salt
3 eggs
1.5 cups of milk
2 tablespoons of canola oil
Fresh berries and fruits, frozen yogurt, or, if you are ready to go a little more processed, sugar-free syrup (for instance Hungry Jack sugar-free syrup, with sugar alcohols), sugar-free jam (for instance Smucker's sugar-free jams), or any other topping you like.

Equipment

Mixing bowls: 1 small, 1 medium (the test kitchen uses stainless steel bowls)
Small cup (to temporarily store egg whites)
Measuring spoons and cups
Eggwhite whip (to mix all, and to beat egg whites up)
Baking spatula(to fold the egg whites into the rest of the batter)
Brush (to brush the waffle maker with oil)
Ladle (to pour batter into the waffle maker)
Very thin fish spatula (to take out the waffles from the maker)
Waffle maker, stovetop or electric

Prep

• 0"    Measure and mix whole wheat flour, baking powder, salt in medium bowl.
•        Measure and mix milk, canola oil.
• 2"    Crack and separate eggs, drop yokes into wet (small) bowl, drop whites into small cup.
•        Pour wet bowl contents into medium bowl, mix with whip.
•  4"   Beat egg whites up until they are stiff with the whip (of course, you can also use a mixer).
•  10" Start heating the waffle maker.
•  Fold stiff egg whites into the medium bowl with the baking spatula. You might need to complete the mixing carefully with the whip afterwards, but be careful not to destroy the stiff egg whites, or you will lose the airy, lose texture of the batter.
•  15" End of prep.

Cooking

• 15" Oil the waffle maker with the brush. 
•        Pour the first set of waffles with the ladle, pouring until the batter reaches just a tad below the top of the waffle mold. If you are using electric waffle maker, because of the texture of the mix we suggest, as a start, using approximately 75% heat, and leaving the waffles approximately 30 seconds after the beep. You can adjust as needed after the first batch. 
•        If you have trouble taking out the waffles (we tried first with some tongs), trying inserting the thin fish spatula (we use a Sweden-made Gastromax) on the side of the waffle and filling it out: it will come out with no tearing. 
•        Oil the waffle maker between batches before refilling it with batter.
•  25" End of cooking.

Spoon some fresh, clean berries on the waffles, and add some Cool Whip Lite, or drip some sugar-free syrup or jam, and enjoy the delicious, light, airy yet healthy results:-)