For very a decade, the public has heeded warnings of suicidal behavior related to antidepressant use in kids and adolescents. However, the use of antidepressants in this population is still increasing. Initially, selective serotonin reuptake inhibitors (SSRIs), the most common class of antidepressants prescribed for kids, were the only drugs associated with the increase in suicidal behavior. Now, a huge cohort study published in a recent issue of Pediatrics reports that there is no difference in the risk of suicidal behavior among different SSRIs or difference classes of antidepressants.
The United States Food and Drug Administration (FDA) issued a public warning in October 2004 that cautioned about an increase in suicidal thoughts and behaviors in kids and adolescents taking SSRIs. Later, the FDA necessary a “black box warning” — the most serious type of warning obtainable — be placed on the labeling of SSRIs detailing the increased suicidal risks. The warning came after a 2007 study in the Journal of the American Medical Association found that the risk of suicidal thoughts and attempts in young patients taking SSRIs was once the rate of patients taking placebo.
However, plenty of patients, parents and prescribers were skeptical of the results and the use of SSRIs in kids and adolescents has continued to increase over the past several years. Several studies and reviews since the issuance of the FDA’s warning have not duplicated the increased suicidal behavior, and plenty of clinicians and patients feel that the benefits of antidepressant therapy outweigh the risks. A landmark study funded by the National Institute of Mental Health, the Treatment for Adolescents with Depression Study (TADS), concluded that a combination of fluoxetine (an SSRI) and psychotherapy is the most effective treatment for depression in young patients.
Several studies have also analyzed the relationship between antidepressant use in adults and suicide risk, but have yielded conflicting results. Further, several huge studies found no increase in suicidal behavior in young people, either. One study even reported that SSRI use was associated with decreased suicidal behavior in kids and adolescents.
Tuesday, June 15, 2010
Good Health Equals Good Sex
Sexuality is an important component of overall health and quality of life. An active sex life can reduce stress, strengthen the immune system, improve cardiovascular health and promote longevity. Not only does sex lead to health benefits, but good health leads to improved sexuality. A recent British Medical Journal (BMJ) report concluded that the better one’s health, the more sex he or she can look forward to later in life.
Sexual health is important throughout a person’s life, and older age is no exception. Unfortunately, sexual activity and function declines with age in both men and women owing to a combination of biological, psychological, and cultural factors. Approximately half of sexually active middle-aged and elderly adults in the United States report at least one bothersome sexual problem; one-third of this population reports at least two problems. The most prevalent problem for women is low desire, while men complain most often of erectile dysfunction.
Fortunately, older adults who wish to remain sexually active have an armamentarium of products and medications to treat sexual dysfunction. Additionally, being in good overall health improves sex and prolongs sexual life expectancy. The BMJ study analyzed two cohorts of more than 3000 adults each and assessed the anticipated number of years remaining of sexually active life for different gender and age groups. Overall, men were more likely to report being sexually active, enjoying a good quality sex life, and having an interest in sex in all age groups. In the study populations, 39% of men and 17% of women were still sexually active at age 75 to 85 years old. Of those who were sexually active, nearly 71% of men and 51% of women reported a good quality sex life, and 41% of men and 11% of women were interested in sex. For all age groups, both men and women in self-reported “very good” or “excellent” health were nearly twice as likely as their unhealthier peers to be sexually active. Good health was also associated with increased frequency of sex, as well as sexual desire.
The good news for healthy, younger adults is that they can look forward to many years of a sexually active life. The average sexually active life expectancy for a 30-year-old today is nearly 35 years for a man and 31 years for a woman. A 55-year-old man today can still anticipate 15 more years of a sex life, while a woman can expect a little more than 10 years. At age 55, men in very good or excellent health can expect an additional 5 to 7 years of sexually active life, compared to their peers in fair or poor health; women in very good or excellent health can expect 3 to 6 additional years of an active sex life.
