America's healthiest schools ranked

Schools today are recognizing the many benefits of a healthy head start -- and Health magazine wants to recognize the ones that are doing an A+ job. Education officials in every state offered nominations; the magazine scored those based on how they measured up to some tough criteria. Congratulations to all of the inspiring winners! full story

Don't Take a Vacation From Healthy Eating

(HealthDay News) -- Even though it's summertime, children shouldn't be allowed to take a vacation from healthy eating habits, advises Dr. Sarah Armstrong, a pediatrician at Duke University Medical Center.

"Routines go haywire, and with nothing to do after a few days in the pool, kids head straight for the refrigerator or snack bar, because they think they're hungry, when they're actually just bored," Armstrong said in a university news release.

Add in things like regular servings of ice cream to beat the heat, hot dogs at the ball park, and funnel cake at the fair, and you have a summer-long binge of bad eating that can lead to weight gain.

Armstrong offered parents a number of ways to prevent their children from packing on excess pounds this summer.

Make sure kids get enough sleep. Research shows that late nights and sleeping in are known risk factors for weight gain. "When kids stay up late, they are more likely to watch TV and snack on dense, low-nutrient foods," Armstrong said.

In addition, a shorter night's sleep limits the body's production of leptin, a hormone that promotes satiety. Lower levels of leptin mean children wake up feeling more hungry and are quicker to grab high-carbohydrate, calorie-rich foods.

When children wake up, encourage them to eat healthy breakfasts that include things such as fruit smoothies, high fiber cereal or a peanut butter and jelly sandwich on whole wheat bread.

Take a holiday from fast foods. Instead of going to a burger joint, pack a picnic with healthy foods such as turkey sandwiches and salads and go to the park or beach. Armstrong said it's important to "incorporate protein in every meal. It releases relases insulin at a slower rate, and that keeps your blood sugars -- and your energy level -- constant throughout the day."

Parents should check out the menu at their child's summer camp. If the meals and snacks aren't acceptable, pack your child a healthy lunch that includes things such as lean lunch meats, raw vegetables and whole wheat crackers.

During the summer, parents also need to limit their children's consumption of sweets and make sure kids are active.

More information
The Nemours Foundation has more about children and healthy eating.

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Marijuana Use Among MS Patients Raises Risk for Cognitive, Mood Problems

(HealthDay News) -- Multiple sclerosis patients who smoke marijuana in search of symptom relief are more likely to suffer cognitive shortfalls and mood disorders, new Canadian research suggests.

A slowing down in the ability to process and remember information is one significant side effect, as is a rise in the rate of depression and anxiety.

"This is a small study, so our findings are preliminary, but the bottom line is that multiple sclerosis patients who smoke cannabis appear to be at an increased risk for cognitive issues, particularly with respect to the speed of their thinking," said study author Dr. Anthony Feinstein, a professor of psychiatry with the Sunnybrook Health Sciences Centre's department of psychiatry at the University of Toronto.

Feinstein's observations are published in the Feb. 13 online edition of Neurology and are focused exclusively on the impact of smoking marijuana illegally obtained by patients themselves. Medically prescribed marijuana was not studied.

The authors noted that a "significant minority" of multiple sclerosis patients smoke marijuana to combat the tingling, numbness, blindness and paralysis that can accompany the progressive and often disabling nervous system disease.

However, Feinstein's team stressed that scientists have yet to definitively prove that the psychoactive substance -- long linked to psychosis, anxiety and delirium among healthy users -- provides a measurable benefit to the more than 400,000 Americans and 2.5 million people worldwide who suffer from the disease.

The researchers therefore assessed the experience of 140 Toronto-based MS outpatients, 10 of whom had smoked the drug at least once in the previous month and were considered regular marijuana users.

All the patients -- three-quarters of them women -- underwent cognitive and mental health exams by a neurologist and a neuro-psychiatrist. Interviews were also conducted to assess disease severity and course, medications being used, and current disability.

Feinstein and his team observed that while pot smokers were younger, there were no differences between marijuana users and nonusers in terms of gender, education, or MS disease course or duration.

However, MS patients who used marijuana were found to perform 50 percent slower on tests tracking information-processing speed and were more likely than nonusers to have a mental disability of some kind.

Marijuana use was also associated with a greater risk for being depressed or experiencing anxiety. However, the authors were not able to determine whether the drug had triggered such conditions, or if patients had sought out marijuana to help deal with a preexisting emotional issue.

They nonetheless cautioned that smoking marijuana might further raise the risk for experiencing the kind of neuro-psychological impairment that typically occurs among 40 percent to 65 percent of all MS patients.

Feinstein said that he next hopes to gather a much larger pool of patients, while exploring possible differences in the health impact of street-purchased marijuana versus prescribed cannabis.

Meanwhile, Dr. Marshall Keilson, director of neurology at Maimonides Medical Center in Brooklyn, N.Y., said he thinks it best to proceed on a case-by-case basis.

"There are some MS patients who are emotionally disabled from their disease, and if we can use cannabis to help them feel better about the world or life, we should," he said. "We need to always err on the side of doing what's best for our patients. And I don't necessarily believe there is a permanent damage to the brain, based on occasional marijuana use. If they're smoking 10 times a day, yes, there will be damage done. But this goes for excessive alcohol use, too. So, I think we're going to end up somewhere in the middle with this."

More information
For more on multiple sclerosis, visit the National Multiple Sclerosis Society.

Antiretroviral Drugs May Prevent Vaginal Transmission of HIV

(HealthDay News) -- Antiretroviral drugs used to treat people with HIV might also prevent vaginal transmission of the virus, claims a study by researchers at the University of Texas Southwestern Medical Center at Dallas.

The vast majority of new HIV infections worldwide, which total about 6,800 new transmissions daily, occur through unprotected vaginal sex with an infected partner.

For this study, the researchers used special mice with fully developed human immune systems that produced the infection-fighting cells specifically targeted by HIV in people. The Texas team found that daily doses of antiretroviral drugs before and after exposure to HIV can prevent vaginal transmission of the virus.

HIV was introduced vaginally into the mice. None of the mice that received the antiretroviral drugs emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) showed any evidence of infection, while 90 percent of mice that didn't receive the drugs became infected by HIV.
The study was published in the Jan. 14 online issue of PLoS Medicine.

"Our motivation is to look for interventions that can be implemented rapidly and have the potential to make a big difference," senior study author Dr. J. Victor Garcia-Martinez, a professor of internal medicine, said in a prepared statement.

"We don't want something in 10 years. We want female-controlled prevention measures now. Our observations support the potential for antiviral drugs to function as an effective pre-exposure prophylaxis against the further spread of AIDS," Garcia-Martinez said.

More information
The New Mexico AIDS Education and Training Center has more about HIV/AIDS drugs.

Dementia Diagnosis Typically Means Death Within Five Years

(HealthDay News) -- People with dementia survive an average of four and a half years following their diagnosis, new British research shows.

However, age, sex and any existing disability can alter life expectancy, according to the report in the Jan. 11 online issue of the British Medical Journal.

Common socioeconomic influences, such as marital status, social class and living in a community or residential home, did not appear to have an influence on longevity, the study found.

Researchers analyzed data on more than 13,000 people aged 65 and older who took part in a population-based study in England and Wales and were regularly assessed for dementia between 1991 and 2005.

During the 14-year study period, 438 of the participants developed dementia and 356 (81 percent) of those people died.

Dementia is known to be associated with increased risk of death, but considerable uncertainty exists about what influences survival. Worldwide, the number of people with dementia is estimated to reach 81 million by 2040.

The study found a nearly seven-year difference in survival between the youngest and oldest dementia patients -- 10.7 years for those aged 65 to 69 and 3.8 years for those aged 90 and older.

