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H1N1: What You Should Know
As a Dallas-based physician, there has been a recent flurry of panic about the H1N1 (swine influenza). School districts closed down. Intramural sports statewide were cancelled. Some even suggested closing the border with Mexico, where approximately three quarters of a million people routinely cross back and forth every day. The panic certainly was fueled by the media reports. Likewise, the media can serve to educate the public about health issues.
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Recognizing 'Intoxication'
One well-known and often deadly consequence of alcohol intoxication is impaired driving. Yet still today, it is difficult for even trained observers to fully identify "intoxication," given that so many factors contribute to it. This review examines the very definition of intoxication, as well as methods designed to prevent impaired driving.
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Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).
Mental Health

Drinking Milk In The Morning May Help Stave Off Lunchtime Hunger

Now there"s a new reason for the weight-conscious to drink fat free milk at breakfast time, suggests a new study published in the July issue of the American Journal of Clinical Nutrition. Researchers in Australia found that drinking fat free milk in the morning helped increase satiety, or a feeling of fullness, and led to decreased calorie intake at the next meal, as compared with a fruit drink. The milk drinkers ate about 50 fewer calories (or nearly 9% less food) at lunch. In the study, 34 overweight but otherwise healthy men and women participated in two testing sessions - one in which they were served about 20 ounces of fat free milk, and one in which they were served the same amount of a fruit drink (both beverages contributed about 250 calories to the breakfast meal). During the four hours between breakfast and lunch, the men and women gauged their feelings of fullness and were allowed to eat until comfortably full at lunch. The researchers found that the milk-drinking adults reported feeling fuller, more satisfied and therefore ate fewer calories at lunch. The researchers suspect that milk"s protein content (providing 16% of the daily value per cup), the lactose (the natural sugar in milk) or simply the thickness of the beverage may play a role in the satiety benefits. And, research suggests choosing foods that can help enhance satiety is an important success factor in any weight management plan. Experts are increasingly focused on small behavior changes that can make a big difference when it comes to maintaining a healthy weight. A calorie decrease as little as 50 calories per day can add up in the long run. Americans may be gaining weight at a rate of up to two pounds per year, likely caused by an average of less than 100 calories per day, according to recent research. Fat free milk is packed with nine essential nutrients Americans need, including calcium and vitamin D, and contains 80 calories per 8-ounce serving. The Dietary Guidelines for Americans recommend three servings of fat free or lowfat milk each day. Dove, ER, Hodgson JM, Puddey IB, Beilin LJ, Lee YP, Mori TA. Skim milk compared with a fruit drink acutely reduces appetite and energy intake in overweight men and women. American Journal of Clinical Nutrition. 2009;90:70-75. Gloria Delgadillo Weber Shandwick Worldwide


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