Technique may improve detection of breast tumors

About 1 out of every 8 women nationwide will develop invasive breast cancer at some point in their lives. It is the second most common type of cancer to affect women. Detecting breast cancer as early as possible is crucial for increasing the chance of survival. However, many women avoid getting screened with the current breast cancer screening method, mammography. Mammography can be uncomfortable or painful. Mammograms also don’t always reveal early tumors in denser breast tissue.

Researchers have been developing a new method for detecting breast cancer called photoacoustic computed tomography (PACT). The technique uses harmless pulses of laser light to penetrate the breast tissue. This causes a type of sound wave called photoacoustic waves to spread through the tissue. These waves can be measured by sensors surrounding the breast. Blood vessels react to the light differently, providing contrast that allows PACT to form clear images of the breast’s blood vessel network. This approach can be used to spot tumors because tumor growth depends on blood vessels.

Previous forms of PACT have been limited by long scan times and other factors that lower image quality. Recently, a research team led by Dr. Lihong V. Wang at the California Institute of Technology developed a system called single-breath-hold PACT (SBH-PACT) that overcomes these limitations. The work was supported by NIH’s National Institute of Biomedical Imaging and Bioengineering (NIBIB) and other NIH components. Results were published in Nature Communications on June 15, 2018.

Internal vascular structure of a human breast
Image of the blood vessels in a human breast created with the PACT photoacoustic imaging technique. Lihong Wang, Caltech
To test the technique, the researchers enrolled one healthy volunteer and seven female patients with breast cancer in a clinical study. The participants had a range of skin pigmentations and breast sizes. For the scan, a soft agar pillow was used to compress the women’s breast to her chest while she laid down. A laser was shone through the breast from beneath the bed. Sensors surrounding the breast detected the resulting photoacoustic waves, and this data was used to map the blood vessels within. This system generated 2-D or 3-D images of the entire breast while the women held their breath for 15 seconds.

In the healthy volunteer, SBH-PACT produced a clear 3-D image of the blood vessel network throughout the entire breast. In the patients with breast cancer, SBH-PACT revealed eight of the nine tumors using the higher blood vessel densities of the tumors. The team was able to detect the ninth tumor using SBH-PACT to measure “elastographic” changes in breast tissue. Breast tumors are less elastic than normal breast tissue, so regions that changed less during breathing indicated tumors. This measurement could be taken in 2-D mode in about ten seconds.

Both blood vessel density and tissue compliance were measured with the SBH-PACT system in about 30 seconds. Together, these two measurements can provide a quick and safe method to detect breast cancer. However, trials with more women are needed to confirm these findings. A company founded by Wang has licensed the technology and is now planning larger studies.

“Because of the detailed images created by PACT, we are looking at other uses such as assessment of the blood vessel damage in diabetics,” Wang says. “The severe vascular damage and death of leg and foot tissues in diabetics is a major health problem that could be significantly improved by early detection and treatment.”

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Editing T cell genomes without viruses

Two T cells that have been altered by using CRISPR and electroporation.
Researchers used CRISPR and a jolt of electricity to get DNA inside T cells. The glowing ring of green demonstrates how DNA can be targeted to specific structures in a cell. Alex Marson, UCSF, Nature
T cells are an important part of the immune system. They help protect the body from infection and can also help fight cancer. Researchers have been working for years to genetically alter T cells to target specific types of cells for fighting cancer and other diseases. Past methods have used viruses (viral vectors) to insert DNA into T cells. However, the viral vectors used in FDA-approved T cell therapies can’t be used to insert genes into specific genomic sites. Using viral vectors to reprogram T cells can also be a difficult and expensive process.

CRISPR-Cas9 is a genomic engineering technology that allows DNA to be inserted, removed, or changed at particular locations in the genome. It’s one of the faster, cheaper, more accurate, and more efficient genome editing methods. To investigate whether human T cell function can be reprogrammed using CRISPR without viral vectors, a team led by Dr. Alex Marson at the University of California, San Francisco, tested a method called electroporation to deliver the CRISPR-Cas9 system and DNA in human T cells. The research, which was supported by several NIH components, was published in Nature on July 11, 2018.

Electroporation uses a pulse of electricity to get DNA or other molecules inside the cell. The researchers tested and refined their electroporation technique using T cells with a combination of CRISPR-Cas9 ribonucleoprotein and the gene for green fluorescent protein (GFP). They confirmed the presence of GFP in the cells and optimized the technique to minimize the impact on the cells and increase its efficiency.