The average survival time after dementia diagnosis was 4.6 years for women and 4.1 years for men.

People who were the most disabled at the time of diagnosis lived about three years less than those who were the least disabled.

People with more education had a slightly shorter length of survival than those with less education, but researchers said the difference was not statistically significant.

Understanding factors that affect survival time after a dementia diagnosis may help health-care providers, patients, caregivers and policymakers, the study authors said.

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about dementia.

Breast Is Best for Reducing Stress

(HealthDay News) -- Breast-feeding is considered a great way for a mother to form a close bond with her infant. And now there's evidence to suggest it may also help kids be more resilient to stress.

Researchers in Sweden and the United Kingdom examined data on almost 9,000 children born in Great Britain in 1970. Relevant information was collected at birth and again at ages 5 and 10 from parents, teachers, health-care workers and midwives.

Teachers were asked to rate the kids' anxiety levels on a zero-to-50 scale at age 10. And parents were asked about major life events -- including divorce or separation -- that occurred when their children were between 5 and 10 years old.

Not surprisingly, children whose parents had divorced or separated were more likely to have high anxiety. But what the researchers found striking was the difference in stress levels between breast-fed and bottle-fed kids. Breast-fed children were significantly less anxious than kids who hadn't nursed at their mother's breast.

Lead author Scott Montgomery, an associate professor at the Karolinska Institutet in Stockholm, said the research team was interested in examining whether there are any specific early-life exposures that make children better able to cope with stress later in life. The study attempted to replicate animal studies that showed close physical contact between a mother and her offspring may have a positive impact on the development of the offspring's stress response, he said.

"The best marker of maternal physical contact in the first month of life that we could find among the research information at our disposal was breast-feeding," Montgomery said.

The American Academy of Pediatrics recommends that healthy women exclusively breast-feed their infants for at least the first six months of life and continue breast-feeding "for at least the first year of life and beyond for as long as mutually desired by mother and child."

Breast-feeding offers many health and development benefits for baby, says the National Institute of Child Health & Human Development. Kids get the right balance of nutrients to support optimal growth, fatty acids to promote brain development and protection against many childhood illnesses. And there are important emotional and physical benefits for moms as well.

"There is no question that breast-feeding is better for the health of mothers and children," said Nicole Else-Quest, an assistant professor of psychology at Villanova University in Pennsylvania, "but it is less clear how breast-feeding affects the mother-child relationship." Breast-feeding may help to establish an early bond, she added, but "it is only one of many ways to do so."
As for why there might be differences in stress between breast-fed and bottle-fed kids, Else-Quest said it is difficult to speculate "given that many factors influence the decisions to breast-feed in the first place."

The research team considered factors that might affect a child's reaction to stress and ability to cope, such as maternal depression, parental education levels, social class, and smoking habits. Even after accounting for those factors, breast-fed children were less anxious than their peers. In addition, bottle-fed children whose parents divorced were more anxious than breast-fed kids.
Yet the study findings don't prove that breast-feeding itself reduces anxiety. It may be a mark of close, early physical contact, the researchers noted.

"A child without such regular contact may perceive greater danger reacting to stress -- indicating a potentially dangerous situation -- with a more reactive and less well-controlled stress response," Montgomery said.

It's also possible, he added, that mothers who breast-fed simply have a better relationship with their child.

"The parent-child relationship influences the child's health and development in many ways," Montgomery said. "A good relationship with parents is important, and this relationship begins in infancy, so good early contact with the child is important."

The study findings were published in the journal Archives of Disease in Childhood.

More information
The National Institute of Child Health & Human Development has the latest research on breast-feeding.

Sleep Problems Plague the Older Set

(HealthDay News) -- Older Americans often have difficulty getting a good night's rest. It's a huge quality-of-life problem, experts say, because contrary to popular belief, seniors require about the same amount of sleep as younger adults.

"Sleep problems and sleep disorders are not an inherent part of aging," said Dr. Harrison G. Bloom, a senior associate at the International Longevity Center-USA and associate clinical professor of geriatrics and medicine at the Mount Sinai School of Medicine in New York City.

"It's pretty much of a myth that older people need less sleep than younger people."

Yet, in a study published recently in The American Journal of Medicine, researchers found that more than half of older Americans have problems getting the shuteye they need.

Older people tend to have "sleep fragmentation," meaning they wake up more often during the night, said study author Dr. Julie Gammack, an assistant professor of medicine in the Division of Geriatric Medicine at St. Louis University.

They also seem to get less "REM" sleep, the type of sleep during which rapid eye movement occurs, Bloom added.

It's unclear what role these naturally occurring changes in sleep patterns have on a person's quality of life, Bloom said. "What is important, though, is that older people often have actual sleep disorders and problems with sleep," he said.

And, experts say, there is usually more than one cause.

"Sleep disturbance in older adults is typically associated with acute and chronic illnesses, including specific sleep disorders like sleep apnea and restless leg syndrome that appear with greater frequency in older populations," said Michael V. Vitiello, a professor of psychiatry and behavioral sciences and associate director of the University of Washington's Northwest Geriatric Education Center.

As people age, they typically develop more diseases and suffer from aches and pains. "These things can disrupt sleep, so what they may perceive as a sleep disorder may actually relate to the effects of some of their other medical problems," Gammack noted.

Taking multiple medications, as many older people do, can also lead to fatigue and "hypersomnia," or being tired all the time, Bloom added.

Another big problem, he noted, is depression and anxiety. "Those are very commonly associated with sleep problems."

Despite the prevalence of sleep difficulties in older adults, many patients aren't getting the help they need.

"The average physician receives very little training about sleep disorders and typically does not routinely screen patients for them," said Vitiello, who serves on the board of directors of the National Sleep Foundation. This may be due to a lack of time or training or the belief that there is little that can be done to improve sleep, he explained.

As a result, problems like insomnia, restless leg syndrome, sleep apnea and circadian rhythm disorders are underdiagnosed and undertreated, Bloom said.

To rectify the problem, a national coalition of aging, geriatric medicine and sleep organizations is currently developing guidelines to promote prevention, diagnosis and treatment of sleep problems in older adults. The National Coalition for Sleep Disorders in Older People expects to publish its recommendations by mid-2008.

"The reason we're concerned with these [problems], besides a major issue on quality of life and being tired the next day and not functioning properly, is that these sleep disorders are associated with hypertension, diabetes, pulmonary disease, heart disease, depression and anxiety," said Bloom, chairman of coalition's expert task force.

A cause-and-effect relationship has yet to be established between sleep disorders and these chronic health problems, but Bloom suspects they at least contribute to each other. And he believes a causal relationship may be found in years to come.

"This is very, very much a tip-of-the-iceberg problem," he said.

More information
For tips on better sleep, visit the National Sleep Foundation.

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No Link Between Anti-Nausea Drug, Heart Trouble

(HealthDay News) -- The current "black box" label warning for the anti-vomiting drug droperidol -- cautioning users against an increased risk of irregular heartbeat with use of the medication -- may be unnecessary, Mayo Clinic researchers conclude.

In late 2001, the U.S. Food and Drug Administration issued a black box warning regarding the risk of heart trouble called prolonged QT in surgical patients receiving droperidol. Prolonged QT can lead to a potentially fatal arrhythmia called torsades de pointes (TdP).

The authors of this study analyzed data on almost 140,000 patients who had surgery before the 2001 black box warning, plus 150,000 patients who had surgery after 2001. Before the black box warning, 12 percent of patients (about 16,791) received the drug. No patients received the drug after the warning.

The rate of prolonged QT, TdP, or sudden death (within 48 hours after surgery) among the first group of patients was 1.66 percent and 1.46 percent in the second group of patients. Overall, there were no documented cases of TdP among patients who took droperidol.

