Malmö, Sweden

As the debate over medical marijuana use continues, a new study among multiple sclerosis patients -- who often use the drug to relieve pain and muscle mass spasticity -- adds to the argument that smoking pot clouds thinking skills.

Canadian experts studied two groups of 25 people between the ages of 18 and 65 with MS, an autoimmune disease that attacks the central nervous system and can lead to paralysis, cognitive problems, incontinence and a host of other sensory and functional deficits. One group used marijuana greatly, while the other group reported no marijuana use for many years.

Patients using pot performed significantly worse on cognitive assessments measuring attention, thinking velocity, executive function and visual belief of spatial associations between objects, the study authors said. Users were also twice as likely to be classified as globally cognitively impaired, meaning they failed at least two of 11 numerous tests.

The study is published in the Mar 29 issue of

Neurology .

"We published a paper a few years back that said cannabis use in MS patients might be linked to delays in control velocity, but it was a very small sample," said study author Dr. Anthony Feinstein, a professor of psychiatry at the University or college of Toronto. "This confirms our earlier thoughts that cannabis could, in fact, have some cognitive side effects . . . but I'm surprised at the breadth. We were thinking we would probably replicate our earlier findings, but it went beyond that."

Data suggests that between 36 percent and 43 percent of MS patients have smoked pot at some time, according to the study, and "a substantial minority" get cannabis relieves pain, insomnia, spasticity, tremors, bladder problems and emotional distress.

Between 40 percent and 60 percent of MS patients are cognitively impaired to begin with, Feinstein added, but study participants using marijuana scored about one-third lower on a sensitive test of information-processing velocity than non-users.

A total of 72 percent of users reported smoking pot daily, while 24 percent reported weekly use. The average duration of marijuana use was 26 years, the study said.

"I would stop and think very carefully about cannabis use . . . it issues me that there's a movement that cannabis can be used as a benign drug," Feinstein said. "So I would need to look at cannabis very closely before using it. The database is usually still small . . . there are so many unanswered questions."

Feinstein noted that the study could not conclude that pot use causes clouded thinking, only that the two were linked. He also could not determine whether the slowdowns in thinking

among pot-using MS patients was any worse than might be observed among users without MS.

Nicholas LaRocca, vice president of healthcare delivery and policy research for the National Multiple Sclerosis Society, said the study is "sort of a wake-up call about the potential effects of long-term and heavy use of marijuana in people who have MS."

While the research could not be randomized because scientists cannot assign participants to ingest a potentially harmful drug, he said, the authors carefully matched the user and control groups and the cognitive evaluations done on both.

Clouded thinking "is usually a potentially very devastating side effect," LaRocca said. "It's a high price to pay for whatever relief is usually being provided. The important point about the study is usually it gives people pretty solid information about the risks they may be taking."

"Many people get the side effects of a given drug are worse than the symptoms," he added. "I think we're looking at a very familiar dilemma."

Beans, pink, mature seeds, cooked, boiled, with salt, 1 cup

The use of energy-absorbing hip protector pads won't prevent hip fractures, new research suggests.

"We found that there was no benefit to the hip protector," said study author Dr. Douglas Kiel, director of medical research at the Institute for Aging Research at Hebrew SeniorLife and an associate professor of medicine at Harvard Medical School in Boston. The finding is reported in the June 25 issue of the Journal of the American Medical Association .

"At this point, I would say that most of the growing number of studies don't support the routine use of hip protectors in nursing homes," said Kiel. "But I don't think the future of hip protectors is totally negative. Maybe there are better pads out there or will be in the future."

Every year, more than 340,000 Americans break a hip. Ninety percent of those injuries are associated with a fall, according to the study. Residents of nursing homes experience some of the highest rates of falls, with up to 50 percent falling each year.

Previous studies of hip protectors have had conflicting results, Kiel said. There are two main types of hip protectors -- ones that divert the energy of a fall away from the hip, and ones that absorb the impact of a fall, he explained.

In the current study, the researchers chose to test energy-absorbing hip protectors. Unlike previous studies which have compared one nursing home population to another control group, each volunteer served as their own control subject by only wearing a protector on one hip.

The study included more than 1,000 residents of 37 nursing homes. The average age was 85 years old, and 79 percent of the study participants were women. The average participation time was nearly eight months.

Each volunteer wore specially designed undergarments that included a one-sided hip protector. The overall adherence rate was about 74 percent, according to the study.

The study found no statistically significant difference in the incidence rate of hip fracture between protected hips -- fracture rate of 3.1 percent -- versus unprotected hips -- 2.5 percent.