They next tested their system by targeting different sections of the genome. They fused GFP to different genes. Using confocal microscopy, they tracked the resulting GFP fusion proteins and confirmed that they were all located in their proper, distinct locations within the cell. They found that normal gene regulation mechanisms still worked for at least one of the tested genes.

The team showed that they could simultaneously modify one, two, or three genes at a time. The researchers also analyzed possible off-target effects. They found that the genes rarely reached sites that weren’t specifically targeted. They showed that certain techniques could nearly eliminate these off-target effects.

Finally, the team tested whether the system could correct a specific gene mutation involved in an autoimmune disease. They identified a family with a loss-of-function mutation in the IL-2α receptor, which is important for proper T cell function. Using cells from the family members with the gene mutation, the researchers corrected two specific defects in the gene and showed that the changes improved the receptor’s function in T cells.

The researchers also showed they could replace large sections of DNA in T cells to reprogram the antigen receptor—the part of the T cell that identifies and targets diseased cells. They compared T cells reprogrammed without viral vectors to virally reprogrammed cells in mice. Both types of reprogrammed cells located cancer cells and accumulated in tumors to similar degrees.

“This is a rapid, flexible method that can be used to alter, enhance, and reprogram T cells so we can give them the specificity we want to destroy cancer, recognize infections, or tamp down the excessive immune response seen in autoimmune disease,” Marson says.

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How night shifts disrupt metabolism

An urban landscape at night that shows lights in office buildings, suggesting people at work.
Being awake at night and asleep during the day can disrupt the rhythms of certain metabolic pathways. Pranodhm/iStock/Thinkstock
You wake up, feel hungry, and fall asleep each day around repeating 24-hour “circadian” cycles controlled by your body’s internal clocks. These clocks are synchronized by a central pacemaker in the brain. Cycles of light and dark are important for the function of the brain’s master clock. Other cycles, such as the behavioral activities of eating and fasting or sleeping and waking, are important for peripheral clocks in the liver, gut, and other tissues.

When you stay awake all night or otherwise go against natural light cycles, your health may suffer. Long-term disruption of circadian rhythms has been linked to obesity, diabetes, and other health problems related to the body’s metabolism.

Previous studies have shown that some metabolites—the products of metabolism—in blood can have daily rhythms. An international research team led by Drs. Hans P. A. Van Dongen and Shobhan Gaddameedhi at Washington State University investigated whether disruptions in these rhythms are influenced by the central pacemaker in the brain or reflect behavioral activities, such as working the night shift. The study was funded in part by NIH’s National Institute of Environmental Health Sciences (NIEHS). Results were published online in the Proceedings of the National Academy of Sciences on July 10, 2018.

Ten men and four women, aged 22 to 34 years, stayed at a research lab for one week. Half had a night-shift sleep pattern for three days and half had a day-shift pattern. The night-shift pattern causes the central pacemaker and behavioral rhythms to be at odds. After three days, the volunteers were kept awake for one day in a constant routine with a constant level of temperature and light. They received identical snacks every hour and provided blood samples every three hours.

The research team found only small differences in the day-shift and night-shift patterns for melatonin and cortisol, which mark the activity of the brain’s master clock. This finding suggests that the master clock is resistant to influence from the night-shift pattern.

The team analyzed the levels of 132 metabolites during the 24-hour constant routine. About half (65) of the metabolites had a significant daily rhythm. Of these, 27 had a significant 24-hour rhythm for both sleep patterns. Only three of these metabolites (taurine, serotonin, and sarcosine) kept the same peak time, similar to the master clock markers melatonin and cortisol. The other 24 showed a 12-hour shift in rhythm for the night-shift pattern.

The researchers noted that the particular metabolites and pathways affected by the night-shift sleep pattern relate to the liver, pancreas, and digestive tract. These findings suggest that night-shift sleep patterns can disrupt certain metabolite rhythms and the peripheral clocks of the digestive system without affecting the brain’s master clock.

“No one knew that biological clocks in people’s digestive organs are so profoundly and quickly changed by shift work schedules, even though the brain’s master clock barely adapts to such schedules,” Van Dongen says. “As a result, some biological signals in shift workers’ bodies are saying it’s day while other signals are saying it’s night, which causes disruption of metabolism.”