"We found no change in bad heart rhythms with the commonly used low-dose droperidol versus no droperidol use in a very large number of surgical patients," lead author Dr. Gregory A. Nuttall, of the Mayo Clinic in Rochester, Minn., said in a prepared statement.

He and his colleagues concluded that the black box warning for droperidol is "excessive and unnecessary."

The study is published in the October issue of the journal Anesthesiology.

More information
The Arizona Center for Education and Research on Therapeutics has more about TdP.

Food Nutrition Labels a Puzzle? Here's Help

(HealthDay News) -- If you think you're the only one who gets confused trying to read nutrition labels on food, relax. You've got plenty of company.

In a study of educated adults -- 75 percent had at least a high school education -- most had trouble understanding everyday food nutrition labels.

Dietitians aren't surprised, since they constantly have to explain food labeling to clients.

"The biggest problem is (figuring) serving size," said Dr. Russell Rothman, an assistant professor of internal medicine and pediatrics at the Center for Health Services Research at Vanderbilt University, who led the study about nutrition labels.

His team surveyed 200 primary-care patients from a wide range of socioeconomic backgrounds and asked them to finish a 24-item measure of food label comprehension.

They answered, on average, just 69 percent of the questions correctly.

Besides confusing serving sizes, people were most often mixed up about extraneous material on the label, Rothman found. They often calculated the data incorrectly -- for instance, only 37 percent could figure the number of carbohydrates consumed from a 20-ounce bottle of soda that contained 2.5 servings.

"A soda bottle is typically 20 ounces," Rothman said, "and it will say, 'servings per container is 2.5.' People will not realize that. They think 20 ounces is a serving." If the label says 200 calories per serving, many will mistakenly think that means the whole bottle. However, after doing the math, the entire bottle would actually provide 500 calories, he said.

"When you are looking at food labels, take your time and be careful," Rothman advised. "They are confusing and have a lot of complex information in them. Pay particular attention to serving size and how to apply that to how much you are actually eating."

The study was published recently in the American Journal of Preventive Medicine.

Another expert, Susan Moores, a nutrition consultant in Minneapolis and a spokeswoman for the American Dietetic Association, agreed that serving size is where many people get tripped up on reading labels.

She said the first few ingredients listed on a label can also give clues to a product's goodness. "You want to recognize what they are," Moores said. "If you don't, that's a red flag. It means the food is probably not so nutritious." One exception, she said, might be the label on fortified cereals, where many non-recognizable names could be vitamins and other nutritious ingredients, she said.

Instead of trying to decipher the entire label, consumers can learn a few tricks, Moores and Rothman suggested.

For instance, follow the "5 and 20" rule. "If a label says it contributes 5 percent or less (of the daily value of a particular) nutrient, that is good on some ingredients, such as sodium and cholesterol, fat and sugar," Moores said. But, she added, it's not ideal for nutrients you want to increase.

If a label says it provides 20 percent of the daily value of a nutrient, likewise, that's good for nutrients you want to boost -- such as vitamins, fiber, calcium or iron -- but not for those you want to curtail.

You can look on the packaging itself for specific phrases, such as "low in fat," Rothman suggested. "These labels are regulated by the Food and Drug Administration," he said, so consumers have some assurances that the foods are as advertised.

That's not foolproof, however. "Some foods low in calories may not be better (than other foods) in other nutritional ingredients. They may have too much salt or fat," Rothman said.

If you still have trouble with label reading, Rothman offered up two more ways to be sure you focus on nutritious foods. First, you can follow an eating plan, such as Weight Watchers, he said, which advises you to eat five servings or more of fruits and vegetables, two to three servings of low-fat or non-fat dairy products daily, and to limit your calories.

"If you still find it very hard, when you meet with your physician or a registered dietitian, ask for help from them," he said. "Ask them to suggest something else practical you can do."

More information
There's more on nutrition labeling at the U.S. Food and Drug Administration.

Steam & Sauna Bathing Offers Multiple Rejuvenating & Healing Benefits

Written by The International Steam Therapy Association

Part 1
Most people laugh when they hear that the Finnish Olympic team lugs a portable sauna with them wherever they go. However, the fair-haired Nordic athletes might be doing more than simply acting out a home-sick longing for the slender birch trees and island dotted lakes of the homeland. They could be on to a secret, non-drug-induced means of giving themselves an edge in the fierce competition of modern-day Olympics.

Although most people simply consider it a pleasant means of relaxation, sweat therapy might in fact have powerful heath-enhancing effects.

In the test of time is any measure, steam bathing has certainly withstood it. For thousands of years people of all cultures have indulged in the soothing warmth of sweat baths. The Romans are well-known for their elaborate baths. The wealthy of 200 B.C. India did not consider their mansion complete unless it included a bathhouse with a steam room. The Muslim Hamman, or bathhouse, with its domed, central steam chamber is stall an integral part of life in Muslim countries. A derivation of the Hamman, the Turkish bath, has been popular in Europe for centuries.

Today, steam and sauna facilities are an integral part of the hydrotherapeutic offerings at European and American spas, and steam rooms and saunas are a common feature of health clubs and public pools. Yet, there is surprisingly little awareness of the wide ranging benefits of steam and sauna bathing. There is evidence that these sweat-inducing treatments stimulate the immune system, improve circulation, and help the body to purge itself of impurities.
Hippocrates, the founder of Western medicine more than two-thousand years ago said, "Give me the power to create a fever, and I shall cure any disease."

Although often misunderstood as a symptom of disease, fever actually is a part of the body's natural healing response. Steam baths, sauna, and other heat-inducing treatments elicit similar healing responses in the body, and consequently are often called "artificial fevers".

During a fever, the functioning of the immune system is stimulated, while the growth of bacteria and virus is forced to slow down. The production of white blood cells, the primary agents of the immune system, is increased, as is the rate of their release into the blood stream. The generation of antibodies speeds up, as does the production of interferon, an anti viral protein that also has powerful cancer-fighting properties.

Apart from stimulating the immune system, fever slows down the proliferation of invading organisms by creating an inhospitable environment. At 104 degrees F., for example, the growth rate of the polio virus is reduced up to 250 times; at 106 degrees pneumococcus, a bacterium responsible for pneumonia, dies.

Part 2
Before the advent of antibiotics, syphilitics were often infected with malaria to prevent the spread of the disease. In addition, there is evidence that the frequent fevers of malaria might function as a cancer-protecting factor. Dr. Paavo Airola in his book, Worldwide Secrets of Staying Young relates the story of the Pontine swamps near Rome in Italy, which, until a few decades ago, were a breeding ground for malaria-carrying mosquitoes. The swamps were dried out, and the malaria disappeared. However, during the next decades, that area, which had before been almost free of cancer, saw an increase in cancerous diseases. After a generation, the cancer incidence level of that area had reached the level of the rest of Italy.

Malignant cells are selectively destroyed at temperatures of 106 to 110 degrees F., so the frequent fever attacks of people in the malaria-infected area might have mobilized the body's own defenses too frequently for a cancer to take hold.

Although the artificial fever induced by sweat therapy does not have the comprehensive effect of real fever, it still produces a striking effect on a number of bodily processes.

There is evidence that artificial fever works as an immune system stimulant by increasing the number of white blood cells in the body. In a 1959-review of studies on the effects of heat treatments, Mayo Clinic researcher Dr. Wakim and colleagues cite findings indicating that the number of white blood cells in the blood increased by an average of 58% during artificially induced fever. Researchers also have found increases in the activity of the white blood cells during induced fever.