The good news from the BMJ study for older adults is that if they are already enjoying a healthy sex life, there are many more years of sexual activity ahead. But, if they are not enjoying a healthy sex life, there is hope: make sexual health a part of overall health. Identifying factors that contribute to good health, and good sexual health, are important for physicians to discuss with patients. A minority of middle-aged and elderly patients report discussing sexual health or function with a physician since the age of 50, despite advances in treating sexual dysfunction in both men and women. Similarly, maintaining cardiovascular health, controlling diabetes, or treating depression can improve sex — all components of overall health that physicians should be addressing anyway. Good health leads to good sex, and good sex leads to good health. That is a cycle that most adults can support.
Sexual health is important throughout a person’s life, and older age is no exception. Unfortunately, sexual activity and function declines with age in both men and women owing to a combination of biological, psychological, and cultural factors. Approximately half of sexually active middle-aged and elderly adults in the United States report at least one bothersome sexual problem; one-third of this population reports at least two problems. The most prevalent problem for women is low desire, while men complain most often of erectile dysfunction.
Fortunately, older adults who wish to remain sexually active have an armamentarium of products and medications to treat sexual dysfunction. Additionally, being in good overall health improves sex and prolongs sexual life expectancy. The BMJ study analyzed two cohorts of more than 3000 adults each and assessed the anticipated number of years remaining of sexually active life for different gender and age groups. Overall, men were more likely to report being sexually active, enjoying a good quality sex life, and having an interest in sex in all age groups. In the study populations, 39% of men and 17% of women were still sexually active at age 75 to 85 years old. Of those who were sexually active, nearly 71% of men and 51% of women reported a good quality sex life, and 41% of men and 11% of women were interested in sex. For all age groups, both men and women in self-reported “very good” or “excellent” health were nearly twice as likely as their unhealthier peers to be sexually active. Good health was also associated with increased frequency of sex, as well as sexual desire.
The good news for healthy, younger adults is that they can look forward to many years of a sexually active life. The average sexually active life expectancy for a 30-year-old today is nearly 35 years for a man and 31 years for a woman. A 55-year-old man today can still anticipate 15 more years of a sex life, while a woman can expect a little more than 10 years. At age 55, men in very good or excellent health can expect an additional 5 to 7 years of sexually active life, compared to their peers in fair or poor health; women in very good or excellent health can expect 3 to 6 additional years of an active sex life.
The good news from the BMJ study for older adults is that if they are already enjoying a healthy sex life, there are many more years of sexual activity ahead. But, if they are not enjoying a healthy sex life, there is hope: make sexual health a part of overall health. Identifying factors that contribute to good health, and good sexual health, are important for physicians to discuss with patients. A minority of middle-aged and elderly patients report discussing sexual health or function with a physician since the age of 50, despite advances in treating sexual dysfunction in both men and women. Similarly, maintaining cardiovascular health, controlling diabetes, or treating depression can improve sex — all components of overall health that physicians should be addressing anyway. Good health leads to good sex, and good sex leads to good health. That is a cycle that most adults can support.
Health Behaviors More Important than Socioeconomic Status
Many studies have reported that socioeconomic status is a predictor of morbidity & mortality. Now, a large-scale, longitudinal study asserts that the association may be more related to health behaviors than socioeconomic status. The study, published in the Journal of the American Medical Association (JAMA), reports that assessment of health behaviors over time diminishes the association between socioeconomic status & mortality.
The present study makes use of information from the Whitehall II study — a long-term follow-up study of over 10,000 British civil servants aged 35 to 55 years. Information was collected from 1985 until April 2009. Of the 9590 men & ladies included in the JAMA evaluation, there were 654 deaths in the work of the follow-up period. To assess the contribution that health behaviors have towards the association between socioeconomic status & mortality, the authors used civil service employment grade as an indicator of socioeconomic status, & measured health behaviors — smoking, alcohol consumption, diet, & physical activity — at 4 points in the work of follow-up.