Further research is needed to better understand the role of these metabolic pathways in obesity, diabetes, and other medical conditions for which shift workers are at increased risk.

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Early family experience affects later romantic relationships

Learning how to form and sustain happy and healthy romantic relationships is a key skill for young adults. Such relationships are based on feelings of love, effective problem-solving, and the absence of physical and verbal violence. The ability to develop a healthy relationship can be influenced by the experiences people have had within their own families. However, the ways in which the family environment influences interpersonal skills and romantic relationships aren’t well understood.

A team of researchers led by Penn State graduate student Mengya Xia set out to explore how interpersonal skills and family factors affect romantic relationships. They examined data from a long-term study on preventing substance use among more than 10,000 youths in rural and semi-rural communities in Pennsylvania and Iowa. A randomly selected set of nearly 2,000 participated in a later follow-up project when they were young adults. For this analysis, the team included the 974 participants between 18 and 21 years old who were in a steady romantic relationship. The study was supported by NIH’s National Institute on Drug Abuse (NIDA) and National Institute of Child Health and Human Development (NICHD). The results were published in the July 2018 issue of Journal of Youth and Adolescence.

The participants were surveyed four times. In grades 6, 7, and 9, they were asked about their assertiveness, positive engagement with their families, family climate, and effectiveness of their parents’ discipline methods. When they were between 18 and 21, they were asked to rate the violence levels, problem-solving skills, and amount of love they felt in their romantic relationships.

The researchers found that young adults from families that were cohesive, organized, and without much conflict were less likely to be in romantic relationships with violence or poor problem-solving. However, neither the family climate nor the parenting practices were linked to feelings of love in the relationships.

Family factors also seemed to affect specific interpersonal skills. More effective parenting and a positive family climate appeared to increase the participants’ assertiveness—the ability to respectfully advocate for their needs in a relationship and have positive interactions with their families.

The influences seemed to go both ways. Participants who had positive family engagement at the start of the study reported later in childhood that they experienced more effective parenting. Assertiveness in childhood also predicted later reports of more effective parenting but did not affect family climate.

This study suggests that adolescents who grow up in positive family climates with effective parenting are more likely to have healthy romantic relationships as young adults. In addition, adolescents who are more assertive and behave positively with their families also help create a positive family climate.

“The family relationship is the first intimate relationship of your life, and you apply what you learn to later relationships,” Xia says. “It's also where you may learn how to constructively communicate—or perhaps the inverse, to yell and scream—when you have a disagreement.”

A better understanding of the family dynamics that affect adult interactions could lead to more effective strategies for improving romantic relationships. However, this study included mostly white families in rural and semi-rural areas—and also more females participated than males. More diverse populations will be needed to confirm and expand on the findings.

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How drugs could repair damage from multiple sclerosis

Oligodendrocyte with nerve cell
Illustration of an oligodendrocyte, right, creating a myelin coating around a nerve cell extension. Damage to myelin can affect communication between nerve cells. Ralwel/iStock/Thinkstock
Multiple sclerosis is an autoimmune disease in which the body’s own immune system mistakenly attacks the lining of the nerves in the brain and spinal cord. When this insulating lining, called myelin, is damaged, communication between nerve cells can be interrupted. This leads to muscle weakness, problems with coordination and vision, and other symptoms of the disease.

Experts estimate that almost half a million people nationwide live with multiple sclerosis. Existing drugs can relieve symptoms for a while by calming the immune system. But in most people, the disease gets worse over time. If scientists can develop drugs that promote myelin repair in people, the damage caused by multiple sclerosis could potentially be reversed.

In previous research, a team led by Dr. Paul Tesar at Case Western Reserve University and Dr. Robert Miller at George Washington University found that miconazole, an antifungal drug, activated stem cells and repaired myelin damage in mice. The researchers, joined by Dr. Drew Adams from Case Western Reserve, wanted to understand exactly how this drug—and others that have been discovered—encourage myelin repair. The study was funded by NIH’s National Institute of Neurological Diseases and Stroke (NINDS) and other NIH components. Results were published on July 25, 2018, in Nature, along with a companion methods paper in Nature Methods.