In those with a higher adherence rate -- more than 80 percent -- there were no significant differences either. The hip fracture rates were 5.3 percent in protected hips versus 3.5 percent in unprotected hips.

"Just padding the hip is not going to protect against fracture," said Dr. Gerard Varlotta, director of sports rehabilitation at New York University Medical Center's Rusk Institute of Rehabilitation Medicine/Hospital for Joint Disease.

Varlotta said that's because many fractures don't even occur as a result of impact but from the unnatural rotation of the hip in a fall. "Fractures often occur prior to impact," he said.

Varlotta and his colleagues are working on a hip protector that would keep the hip in proper alignment.

In an accompanying editorial, Finnish experts pointed out that because the hip-protecting device was one-sided, it's possible that it might have affected the way people stood or walked, possibly increasing the risk of falls.

Kiel said the device weighed only two ounces, so he doubts it had much of an effect on gait or in causing people to fall more on the protected hip.

Kiel said there are more than a dozen types of hip protectors on the market, ranging from about $30 to as high as $175.

But, he said, people need to know that most of these devices haven't been tested and haven't been proven effective. If they'd like to try them, he suggested asking your doctor which type has had positive clinical trial results.

Additionally, he said that it's important to try to reduce the risk of falls in the first place. Leg-strengthening exercises can help, as can limiting the use of sedating medications. If a medication makes you or someone you're caring for dizzy, ask the doctor if another medication that doesn't cause dizziness can be substituted.

Additionally, be sure to remove throw rugs and any obstacles from the walking path and that the lighting is adequate, advised Varlotta.

India Muzzles Nuclear Watchdog

The even more hours a child spends in day care during the first four and a smaller portion years of his life, the even more behavioral problems he will exhibit when he reaches kindergarten.

That's the bottom line of new analysis that shows up in the September/September concern of Kid Development .

But there's zero cause for anxiety, state the research writers and other child-care professionals familiar with the new analysis. The behavioral complications open weren't outside the regular range. And, the professionals state, delicate being a parent, combined with selecting a high-quality plan, can outburst the results of lengthy hours in time caution.

The research is an update of the State Institute of Kid Wellness and Individual Development's Research of Early Kid Treatment, launched in 1991. In the research, 27 researchers have got been monitoring even more than 1,000 kids at 10 sites from delivery into their college years.

The researchers found a hyperlink between the average number of hours a week a child spent in time care during the first four and a half years of lifestyle, and how their moms, child-care providers and kindergarten teachers rated their behavior when they entered school.

The greater the number of hours, the larger the scores for problem behaviors such simply because getting assertive, disobedient and aggressive.

But now there had not been a threshold beyond which the research workers could tell you a particular amount of hours was undesirable, emphasizes Sarah Friedman, the scientific planner of the research. In the test, 16 percent of the kids proceeded to go to kid treatment up to nine hours a week; 38 percent for 10 to 29 hours; 36 percent for 30 to 45 hours; and 10 percent, even more than 45 hours every week, says Friedman, on personnel at the State Start of Kid Wellness and Individual Advancement.

General, says Friedman, a fraction of kids -- 12 percent to 16 percent -- had behavior that chop down into the "at-risk" range. By that, the research workers mean the behavior was still in the regular range, but at the higher amounts of regular, placing them at risk of developing unusual behavior.

"The conjecture of issue behavior would not simply come from hours in treatment," Friedman says. "It also comes from quality of treatment and the family members environment." The awareness of the mom to the child's requirements, for example, has a great function in whether the kid will possess behavior complications, she says.

Some of the issue behavior might end up being improved just by paying more interest to the kid once he is house from time treatment.

While functioning parents frequently have a lot to carry out when they get house, Friedman suggests involving the kids in home duties when they are old more than enough. Allow the kid help prepare meals, flip the laundry and perform various other required duties, she says, rather of car parking them in entrance of the tv.

Another report in the same concern seems to point to the need to have to be delicate to the specific needs of kids in time care, and to be conscious that some kids may experience insecure or scared in such a environment. Megan Gunnar of the School of Mn and her analysis group discovered the hormone cortisol, released in response to tension, proceeded to go up in some of 55 newborns and tots during time treatment hours but reduced when they had been at house. This selecting duplicates outcomes of previously research and underscores the want to discover time treatment that matches the requirements of each kid.

The two studies in the paper are accompanied by nine commentaries from child advancement experts who expected to shed light and perspective on the issue of time care and behavior.

"It's not stress period because millions of kids are carrying out very well in their several day-care configurations," says Eleanor Maccoby, teacher emerita of developing mindset at Stanford School, who authored one of the commentaries.