In addition, as in the case of bodily induced fever, the raised temperature during the artificial fever reduces the growth rate of most bacteria and viruses, giving the immune system time to mobilize its own forces. Indeed, many regular steam or sauna bathers have experienced that a good, long sweat bath at the early onset of a cold or flu can help ward off the disease before in manifests as actual symptoms.

Apart from the immune system-stimulating effects of sweat therapy, many thought it as one of the most effective and painless detoxifying treatments available.

Dr. Veronica Butler, medical co-director at the Raj, a health center based on principles of Ayurveda, recommends herbalized steam baths, called swedenas, to clients as part of the ancient Ayurvedic purification treatment, known as panchakarma.

According to the classical Ayurvedic texts, for maximum results, a swedena or steam bath should be given while keeping the head cool and the client supine.

"A swedena clears the shrotas, the channels through which the biological intelligence flows," says Dr. Butler. "If impurities clog these channels, the flow of intelligence in the body becomes more susceptible to disease."

Part 3
Heat speeds up the chemical processes in the body, making steam and sauna bathing one of the simplest and most comfortable ways to rid the body of accumulated toxins. As the pores open up and the million of sweat glands start to excrete, the body rids itself of metabolic and other waste products. Sweat contains almost the same elements as urine, and for this reason, the skin is sometimes called the third kidney. It is estimated that as much as 30% of bodily wastes are eliminated by way of perspiration.

However, more than common metabolic waste products are secreted through the skin. Natural health practitioners often notice that when heavy smokers get a steam bath for a body wrap (where the body 'simmers' for up to 45 min. Under hot covers), they will leave a yellow residue on the towels. Reino Tarkianinen, President of Finlandia Sauna, reports that when the company replaces sauna benches from public baths, a thick, black layer of accumulated tar can be found underneath the benches.

In Finland, research is being done on the use of sweat therapy in the treatment of people who are chemically affected. The purifying effects of perspiration could also be behind claims that steam and sauna treatments can help cur or control such ailments as acne and arthritis.

Last but not least, steam and sauna bathing produces powerful therapeutic effects simply by increasing circulation. As the carrier of the rebuilding forces of the nutrients to all parts of the body, the bloodstream plays a crucial role in the maintenance of health.

Steam and sauna treatments have a stimulating effect on the cardiovascular system. The pulse rate increases from 75 beats per minute to between 100-150 beats per minute during a 15-20 minute treatment. This increases blood circulation, but not blood pressure, since the heat also causes the tiny blood vessel in the skin to expand, accommodating the increased blood flow. The dilation of the capillary vessels enables the bloodstream to carry great amounts of nutrients to the skin, enhancing the nutritive status of the skin. The flushed, youthful look that steam and sauna bathers maintain for up to several hours after treatment is due to this effect.

Which is the best way of taking a steam or sauna treatment?
First of all, it is good to be aware of the distinction between the two. Most people think of the heat of a sauna as dry heat and the heat of a steam room as wet, humid heat. This distinction is only partially correct. Sauna bathers in Finland splash water on the heated stones in the sauna, raising the humidity level to as much as 40%. Without that, the hot, dry sauna air can irritate the mucus membranes.

Part 4
In the hydrotherapeutic tradition used at European and America spas, sweat therapy is used in preparation for massage as a means of increasing the suppleness of the muscles and creating a deep sense of relaxation in body and mind. In the Ayurvedic tradition of India, which has gained popularity in the U.S. in recent years, steam treatments are part of the traditional purification treatment panchakarma, where they are used after massage to help the body get rid of toxins dislodged during the treatment.

Sweat treatments can also be enjoyed on their own, as a workout for the cardiovascular system, a deep-cleansing treat for the body, an immune system booster, and a soothing and invigorating refreshment for the mind.

There are a few precautions to keep in mind. Because of the increase in cardiovascular activity caused by the high heat, sweat therapy is not recommended for people with heart disease or other cardiovascular problems. Individuals with high blood pressure pressure should first consult their doctor.

In addition, the treatment is not advised for pregnant women, small children, or the elderly. Do not take a sweat treatment if you have a fever or an open wound. If you have been working out, be sure that your body has had time to cool down before exposing it to the heat of a sweat bath.

Limit treatment time to 10 to 15 minutes. Drink plenty of water of herbal tea before and after the sweat bath to replace fluids lost during the treatment. The sweat glands can secrete up to 30 grams of sweat per minute, or almost one pint per 15 minutes, so dehydration is a very real possibility, if you are not careful. Fatigue and other indications of dehydration can occur with as little as 1 to 2% loss in body weight.

The main thing to keep in mind is to enjoy the process. Do not push your body beyond its comfort level; the point is not to sweat it out the longest, but to allow your mind and body to luxuriate in this health-enhancing and invigorating miniature spa treatment.

Working up a sweat is one of our oldest folk remedies. "Give me an opportunity to create fever and I will cure any illness," said the Greek physician Paramenides two thousand years ago.

Today, besides creating a relaxing sense of well-being, relaxes and loosens muscles tissue, reducing daily buildup of tension and increasing muscle flexibility:
-boosts blood circulation, which helps aching and injured muscles to recover faster, because the stronger the flow of blood, the faster metabolic waste products are carried off. -stimulates vasodilatation of peripheral blood vessels, which relives pain and speeds healing of sprains and strains; -speeds up the metabolic processes of vital organs and endocrine glands resulting in a calorie loss of between 200 and 450 in a 20 minute session.

Part 5
According to Michael Marino, research associate at Lennox Hill Hospital's Institute of Sports Medicine and Athletic Trauma in New York City:
"….. heat exposure stimulates the hypothalamus, the gland that normally maintains and stabilizes body temperature to dissipate the excess heat. Heart rate increases as more blood flow is diverted from the inner organs towards the extremities of the skin. This automatic "cooling" reaction is actually a form of beneficial stress, a passive kind of cardiovascular exercise that helps to keep the body's system alert and functioning well."

The beneficial stress of heat on the heart is confirmed by physical fitness expert Bernard Gutin, Professor of Applied Physiology and Education at Teacher's College, Columbia University:
"Heat acts as a form of mostly beneficial stress on the body that produces physiological changes in heightened blood pressure, stepped-up heart rate and an increase in stress hormones."
According to Dr. Paavo Aviola, an author in health matters:

"The sauna increases the eliminative, detoxifying and cleansing capacity of the skin by stimulation of sweat glands. A steam bath provides a mild cleansing process for the skin as certain body fluids are released through the skin. It also promotes healthy skin tone and texture due to increased blood circulation."

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Regular Exercise Helps Obese Teens' Hearts

(HealthDay News) -- Obese teens who start a regular exercise program can reverse or reduce early signs of heart disease, new research shows.

The finding suggests that continued exercise could decrease their risk of developing hardening of the arteries, heart attacks and strokes, said Dr. Andreas Alexander Meyer, of the University of Rostock in Germany.

"Obese young adults who were already obese in childhood have a high risk of developing serious cardiovascular events," Meyer said. "First events can occur between the age of 20 and 30 years."

Meyer's team studied 67 obese German teens with early signs of hardening of the arteries: decreased flexibility of their arteries and increased thickness in the linings of the carotid arteries of the neck.

"It was in the range we usually see in adults between the ages of 30 and 40," Meyer said. "This is clear evidence of vascular changes in obese children."

During the study, the researchers randomly assigned the teens, who averaged 15 years of age, to either a six-month exercise program or no change in their usual routine.

The exercise regimen included 60 minutes of swimming and water aerobics on Mondays, 90 minutes of team sports on Wednesdays and 60 minutes of walking on Fridays.

In the exercise group, the researchers saw an almost complete restoration of the arteries' flexibility, which resulted in improved blood flow. They also observed a significant reduction in the thickness of the linings of the youths' carotid arteries.