Overall, the risk of all-cause mortality was 1.6 times higher in the lowest socioeconomic status group versus the highest, amounting to 1.94 deaths per 1000 person-years. However, this association between socioeconomic status & death was weakened when adjusted for health behaviors: 42% weaker when only baseline health behaviors were thought about & 72% weaker when time-dependent health behaviors were thought about. Adjusting for health behaviors also decreased the association between socioeconomic status & specific causes of death. When assessed only at baseline, the association was weakened by 29% for cardiovascular mortality, versus 45% when health behaviors were assessed over time. Similarly, the association between socioeconomic status & noncardiovascular & noncancer mortality decreased by 61% when health behaviors were analyzed at baseline versus 94% when thought about over time.
These differences in associations of mortality reflect the effect of lifestyle changes on all-cause mortality. Likewise, the effect of diet was increased from 7% to 17% when health behaviors were thought about at baseline versus over time, respectively. The corresponding explanatory power of physical activity on all-cause mortality increased from 5% to 21%, & that of alcohol consumption increased from 3% to 12%. The role of smoking did not change the association between socioeconomic status & all-cause mortality.
The prevalence of unhealthy behaviors is high among lower socioeconomic groups, & they contribute to increased morbidity & mortality. Until this study, most evaluations of socioeconomic status & morbidity & mortality only assess health behaviors at baseline; this study emphasizes the effect of changing health behaviors on mortality, irrespective of socioeconomic status. Health behaviors likely play a bigger role than socioeconomic status in all-cause mortality, according to the authors.
However, inequalities in health behaviors, policies & interventions exist, which are correlated to socioeconomic status. So, which comes first? Are health behaviors socially patterned & predetermined , leading to maintenance of a positive socioeconomic status? Or, do inadequate health policies & interventions among low socioeconomic groups lead to poor health behaviors? Does basically the stress associated with having low socioeconomic status influence poor health behaviors? Lots of recent studies describe associations between low socioeconomic status & higher all-cause mortality, as well as specific cancer-related deaths, kidney transplant failure & mortality, & heart transplant rejection, but fail to identify the root of the association.
Since the current analysis of the association between socioeconomic status & mortality appears to be attenuated by changing health behaviors, health policies & interventions among low socioeconomic groups ought to focus on health schooling & affecting change in populations that have notoriously poor health behaviors.
The present study makes use of information from the Whitehall II study — a long-term follow-up study of over 10,000 British civil servants aged 35 to 55 years. Information was collected from 1985 until April 2009. Of the 9590 men & ladies included in the JAMA evaluation, there were 654 deaths in the work of the follow-up period. To assess the contribution that health behaviors have towards the association between socioeconomic status & mortality, the authors used civil service employment grade as an indicator of socioeconomic status, & measured health behaviors — smoking, alcohol consumption, diet, & physical activity — at 4 points in the work of follow-up.
Overall, the risk of all-cause mortality was 1.6 times higher in the lowest socioeconomic status group versus the highest, amounting to 1.94 deaths per 1000 person-years. However, this association between socioeconomic status & death was weakened when adjusted for health behaviors: 42% weaker when only baseline health behaviors were thought about & 72% weaker when time-dependent health behaviors were thought about. Adjusting for health behaviors also decreased the association between socioeconomic status & specific causes of death. When assessed only at baseline, the association was weakened by 29% for cardiovascular mortality, versus 45% when health behaviors were assessed over time. Similarly, the association between socioeconomic status & noncardiovascular & noncancer mortality decreased by 61% when health behaviors were analyzed at baseline versus 94% when thought about over time.
These differences in associations of mortality reflect the effect of lifestyle changes on all-cause mortality. Likewise, the effect of diet was increased from 7% to 17% when health behaviors were thought about at baseline versus over time, respectively. The corresponding explanatory power of physical activity on all-cause mortality increased from 5% to 21%, & that of alcohol consumption increased from 3% to 12%. The role of smoking did not change the association between socioeconomic status & all-cause mortality.