The team used a series of laboratory techniques to examine how drugs interact with the molecules in the body that are involved in myelin production. They found that miconazole and eight other related drugs all blocked an enzyme called CYP51. Blocking CYP51 encouraged stem cells to form new oligodendrocytes. These are the cells that create the myelin coatings around nerve cells.

CYP51 is part of the molecular pathway that produces cholesterol. The researchers discovered that blocking two other enzymes in that pathway also promoted oligodendrocyte production.

The boost in oligodendrocyte production appeared to be due to buildup of a specific type of cholesterol precursor (called 8,9-unsaturated sterols) when any of the three enzymes was blocked. When the researchers treated stem cells with 8,9-unsaturated sterols, they saw oligodendrocyte production rise.

The team next screened over 3,000 approved drugs and other small molecules for their ability to promote oligodendrocyte production. The top ten all caused a buildup of 8,9-unsaturated sterols.

When tested on human stem cells grown in the laboratory, drugs or genetic manipulations that targeted any one of the three enzymes caused oligodendrocytes to form and start laying down myelin. In mice with damage to myelin in their spinal cords, injection of drugs that targeted one of the enzymes caused restoration of myelin in the damaged tissue.

“We were shocked to find that almost all of these previously identified molecules share the ability to inhibit specific enzymes that help to make cholesterol. This insight reorients drug discovery efforts onto these novel, druggable targets,” Adams says.

The researchers have formed a company to build on these findings and develop therapeutics to promote myelin repair.

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Risk in Red Meat?

A new study adds to the evidence that eating red meat on a regular basis may shorten your lifespan. The findings suggest that meat eaters might help improve their health by substituting other healthy protein sources for some of the red meat they eat.

Past research has tied red meat to increased risks of diabetes, cardiovascular disease and certain cancers. The studies have also pointed to an elevated risk of mortality from red meat intake. But most of these studies were done over limited periods of time, had design flaws, or were done in populations with diets other than that of the typical American.

A research team led by Dr. Frank Hu of the Harvard School of Public Health set out to learn more about the association between red meat intake and mortality. They studied over 37,000 men from the Health Professionals Follow-up Study (beginning in 1986) and over 83,000 women from the Nurses' Health Study (beginning in 1980). All the participants were free of cardiovascular disease and cancer at the start of the study.

The participants filled out food frequency questionnaires every 4 years. The scientists also gathered information every 2 years on a variety of other health factors, including body weight, cigarette smoking and physical activity level. The study was supported by NIH’s National Heart, Lung and Blood Institute (NHLBI), National Cancer Institute (NCI) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It appeared online in Archives of Internal Medicine on March 12, 2012.

Almost 24,000 participants died during the study, including about 5,900 from cardiovascular disease and about 9,500 from cancer. Those who consumed the highest levels of both unprocessed and processed red meat had the highest risk of all-cause of mortality, cancer mortality and cardiovascular disease mortality. After adjusting for other risk factors, the researchers calculated that 1 additional serving per day of unprocessed red meat over the course of the study raised the risk of total mortality by 13%. An extra serving of processed red meat (such as bacon, hot dogs, sausage and salami) raised the risk by 20%.

The researchers estimated that substituting 1 serving per day of other foods—like fish, poultry, nuts, legumes, low-fat dairy and whole grains—for red meat could lower the risk of mortality by 7% to 19%. If the participants had all consumed fewer than half a serving per day (about 1.5 ounces) of red meat, the scientists calculated, 9.3% of the deaths in men and 7.6% of the deaths in women could have been prevented.

“Our study adds more evidence to the health risks of eating high amounts of red meat, which has been associated with type 2 diabetes, coronary heart disease, stroke and certain cancers in other studies,” says lead author Dr. An Pan.

Since this was an observational study in which people reported their own food intake, it's possible that the associations seen may be due to other factors. When the researchers accounted for known risk factors in red meat—like saturated fat, dietary cholesterol and iron—they still couldn't account for all of the risk associated with eating red meat. Other mechanisms may be involved, or other unknown factors may affect the results. Further study will be needed to fully understand the connection between red meat consumption and health.

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How dietary factors influence disease risk

Young woman at store looking at apples
A healthy eating plan lowers your risk for heart disease and other health conditions. m-imagephotography/iStock/Thinkstock
Having too much sugar, salt, or fat in your diet can raise your risk for certain diseases. Healthy eating can lower your risk for heart disease, stroke, diabetes, and other health conditions. A healthy eating plan emphasizes vegetables, fruits, whole grains, and fat-free or low-fat dairy products; includes lean meats, poultry, fish, beans, eggs, and nuts; and limits saturated and trans fats, sodium, and added sugars.