Because exercise also led to improvements in body-mass index (BMI), blood pressure, and cholesterol and triglyceride levels, the researchers concluded that it could significantly reduce the teens' risk of developing heart disease. "Even children who did not lose weight showed improvements in vascular status and obesity-related risk factors," Meyer said.

The study results are published in the Nov. 7 issue of the Journal of the American College of Cardiology.

Meyer cautioned that these benefits would quickly vanish if the teens did not maintain their healthy new lifestyle and strive to become even more physically active. "Generally, in children, we recommend moderate exercise of 45-90 minutes per day to keep cardiovascular risk low," he said.

Parental support is essential, Meyer said, but it can be difficult to convince parents -- who may themselves be obese and sedentary -- that their children's lives depend on eating right and exercising regularly.

"Most obese children don't get sufficient support in their efforts to reduce weight," Meyer said. "We have intensive talks with the parents about their children's medical and vascular status. We try to make clear that the whole family needs to change its risky behavior."

In recent years, childhood obesity has become a worldwide epidemic, affecting an estimated 22 million children under age 5. In the United States, one-third of children are either obese or at risk of becoming obese, according to a 2006 federal report, Progress in Preventing Childhood Obesity: How Do We Measure Up?.

Between 2002 and 2004, the obesity rate for American children and teens increased from 16 percent to 17.1 percent and is expected to reach 20 percent by 2010, according to the report.

"All children and adolescents should engage in at least 60 minutes of physical activity on most, preferably all, days of the week," said Karen A. Donato, coordinator of the National Heart, Lung and Blood Institute's Obesity Education Initiative. She was not part of the study.

"According to the U.S. dietary guidelines for Americans, regular physical activity has been shown to reduce the risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease and type 2 diabetes," Donato said.

"The National Institutes of Health has begun a national education program entitled We Can! (Ways to Enhance Children's Activity and Nutrition) to provide parents and primary caregivers of children with important information and tips on ways to increase physical activity in children and youth, as well as to decrease screen time, and eat a nutritious diet."

More information
For more on childhood obesity, head to the U.S. Centers for Disease Control and Prevention.

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Exercise Key to Seniors' Independence: Study

(HealthDay News) -- Structured exercise programs can help keep sedentary seniors from losing their independence, new research shows.

"Compared with those who received health education [only], participants in the physical activity group had a lower risk of becoming unable to walk 400 meters," or about a quarter-mile, said lead researcher Dr. Marco Pahor of the University of Florida, Gainesville.

The study, conducted at four centers across the United States, also found it's largely safe for many older adults to start a moderate exercise program.

The study was funded by the U.S. National Institute on Aging (NIA) and included 424 people, ages 70 to 89, who exercised less than 20 minutes a week and had low scores on three physical performance assessments -- walking speed, balance and the ability to get out of chair. They also had to walk 400 meters (about a quarter of a mile) within 15 minutes without sitting or using a cane or any other kind of assistive device.

Half the participants were assigned to a control group that took part in a "successful aging" health-education program that offered information about nutrition, foot care, medications, preventive services, and other health topics. It also included arm-and-shoulder flexibility exercises led by an instructor.

The other participants were enrolled in an exercise program that included individualized counseling and supervised and home-based exercises that focused on areas such as endurance, strengthening, flexibility and balance.

After 6 months and 12 months, seniors in the exercise group had significantly higher physical performance scores than those in the control group and were more likely to maintain their walking speed through the 400-meter walking test.

The findings, published in the November issue of the Journal of Gerontology: Medical Sciences, were to be presented Friday at a meeting of the Gerontological Society of America.
The researchers said their findings from this pilot study confirm the feasibility and safety of testing this kind of exercise program in a larger study.

"As U.S. life expectancy rises, functional decline and disability among older people are growing public health and clinical concerns," Dr. Richard J. Hodes, NIA director, said in a prepared statement.

"This pilot study helps us to understand better the relationship between exercise training and mobility, which is a key to maintaining older adults' independence and quality of life, and provides a basis for designing more definitive large-scale clinical trials," Hodes said.

More information
The American Medical Association has more about fitness for older adults.

Immune Cell Insights Could Fight Arthritis, Lupus

(HealthDay News) -- Regulatory T cells, which "police" the immune system, are produced in the thymus and not from other circulating T cells, researchers report.

The study also provides new information about how mistakes made by regulatory T cells may contribute to autoimmune disease.

The findings suggest that it may one day be possible to control the early education of regulatory T cells in children in order to prevent autoimmune diseases, according to a team from the Medical College of Georgia.

It may also be possible to introduce new regulatory T cells into people with autoimmune disease, they said.

The thymus, a small organ located in the upper/front portion of the chest, is involved in the production and maturation of T cells during fetal development and childhood. Regulatory T cells direct the immune systems' roaming T cells.

Before regulatory T cells leave the thymus, they learn to distinguish between normal body tissue and invaders such as bacteria and viruses.

However, in some cases, regulatory T cells fail to learn how to recognize all the different kinds of normal body tissue, the Georgia group explained. This, along with environmental and other factors, can result in autoimmune diseases, where the body attacks its own tissues, the researchers said.

Lupus, arthritis, and type 1 diabetes are types of autoimmune diseases.

The MCG team found that, in mice, the regulatory T cell learning process in the thymus peaks in the first six weeks of life. That's about equivalent to the first 15 years of life in a human.

The early lessons, correct or not, learned by the regulatory T cells seem to last a lifetime.

The few cells that develop later in life will likely behave like the earlier cell.
The study was published in the August issue of the journal Immunity.

More information
The U.S. National Institute of Allergy and Infectious Diseases has more about the immune system.

Childhood Cancer Survivors Face Long-Term Stroke Risk

(HealthDay News) -- Long-term survivors of childhood leukemia and brain tumors are at increased risk for stroke, even years after they finish their cancer treatment, a new study finds.

This risk is especially high in people treated with cranial radiotherapy, which involves moderate or high-dose radiation therapy to the brain.

"This is the first study to show that childhood leukemia and brain tumor survivors are at an increased risk of stroke," study lead author Dr. Daniel C. Bowers, associate professor in pediatrics at the University of Texas Southwestern Medical School at Dallas, said in a prepared statement.

"These strokes can occur 10 to 20 years after diagnosis, when most people believe they are no longer at risk for new side effects of treatment, underscoring the need for long-term medical follow-up for childhood cancer survivors," he added.

The research, conducted as part of the Childhood Cancer Survivor Study, was published online Monday in the Journal of Clinical Oncology.

Leukemia and brain tumors together account for 53 percent of all cancers diagnosed in children under age 15, according to background information in the article. Current five-year survival rates in the United States are about 80 percent for leukemia patients and 74 percent for brain tumor patients. Due to these high survival rates, it's important to study the long-term effects of treatments for these cancers, the researchers said.

Cranial radiotherapy is commonly used to treat brain tumors, while treatment for leukemia includes chemotherapy drugs that are injected directly into the spinal fluid that bathes the brain. Leukemia patients may also receive cranial radiotherapy.

This study included over 4,800 childhood leukemia survivors and nearly 1,900 brain tumors survivors, along with a control group of over 3,800 of the patients' siblings who had not had cancer.

The leukemia survivors had a stroke rate of 0.8 percent (1 in every 125), compared with 0.2 percent (1 in every 500) for those in the sibling control group. The average length of time from leukemia diagnosis to stroke was 10 years.

Among the brain tumor survivors, the stroke rate was 3.4 percent (1 in 30), but was as high as 6.5 percent (1 in 15) among those treated with both cranial radiotherapy and chemotherapy. The average length of time from brain tumor diagnosis to stroke following treatment was 14 years.

Other long-term effects of treatment for childhood cancers include secondary cancers, neurocognitive deficits, heart problems, obesity, hormone deficiencies, and shorter stature, the study authors noted.