"Parents simply want to end up being vigilant, to produce sure that the particular agreement for their kid is functioning very well," she says. For example, if your young child is normally careful of various other kids and relatively timid, Maccoby suggests selecting a kid in time treatment or somewhere else who isn't really excessively terrifying and environment up play schedules therefore your kid can become used to public connections.

Also, keeping in touch with your day-care provider and asking approximately any kind of difficulties may help nip behavior problems early, Maccoby says.

She adds that on a community plan level, what's needed are measures that will improve day-care quality. Friedman's analysis demonstrated that better quality time treatment led to fewer behavior complications.

Sandeep Mendiratta, MD

The use of a testosterone gel in combination with an erection pill might help men with sexual malfunction who no longer respond to an erection pill alone, fresh research says.

The study, published in the August issue of the Log of Urology , found the combination approach improved erectile function and overall sexual satisfaction for men with erectile malfunction and low testosterone who failed to respond to sildenafil (Viagra) alone.

"Our data support the potential benefits of a mixture therapy with testo-sterone gel for males with erectile malfunction and low testo-sterone who find sildenafil by itself inadequate," lead detective Dr. Ridwan Shabsigh, an correlate teacher of urology at Columbia College or university University of Doctors and Cosmetic surgeons, stated in a ready declaration.

"When assessing erectile malfunction, doctors and individuals should consider using a basic bloodstream check to determine if low testo-sterone can be a contributing element. If the basic trigger can be low testo-sterone, sidlenafil only won't repair the issue," Shabsigh stated.

NIDA International Program Announcements

A single dosage of the L1D1 flu vaccine might be more than enough to safeguard kids and newborns against potential infection, Australian analysts record.

Presently, the U.S. Centers for Disease Control and Avoidance suggests that kids and newborns obtain two dosages of the L1D1 vaccine, spread about a month aside. This is certainly the same suggestion the CDC provides for in season flu vaccine, because generally a initial dosage is certainly required to leading the child's resistant program for the second dosage to create more than enough antibodies to end up being defensive.

"It will show up that a solo dosage is to end up being extremely likely all that is needed, even for infants," said lead specialist Dr. Terry Nolan, mind of the Melbourne College of Inhabitants Wellness and Section of Open public Wellness at the College or university of Melbourne.

This finding runs counter to the usual expectation that two doses are needed for children who have never been immunized against flu before, he said.

Offering a solo amount to kids might end up being many useful in vaccinating huge populations. "It's logistically simpler, it's fifty percent the price and for those incapable to obtain the two dosages, there are apparent advantages," he stated.

This vaccine is likely to be highly protective against pandemic swine flu, Nolan added. "In addition, there is certainly nothing at all to end up being worried about in conditions of protection or response prices to the vaccine."

The report is published in the Dec. 21 online model of the Newspaper of the American Medical Association .

For the research, Nolan's team tested the efficiency of the H1N1 flu vaccine in 370 infants and children aged 6 a few months to 9 years old. The kids had been arbitrarily designated to receive two shots of the vaccine, at either 15-microgram or 30-microgram dosages.

These are higher dosages than what is generally given, which is 7.5 micrograms, Nolan noted.

After the first dose, 92.5 percent of the children who received the 15-microgram amount and 97.7 percent of the children given the 30-microgram dosage created enough antibodies to the H1N1 swine flu to secure them from the virus.

The immune response was robust for all these children irrespective of age, previous antibody status, or whether the child had received a seasonal flu shot, the researchers found.

Nolan noted that ongoing research are tests whether a single 7.5-microgram dosage is enough to confer complete security from the L1D1 flu.

Structured upon the results of this research and others, wellness officials about the world might desire to reevaluate the suggestion on the subject of the amount of pictures and amounts kids require to end up being secured, this individual stated.

Dr. Anthony Age. Fiore, a medical epidemiologist in the influenza department at the U.S. Centers for Disease Control and Avoidance and co-author of an associated newspaper content, stated that although the researched demonstrated a great resistant response to a one dosage, "we would like to discover extra research."

Fiore noted that data from seasons flu vaccine suggests that two dosages are "the very best choice for kids under the age group of 10. It's early to move to the following stage and state kids just require one dosage of the L1D1 vaccine," he stated.

Parents should not rely on this research if their kid received only a single dosage of the L1D1 flu vaccine, Fiore said.

"Have a tendency relax based upon this research, thinking they have a tendency want that second dosage, because they really carry out to end up being specific and provide a level of an defense response that we are more confident is heading to protect them," he said.

Contagious disease professional Dr. Marc Siegel, an correlate teacher of medication at New You are able to College or university in New You are able to Town, observed that last week's recognition of children's L1D1 flu vaccine because it was not really powerful more than enough may end up being very much ado about nothing at all.