The major cardiometabolic diseases—heart disease, stroke, and type 2 diabetes—pose substantial health and economic burdens on society. To better understand how different dietary components affect the risk of dying from these diseases, a research team led by Dr. Dariush Mozaffarian of Tufts University analyzed data from CDC’s National Health and Nutrition Examination Survey (NHANES) and national disease-specific mortality data. The study was supported in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results appeared on March 7, 2017, in the Journal of the American Medical Association.

The researchers investigated the relationships of 10 different foods and nutrients with deaths related to heart disease, stroke, and type 2 diabetes. They also compared data on participants’ age, sex, ethnicity, and education. They found that nearly half of all the deaths in the United States in 2012 that were caused by cardiometabolic diseases were associated with suboptimal eating habits. Of 702,308 adult deaths due to heart disease, stroke, and type 2 diabetes, 318,656 (45%) were associated with inadequate consumption of certain foods and nutrients widely considered vital for healthy living, and overconsumption of other foods that are not.

The highest percentage of cardiometabolic disease-related death (9.5%) was related to excess consumption of sodium. Not eating enough nuts and seeds (8.5%), seafood omega-3 fats (7.8%), vegetables (7.6%), fruits (7.5%), whole grains (5.9%), or polyunsaturated fats (2.3%) also increased risk of death compared with people who had an optimal intake of these foods/nutrients. Eating too much processed meat (8.2%), sugar-sweetened beverages (7.4%), and unprocessed red meat (0.4%) also raised the risk of heart disease, stroke, and type 2 diabetes-related deaths.

The study showed that the proportion of deaths associated with suboptimal diet varied across demographic groups. For instance, the proportion was higher among men than women; among blacks and Hispanics compared to whites; and among those with lower education levels.

“This study establishes the number of cardiometabolic deaths that can be linked to Americans’ eating habits, and the number is large,” explains Dr. David Goff, director of the NHLBI Division of Cardiovascular Sciences. “Second, it shows how recent reductions in those deaths relate to improvements in diet, and this relationship is strong. There is much work to be done in preventing heart disease, but we also know that better dietary habits can improve our health quickly, and we can act on that knowledge by making and building on small changes that add up over time.”

These findings are based on averages across the population and aren’t specific to any one person’s individual risk. Many other factors contribute to personal disease risk, including genetic factors and levels of physical activity. Individuals should consult with a health care professional about their particular dietary needs.

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Dairy fatty acids not linked to death in older adults

Dairy products like cheese, butter, and whole milk contain saturated fats. Past research has shown that diets with high levels of saturated fat
s can increase the risk of cardiovascular disease, such as heart disease and stroke. Saturated fats have also been linked to increased mortality rates. Understanding the health effects of dairy fats is challenging because dairy products are complex. They contain many nutrients like calcium that have health benefits.

When we digest dairy foods, the fatty acids from the food travel through the bloodstream. These fatty acids can be used in research studies as biomarkers of dairy fat consumption. A research team led by Dr. Marcia C. de Oliveira Otto at the University of Texas Health Science Center at Houston and Dr. Dariush Mozaffarian of Tufts University explored the connections between dairy fatty acids and cardiovascular disease and death. Their work was funded in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI) and other NIH components.

The study included nearly 3,000 adults in California, Maryland, North Carolina, or Pennsylvania who were older than 65 and free of heart disease at the start of the study. The participants had physical exams and lab tests, and answered questionnaires. The team assessed three fatty acids that reflect dairy intake (pentadecanoic, heptadecanoic, and trans-palmitoleic fatty acids) in blood samples obtained at the start, at six years, and at 13 years. The results appeared online in the American Journal of Clinical Nutrition on July 11, 2018.

More than 2,400 people died over the course of the 22-year study period. The researchers accounted for demographic, lifestyle, cardiovascular, and dietary factors. They found no significant links between overall risk of death and long-term exposure to the three dairy fatty acids.