The prevalence of unhealthy behaviors is high among lower socioeconomic groups, & they contribute to increased morbidity & mortality. Until this study, most evaluations of socioeconomic status & morbidity & mortality only assess health behaviors at baseline; this study emphasizes the effect of changing health behaviors on mortality, irrespective of socioeconomic status. Health behaviors likely play a bigger role than socioeconomic status in all-cause mortality, according to the authors.
However, inequalities in health behaviors, policies & interventions exist, which are correlated to socioeconomic status. So, which comes first? Are health behaviors socially patterned & predetermined , leading to maintenance of a positive socioeconomic status? Or, do inadequate health policies & interventions among low socioeconomic groups lead to poor health behaviors? Does basically the stress associated with having low socioeconomic status influence poor health behaviors? Lots of recent studies describe associations between low socioeconomic status & higher all-cause mortality, as well as specific cancer-related deaths, kidney transplant failure & mortality, & heart transplant rejection, but fail to identify the root of the association.
Since the current analysis of the association between socioeconomic status & mortality appears to be attenuated by changing health behaviors, health policies & interventions among low socioeconomic groups ought to focus on health schooling & affecting change in populations that have notoriously poor health behaviors.
Survive the A-Bomb, Die Prematurely from Stroke and Heart Disease
The survivors of the World War II atomic bombings of Hiroshima & Nagasaki may have thought about themselves lucky, at least at first. Soon thereafter, however, those who didn’t die from radiation poisoning learned that the radiation from the bombings placed themselves & their babies at increased risk of cancer. Now, they can add heart illness & stroke to their list of potential medical issues.
A recent article in the British Medical Journal (BMJ) examined the rates of death from heart illness & stroke in survivors of these bombings based on their distance from the epicenter & later calculated radiation exposure. It found that those exposed to higher doses of radiation had an increased risk of both stroke & heart illness, with excess relative risk per grey of radiation of 9% for the former & 14% for the latter. Correcting for other habits known to be associated with both conditions had no impact on their findings, proposing that the radiation alone was responsible for their findings.
While no one anticipates another atomic bombing, the results of this study are still relevant due to the widespread exposure of individuals to radiation from medical diagnostic tests such as CT scans. According to a publication from the Health Physics Society, the standard CT scan of the pelvis delivers about 10 mSv of radiation (by comparison, people are exposed to 3 mSv from natural background radiation yearly). An angioplasty can deliver up to 57 mSv. Not only that, it's become increasingly apparent that even modern radiologic equipment is liable to failure, with recent reports of patients receiving several-fold greater doses of radiation than intended. Two times felt to be administered with doses of radiation low to cause any long-term ill effects, such tests are likely to come under increased scrutiny as potential causative agents in heart issues
A recent article in the British Medical Journal (BMJ) examined the rates of death from heart illness & stroke in survivors of these bombings based on their distance from the epicenter & later calculated radiation exposure. It found that those exposed to higher doses of radiation had an increased risk of both stroke & heart illness, with excess relative risk per grey of radiation of 9% for the former & 14% for the latter. Correcting for other habits known to be associated with both conditions had no impact on their findings, proposing that the radiation alone was responsible for their findings.
While no one anticipates another atomic bombing, the results of this study are still relevant due to the widespread exposure of individuals to radiation from medical diagnostic tests such as CT scans. According to a publication from the Health Physics Society, the standard CT scan of the pelvis delivers about 10 mSv of radiation (by comparison, people are exposed to 3 mSv from natural background radiation yearly). An angioplasty can deliver up to 57 mSv. Not only that, it's become increasingly apparent that even modern radiologic equipment is liable to failure, with recent reports of patients receiving several-fold greater doses of radiation than intended. Two times felt to be administered with doses of radiation low to cause any long-term ill effects, such tests are likely to come under increased scrutiny as potential causative agents in heart issues
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