"It is important for survivors and their doctors to know that the impact of some of these long-term effects can be reduced through careful follow-up screening and care, and education to help survivors stay healthy long after their treatment has ended," Bowers said.

More information
The American Cancer Society has more about childhood leukemia.

Researchers Apologize for Disclosure Failure on Drug Study

(HealthDay News) -- The failure of researchers to fully disclose pharmaceutical-industry connections in a study of drugs used to treat rheumatoid arthritis has resulted in a letter of apology to the Journal of the American Medical Association.

However, everyone involved is quick to note that both the findings of the study and the methods used were sound. And while the exact meaning of the findings is the subject of debate, there appears to be no question of the validity of the science involved.

The original study appeared in the May 17, 2005, issue of JAMA. In that study, Dr. Eric L. Matteson, a professor of medicine at the Mayo Clinic, and colleagues looked at the risk of cancer among patients taking infliximab (Remicade, Enbrel) and adalimumab (Humira) for rheumatoid arthritis.

These drugs are tumor necrosis factor-alpha blockers (TNFs). TNF blockers bind to tumor necrosis factor-alpha, making it inactive, reducing inflammation and joint damage.
These drugs have been associated with an increased risk of some cancers, particularly lymphoma, and with an increased risk of infection.

In its study, Matteson's team concluded: "There is evidence of an increased risk of serious infections and a dose-dependent increased risk of malignancies in patients with rheumatoid arthritis treated with anti-TNF antibody therapy. The formal meta-analysis with pooled sparse adverse events data from randomized controlled trials serves as a tool to assess harmful drug effects."

The disclosure problem arose because the researchers failed to tell JAMA editors that they had let Abbott Laboratories, the maker of Humira, review the paper before it was published because they had a prior agreement to do so. However, they did not let Centocor Inc., the maker of Remicade, review the paper, since they had no such agreement with that company. They also failed to note that a TNF drug made by Wyeth was not included in the study, even though they were working with Wyeth on another study.

In addition, the Mayo researchers didn't tell the journal they had received $25,000 from Amgen, the marketer of Enbrel, for the fellowship education training of Dr. Tim Bongartz, one of the study co-authors. "The stipend was not linked to the study or systematic review of TNF-alpha antibodies," Drs. Bongartz and Matteson write in the apology letter.

"This was really a very embarrassing thing to me," Matteson said. "This occurred due to my inattention to our disclosure statement when we submitted our original paper. There were mistakes in the disclosure, not because I intended to mislead them, but simply because I was negligent."

According to Matteson, he alerted JAMA editors to the error a week before the study was to be published -- a fact disputed by Dr. Catherine D. DeAngelis, JAMA's editor-in-chief, who said she was first notified by one of the drug companies involved.

"It was very nice of him [Matteson] to do it after the fact, since he knew we were about to initiate an investigation because someone let the cat out of the bag," DeAngelis said. "We are very serious about it. I don't like it when people don't fully disclose. I wanted this letter of apology."

Based on DeAngelis's concern, the Mayo Clinic looked into the matter and instituted conflict-of interest-education for its researchers.

The disclosure issue did not stop JAMA from publishing the study on schedule. Both Matteson and DeAngelis agree there was nothing wrong with the science in the paper.

"No one is questioning the veracity of the paper," DeAngelis said. "What we are questioning is why they didn't disclose."

Based on this and other occurrences surrounding disclosure, JAMA tightened its disclosure policy on conflicts of interest.

In a July 12, 2006, JAMA editorial, DeAngelis announced an updated disclosure policy. "To further improve the transparency of reporting of potential conflicts of interest and to encourage more accurate and complete disclosures, an important new policy is that JAMA will begin requiring all authors to disclose all potential conflicts of interest in the 'Acknowledgment' section of the manuscript at the time of submission," she wrote.

Despite the disclosure problems, Matteson stands behind the findings in the study. Basically, the study found that there is a significant risk of developing cancer associated with these drugs. However, in terms of actual cases, the risk is small, he said.

"The cancer events are relatively rare," Matteson said. "But the relative risk is increased. Whether that holds up in other studies isn't known. We also documented that there was an increased risk of infection. That remains a concern with these drugs."

"The real bottom line is that these are very effective drugs for the treatment of rheumatoid arthritis, and are with justification used in patients with severe disease," Matteson said. "However, they do interfere with immunological function. We have to be concerned that in individual cases this interference may cause adverse events."

Patients need to be told about the risk, so they can make an informed decision whether to use them or not, Matteson said.

Several letters in this week's JAMA devoted to Matteson's study find fault with the methodology used or the findings. But all agree there are risks with the drugs to one degree or another. In fact, the risk of cancer and infection are stated on the drugs' labels.
One expert has problems with the methods used in the study.

"There are a lot of problems with meta-analysis [a review of previous studies]," said Dr. Elinor Mody, a rheumatologist at Brigham and Woman's Hospital, in Boston. The inclusion in the Matteson study of certain skin cancers and cancers that develop over a long time are particularly concerning, she noted. In addition, the study authors didn't include data on the drugs from other important trials.

However, Mody tells her patients that with rheumatoid arthritis, there is an increased risk of lymphoma. "Maybe these medications increase the risk even more," she said. "The concern about infection is nothing new -- and that's my major concern," she said.

"We are not at the point that these drugs are first-line agents," Mody said. "But this study didn't really change my mind about these medications. For some patients, they are wonder drugs."

More information
The Arthritis Foundation can tell you more about rheumatoid arthritis.

Behavioral Problems Common in Mentally Retarded Children

(HealthDay News) -- Behavioral and emotional problems are common among young people who are mentally retarded, and the incidence of such problems declines very slowly over the years, an Australian study finds.

Not much attention has been paid to these problems, ranging from cursing and head-banging to failure to communicate with other people, said researchers from the University of Sydney. But the study found that 41 percent of the young people they followed had such problems, and the incidence dropped by only about 1 percent a year over a 14-year period.

"Although it declined, the level remained relatively high," said Andrea M. Piccinin, who took part in the study and now is a research associate professor of human development and family sciences at Oregon State University. "We make the case that intervention and more understanding of the factors that would lessen psychopathology would be important."

The findings are published in the Oct. 25 issue of the Journal of the American Medical Association.

The study included 578 children and teens who were ages 5 to 19 at the start of the research in 1991. They were judged by the Developmental Behavior Checklist, a standard measure for children with what are formally called developmental disabilities.

"We looked at a global score and five subscales," Piccinin said. "The social relations subscale showed an increase. As these children come into adolescence and get older, there are more issues with their social relations, because they are in a situation where more is expected of them."

The decrease occurred in the scales that measured anxiety, communication ability, destructive behavior and general disturbance, she said. Overall, the incidence of problems was 30 percent at the end of the study.

The decrease in problems was greater in boys than girls over time, and the decrease was greater in those with mild retardation than in those with severe mental disability.

"The observation that severe psychopathology was already present in a high proportion of the cohort at commencement of the study, and the persistence of these symptoms, suggest the need for effective mental interventions," the researchers said. "This should include support, education and skills training for their parents, who are likely to be stressed by the burden of care."

Only 10 percent of the young people with behavioral and emotional problems received mental health interventions during the study, the researchers found.

"This points to the importance of intervention," Piccinin said.

More information
More on mental retardation is offered by the National Dissemination Center for Children With Disabilities.

Home Visits Boost Mammography Rates for Rural Poor

(HealthDay News) -- Trained lay health advisers can dramatically boost the number of rural, low-income American women who get mammography screening for breast cancer, a new study concludes.

Rural, poor and minority women are less likely than other women to have mammograms, the researchers noted.