Nearly 800,000 children's doses of H1N1 swine flu vaccine were recalled simply by manufacturer Sanofi Pasteur Inc. because they got dropped some efficiency, federal government wellness officials stated Wednesday.

"It runs to present you the buzz about recalled children's pre-filled syringes and whether there is enough immunity might not really end up being a issue," he stated. "Today there's this paper, which obviously displays that a one dosage is certainly more than enough to trigger defenses in children."

Nevertheless, Siegel will not really believe the current two-dose process should be transformed until generally there is certainly even more evidence to present that one dose is certainly actually effective.

"I have a tendency think that we should modification the process. Two dosages is certainly ideal, but one is certainly most likely enough," he stated.

Title IX Incident – Investigative Policy and Procedure

Hospital design has little effect about patient satisfaction, according to a fresh study.

Experts analyzed studies of more than 5,600 hospital individuals in both newly renovated facilities and older facilities.

"Our team desired to know how important looks are to a patient's encounter with care. So we looked at studies from individuals before and after a move. We then compared those results to satisfaction studies from individuals becoming cared for on related devices that experienced not undergone a move to a fresh facility," said study author Dr. Zishan Siddiqui. He is definitely an assistant professor of medicine at Johns Hopkins University or college School of Medicine.

"We originally thought fresh and pleasing surroundings would improve patient satisfaction scores with physicians, healthcare professionals and overall care, but our study showed this is definitely not the case," Siddiqui said in a Hopkins news launch.

The study appears in the Mar issue of the Journal of Hospital Medicine .

Some hospital officials believe that increasing their facilities to be more patient-focused will automatically improve individual satisfaction.

"Not so. Hospital market leaders will have to stop blaming poor patient satisfaction scores on ageing buildings and devices," Siddiqui said.

"Although we did see significant improvement in facility-related satisfaction scores [in newer facilities], we did not see significant switch in satisfaction related to care, or overall satisfaction, for that matter," he added.

More effective ways to improve patient satisfaction include teaching health care companies about personalized care, educating individuals, and involving families in care decisions, the experts said.

Cheryl Andam

Repairing a torn knee meniscus at the same time as anterior cruciate ligament (ACL) reconstruction is usually safe and effective in children, a new study finds.

Meniscus cartilage acts as a cushioning/shock absorber in the knee joint. The ACL is usually one of four major ligaments in the knee.

This study included 99 patients, 18 and younger, who had meniscus repair at the time of an ACL reconstruction. The overall success rate of meniscus repair was 74 percent. The rate was 84 percent for patients with simple tears (one major tear), 59 percent for displaced bucket-handle tears (a tear around the rim of the meniscus, causing the central portion to displace into the joint), and 57 percent for complex tears (a tear in multiple planes).

The freedom-from-failure rate was 90.9 percent after two years and 76.8 percent after eight years.

Knee function on a 100-point scale improved from a median of 48 (range of 38-70) before surgery to 90 (range of 52-100) after medical procedures. On a sporting activity scale of 0-10 (with 10 being national elite competitive sports), the patients improved from 1.9 before surgery to 6.2 after surgery.

"We have a wealth of information regarding adults who have a meniscus tear repaired at the time of ACL reconstruction, but there was very little data regarding the pediatric populace," Dr. Aaron Krych, main resident in the orthopedic medical procedures department at the Mayo Clinic, Rochester, Minn., said in a news release. "To our knowledge, this is usually the largest study reported on the pediatric populace. These knee injuries are common in kids that play football, wrestling and soccer."

The study was to be presented Saturday at the American Orthopaedic Society for Sports Medicine's annual meeting in New Orleans.

At the same meeting, another team of researchers said they found that "Tommy John" elbow reconstruction was 95 percent successful in teen baseball pitchers with fully mature bones.

The procedure -- named for the Hall of Fame pitcher who was the first to have the operation in 1974 -- involves using a tendon from elsewhere in the body to replace a damaged elbow ligament called the ulnar collateral ligament (UCL).

The study of 20 high school pitchers who had the surgery found that 17 were very satisfied and two were somewhat satisfied with the outcome. Of those 19 patients, 18 said they returned to competitive baseball -- three in the highest level of competition in the minor leagues, 13 in intercollegiate baseball, and three in high school baseball.

"High school kids have been a gray zone for this surgery," Dr. Michael J. Angel, of Premier Orthopaedics of Westchester and Rockland. "Obviously, surgeons would avoid medical procedures on young patients whose growth dishes had not closed. But this study can give surgeons the confidence to recommend this surgery to teenage, skeletally mature athletes. It also gives the teen and their parents assurance that the surgery should go well."