The four-year study began in 1998 and included 851 low-income white, black and Native American women in rural North Carolina who had not had a mammogram in the previous year.
Each women filled out a survey about her knowledge of breast and cervical cancer screening and were randomly assigned to a group that received home visits from a lay health adviser or to a comparison group.

The women in the comparison group received a letter and a brochure about the need for regular cancer screening. The women in the intervention group received three in-person home visits from a lay health adviser over nine to 12 months.

During the visits, the advisers talked to the women about breast cancer, mammography, breast self-exam, and scheduling a mammogram. They also provided educations materials about cancer risk. Follow-up phone calls were made to the women to help them make mammography appointments and to encourage the women to discuss their mammogram experiences.

By the end of the study, 42 percent of the women in the intervention group had received a mammogram, compared to 27 percent of the women in the comparison group. This effect was noted in all three racial groups in the study.

"Our results show that lay health advisers can improve the rates of mammography screening among low-income, rural white, African-American and Native American women," principal investigator Electra D. Paskett, professor, College of Medicine and School of Public Health, Ohio State University, said in a prepared statement.

"The intervention improved knowledge and beliefs about mammography screening. We also empowered these women to realize that they can schedule a mammogram on their own, with or without encouragement from their doctors," Paskett said.

The findings are published in the Sept. 6 issue of the Journal of the National Cancer Institute.

More information
The U.S. National Cancer Institute has more about breast cancer screening.

Older Minorities More Likely to Seek Home Remedies for Ills

(HealthDay News) -- When older minorities turn to home remedies to cure what ails them, it's more likely to be a reflection of their cultural beliefs rather than an inability to afford or access mainstream medicine, new research suggests.

The study found that many older people of all races tended to use home remedies for chronic ills, but black seniors were three times more likely than whites to seek such solutions for daily aches and pains, and Native American seniors were twice as likely to do so.

The revelation is reported in the January-February issue of the American Journal of Health Behavior.

"There's pretty good evidence out there suggesting that sometimes people's health behaviors are shaped by who they are and where they live. The fact that those things explained as little as they did was somewhat surprising," said study author Joseph G. Grzywacz, an assistant professor of family and community medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.

"Health-care [providers] really need to be aware that this is taking place," Grzywacz added. "The real implication is to say, 'Hey, wake up. A lot of stuff is going on.'"

Older adults tend to rely on home remedies, and older adults who are members of ethnic minorities are even more likely to do so, the researchers said.

Home remedies can range from bran flakes to prevent and treat constipation to over-the-counter liniments and salves for muscle aches. One study found that up to half of older adults use food preparations involving honey and vinegar for various conditions.

The current study set out to determine why home remedy use is more common among ethnic minorities and whether it had to do with availability of conventional health care, economic hardship or health disparities.

The researchers analyzed a group of elderly adults with diabetes in Robeson and Harnett counties in North Carolina. Both counties are largely rural, and have a high proportion of ethnic minorities.

Participants were asked about two kinds of home remedies: food-based remedies such as tea, plant extracts and baking sodas, and "other" remedies such as over-the-counter creams and ointments and petroleum products.

The majority of older adults reported using at least one remedy in either category during the past year.

After controlling for age, education, gender and other factors, the researchers found that black elders were almost three times as likely as whites to use "other" home remedies for health purposes, while Native American elders were almost two times as likely.

Cultural explanations in general explained the differences more than other factors such as health-care accessibility and economic situation, the authors stated.

The fact that so many people use home remedies overall points up one thing, however.
"Being ill is a great leveler," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge. "Whether you're rich, poor, white, black, Native American, people are people."

More information
Visit the National Center on Minority Health and Health Disparities for more on this topic.

Medicare Drug Benefit Won't Help All Equally

(HealthDay News) -- Although the new Medicare drug benefit is likely to result in small savings for most seniors, these savings aren't likely to be divided equitably among all groups, a new study finds.
The most vulnerable seniors, namely blacks, Hispanics, low-income seniors and seniors with chronic disease, still face sizable out-of-pocket costs, according to the study that appears in the January/February issue of Health Affairs.
"Although people are going to save money on average out-of-pocket costs, the benefit is not ideally structured to help people with chronic diseases," said study author Dr. Walid Gellad, a research fellow and internist in general medicine at Brigham and Women's Hospital in Boston. "In general, the benefits are not going to be equally distributed."
"Most experts would say these findings are predictable," added Robert M. Hayes, president of the Medicare Rights Center in New York City. "Fundamentally, when we have a for-profit insurance industry administering a benefit, of course sicker people will be paying more and more because they cost more, but also because the insurance companies have every financial incentive to find customers who don't need expensive medications. Some refer to it as a 'sick tax.' If you need the benefit, it'll help you the least."
Ironically, the study appears alongside another study in the journal that reports overall prescription drug cost growth is actually slowing.
Medicare Part D, a prescription drug benefit created to ease the financial burden of soaring drug costs for America's seniors, became effective Jan. 1. The plan works with private plans to supplement drug costs.
So far, the plan seems to have gotten off to an uneven start. The Los Angeles Times reported recently that one man spent 15 1/2 hours trying to get through to his mother's insurer on the phone. And Hayes said he's considering bringing in a psychologist to help his young staffers who are getting calls from people they can't help. "They're so upset," he said. "My education director just asked if we could bring in secondary trauma counseling."
While much research has focused on the low-income segment of the population that is eligible for both Medicare and Medicaid, those who are not eligible for such subsidies are often left out of analyses, Gellad said.
Gellad and his colleagues analyzed out-of-pocket drug spending for seniors over the age of 65 who were not eligible for additional subsidies and who did not have prescription coverage through their employers. Within this group, the study authors focused on the "most vulnerable" groups, including ethnic and racial minorities, the "near poor" and those with three or more chronic health conditions.
Overall, the study found that seniors will save $478 under the new drug benefit, but these savings are not divided equally. Blacks stand to save 26.9 percent of their current out-of-pocket costs, Hispanics 23.3 percent and whites 34.3 percent. Blacks and Hispanics will save an estimated $237 less annually than whites, the study concluded.
"Blacks and Hispanics are going to save, but they will save less than whites both in absolute dollars and as a percent of their current out-of-pocket costs," Gellad said.
The near poor, or seniors with incomes below $21,450 who don't qualify for subsidies, will save $525 annually on average. "It's a decent amount of money but they still have $957 in out-of-pocket costs, which is still a lot when you consider their income," Gellad pointed out.
More than one-third (35 percent) of people with three or more chronic conditions will have total costs that fall into the so-called "donut hole," the gap in coverage resulting from the deductible and benefit structure. This means they may end up paying 100 percent of the cost of any new medications, the study concluded.
Should people with employer-sponsored coverage join the Medicare drug benefit, they will end up paying $123 more in out-of-pocket costs, the study found.
"Dually eligible people are going to have great savings but no one seems to talk about these other people," Gellad said. "Do we need to expand subsidies to include these people who are still poor, and are still going to have trouble with medicines?"
Despite the continuing individual burden of health-care costs, another study in the same issue of the journal found a slowing in U.S. health spending in 2004, to its lowest level in four years.
This decline was aided largely by a decline in prescription drug spending, the study found.
National health-care spending grew 7.9 percent in 2004, down from 8.2 percent in 2003, while growth of drug spending slowed to single digits (8.2 percent) for the first time in a decade.
Despite this modest good news, U.S. health spending is still huge, at $1.87 trillion in 2004, according to the report, which was prepared by economists from the Centers for Medicare and Medicaid Services. This amounted to $6,280 per person. That total spending figure is nearly twice that of a decade ago.
"There's never going to be a rational expenditure of U.S. health dollars until we get something like a Medicare for America program going," Hayes said. "We will continue to waste billions and billons of dollars unless we have a rational health-care system and, at this point, there's no system at all."
More information
Visit Medicare for more on the new prescription drug benefit.

Chilling out in Chiang Mai

Published on May 15, 2004
The Northern capital boasts a wealth of spas, all geared to treating stressed minds and abused bodiesChiang Mai spas are a modern take on an old concept, where modern seekers of good health, fitness and beauty immerse themselves in hot tubs much as how the ancients did.

The oldest known spa dates back 5,000 years to Merino, Italy and it’s believed that Egyptians used mineral baths for therapeutic practices during the same era. Most early spas were located near natural hot springs, but in 600 BC water in rustic cauldrons was heated by sizzling hot stones.Later, the Greeks discovered hydrotherapy for ailments such as jaundice and rheumatism, and more than 2,000 years ago the Romans introduced hot water to fun and decadence.

The Roman thermae was an elaborate technology of aqueduct systems carrying mineral waters throughout complex private chambers, steam rooms and public baths. In an effort to outdo their predecessors, each emperor would increase the size and extravagance of their spa, with the Diocletian capable of holding 6,000 bathers.The thermae or spa has since spread to resorts around the world offering sport, refreshment and therapeutic facilities. But they vanished with the fall of the Roman Empire and, apart from a brief revival during the Middle Ages, the concept was lost until its modern resurrection.Today’s spas have been updated to treat the stressed minds and abused bodies of modern humans. “It’s mainly a matter of education,” says Chitra Klanprayoon, co-owner of Chiang Mai’s Ban Sabai Spa Village.“

Greater knowledge of oneself might bring on a need to change, shed a few kilos, detoxify the body, relax the mind, and that’s where the modern spa comes in. We can provide a mixture of holistic and contemporary treatment, with some wellness spas seeking medical evaluations by physicians before giving prescriptions and advice on treatment,” adds fellow co-owner Matthias Froelich.Chiang Mai has a perfect environment for rejuvenation, with Lanna culture being a vital ingredient. Lanna – meaning “Land of One Million Rice Fields” – holds with traditions of tranquillity, politeness and living with nature and forms a philosophical base for spas in northern Thailand.

Natural surroundings, such as the mountainous landscape, hot springs, herbs and organic products also play a large part in this ideal setting for disease prevention, recuperation, comfort for the terminally ill or simply a place where one can be pampered.In the past eight years, many spas have developed in the Chiang Mai area, and 20 of them belong to the Thai Lanna Spa Association, of which Chitra Klanprayoon is president.“This organisation is essential,” she says.

“The word spa is being used for a greater variety of services these days and the public must be assured of what association members have to offer. Our spas can guarantee high quality and effective therapy from qualified doctors and staff, and we must not be confused with night-time entertainment places.”The association proudly took part in the first World Congress of Holistic Medicine, held in Chiang Mai last month. Supported by the World Health Organisation, Thai Ministry of Public Health, the event was seen as a major step toward the region’s endeavour to become a regional centre for medical and therapeutic care.

Apart from 50 presentation booths, lecturers and delegates attended from more than 20 different counties.The gathering also revealed the remarkable diversity of spas, and how many spas succeed by concentrating on specific therapies and themes.The Ban Sabai Spa Village, for example, specialises in detoxification courses for colon irrigation, life management, dietary advice, weight loss and fasting. Set in lush tropical gardens a few minutes from downtown Chiang Mai, guests are invited to drown their troubles in the swimming pool or salt flotation tank.

There is a range of single remedies and mixed therapy packages to tone up the body and evaporate stress including steam baths and assorted massages. Aromatherapy can help to achieve meditation and the beauty conscious can treat themselves to a manicure, pedicure and body wax. Prices range from Bt450 for a single therapy to Bt5,500 for the six-hour Jasmine Spa Package.Day visitors are welcome and for guests staying over, luxurious Lanna style villas are available at Bt4,800 per night. Each one contains a whirlpool, steam room, sauna and outdoor bathroom with aromatic plants. Standard rooms in similar design are Bt2,700.Ban Sabai Spa Village is an ideal place to improve your mental and physical condition or simply be thoroughly spoiled.For seekers of spiritual enlightenment, there’s the Tao Garden Health Spa, beautifully situated in a mountainous area 30 kilometres north of Chiang Mai

.Paths wind their way though more than 30 hectares of shrub lands shrouded by trees and lead to the Immortal and Lao Tzu’s Meditation Halls, and the Ba Shen Memorial Hall for Tai Chi, Tao Yin and Chi Nei Tsang activities. A swimming pool and gym are nearby.The body cleansing programmes here follow a Taoist or Chinese regimen supported by modern medicine and the spa is especially pleased with its Karsai Nei Tsang genital massage for both sexes. This manipulation of the sexual organs may help alleviate impotency, frequent and difficult urination, painful menstruation and intercourse, and low libido.

Chi Nei Tsang is a stomach massage, but one designed to soothe both body and mind. Stress and worry move from the brain to create physical obstructions in the tummy. This therapy not only clears out toxins and smoothes knotted intestines, but also provides spiritual well-being.Sitting in the Dark Room is a departure from the physical. Totally devoid of light or sound, this method of detachment, meditation and discovery of one’s inner self is endured by some for as long as three weeks, while others might start screaming shortly after the light goes out.Individual spa treatments start at Bt300, and there are inexpensive beauty preparations. One- to seven-day packages range from Bt1,900 to Bt32,300, without accommodation, which is priced from Bt3,200 to Bt5,300 and includes use of facilities.Some spa goers prefer vigorous sport to blissful tranquillity, and that’s where the Northern Heritage Resort & Spa comes in.

Located 25 kilometres east of Chiang Mai Airport and surrounded by forested mountains, one can jump out of the jacuzzi and straight onto the first tee of the challenging Chiang Mai – Lamphun Golf Club. And if 18 holes on this magnificent championship course aren’t enough there’s cycling, trekking, pool, snooker, tennis and karaoke.Five spa pavilions – spread around the swimming pool – are waiting to rejuvenate worn out bikers, adventurers and foot sloggers with a large selection of therapies. The athlete’s rejuvenation course costs Bt6,200 and a sport massage is Bt2,500.For those who might have overdone things, an in-house medical centre is linked to Chiang Mai Ram Hospital.Back in the spa, one can experience the benefits of soaking in Dead Sea minerals for Bt8,000. Or how about a bath in red wine for Bt7,400? There are many packages, and prices can be found on the resort’s website. Luxury rooms and suites in a hotel environment go from Bt3,500 to Bt10,500 per night and log cabins cost up to Bt12,000. There are special rates for long term guests.

The Chiangmai Oasis Spa has adopted the Roman concept of unadulterated pleasure. After negotiating the stepping stones in the fish pond and soaking up the warm greeting at reception, it’s easy to forget that you’re bang in the middle of town.Escape the rigours of modern living. Slip out of the office to a haven of fragrant flowers and fountains and into a relaxing steam room. Or watch your troubles float away in the bubbles from the bath. The Oasis is a place to be pampered by therapists trained to take care of your every need.

At the two villas you’ll find steam rooms, private gardens, and alfresco showers and jacuzzis. Once settled into this perfect setting, there is an exciting menu of treatments to ponder.This day spa provides many individual therapies and six packages, and the proprietors are particularly proud of their Tibetan style “hands on” foot massage.

Massages range from Bt550 to Bt2,500 and most of the scrubs, wraps, facials and hydrotherapy cost less than Bt1,000. Packages start at Bt1,900. Or lash out Bt5,400 for a fully gratifying four hour Oasis Experience.So for the body pampering, health conscious, sporty and decadent – when in Chiang Mai, do as the Romans did.
Bob Kimmins

The Nation

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