Next, the team investigated specific causes of death. More than 800 people died from cardiovascular causes, such as heart attacks and strokes. About 1,600 deaths were from other causes, such as cancer and infection. The team noted a lower risk of death from cardiovascular disease—in particular, stroke—for those with higher levels of heptadecanoic acid. On the other hand, those with higher levels of heptadecanoic acid had a higher risk of death for non-cardiovascular causes. The other two dairy fatty acids did not have significant links to cardiovascular or noncardiovascular deaths.

The findings support a growing body of evidence that suggests dairy fat does not increase the risk of heart disease or overall mortality in older adults.

“Our results highlight the need to revisit current dietary guidance on whole fat dairy foods, which are rich sources of nutrients such as calcium and potassium,” Otto says.  

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That stinks! 1 in 15 Americans smell odors that aren’t there NIH study reveals prevalence of and risk factors for phantom odor perception.

Imagine the foul smell of an ash tray or burning hair. Now imagine if these kinds of smells were present in your life, but without a source. A new study finds that 1 in 15 Americans (or 6.5 percent) over the age of 40 experiences phantom odors. The study, published in JAMA Otolaryngology-Head and Neck Surgery (link is external), is the first in the U.S. to use nationally representative data to examine the prevalence of and risk factors for phantom odor perception. The study could inform future research aiming to unlock the mysteries of phantom odors.

The study was led by Kathleen Bainbridge, Ph.D., of the Epidemiology and Biostatistics Program at the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health. Bainbridge and her team used data from 7,417 participants over 40 years of age from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) (link is external). The NHANES data were collected by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention; data collection was partly funded by the NIDCD.

<“Problems with the sense of smell are often overlooked, despite their importance. They can have a big impact on appetite, food preferences, and the ability to smell danger signals such as fire, gas leaks, and spoiled food,” said Judith A. Cooper, Ph.D., acting director of the NIDCD.

Donald Leopold, M.D., one of the study’s authors and clinical professor in the Department of Surgery at University of Vermont Medical Center, Burlington, adds that patients who perceive strong phantom odors often have a miserable quality of life, and sometimes cannot maintain a healthy weight.

Researchers used this NHANES survey question to determine whether participants had experienced phantom odor perception: “Do you sometimes smell an unpleasant, bad, or burning odor when nothing is there?” To explore the correlation between phantom odors and participant characteristics, the researchers looked at participants’ age, sex, education level, race/ethnicity, socio-economic status, certain health habits, and general health status.

The ability to identify odors tends to decrease with age. Phantom odor perception, on the other hand, seems to improve with age. One previous study, using data from a community in Sweden, showed that 4.9 percent of people over the age of 60 experience phantom odors, with a higher prevalence in women than men. The present study found a similar prevalence in the over-60 age group, but in examining a broader age range, found an even higher prevalence in ages 40-60. The study also found that about twice as many women as men reported phantom odors, and that the female predominance was particularly striking for those under age 60.

Other risk factors for the onset of phantom odors include head injury, dry mouth, poor overall health, and low socio-economic status. Researchers hypothesized that people with lower socio-economic status may more commonly be exposed to environmental pollutants and toxins, or have health conditions that contribute to phantom odors, either directly or because of medications needed to treat their health conditions.

“The causes of phantom odor perception are not understood. The condition could be related to overactive odor sensing cells in the nasal cavity or perhaps a malfunction in the part of the brain that understands odor signals. A good first step in understanding any medical condition is a clear description of the phenomenon. From there, other researchers may form ideas about where to look further for possible causes and ultimately for ways to prevent or treat the condition,” said Bainbridge.

About the National Institute on Deafness and Other Communication Disorders (NIDCD): NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language and provides health information, based upon scientific discovery, to the public.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Saying Goodbye to Tension

eeling stressed out? You're not alone. According to a 2007 survey conducted by the American Psychological Association, a third of all Americans say they experience extreme stress, and more than half say that their stress level has increased over the past 5 years. Because constant stress is bad for your health, it's important to take time to decompress. Not sure how to do it? Try one of these five ways to de-stress:

1. Work up a sweat.
It doesn't matter if you run a mile, walk around your neighborhood, or do some yoga poses. Getting your body moving is one of the best ways to relieve stress. "You need a way of releasing that energy. And exercise and yoga do that," says Carolyn Swithers, RN, BSN, CDE, director of the Center for Nutrition and Diabetes Management at Hunterdon Medical Center in Flemington, N.J.. If you've ever heard of the term "runner's high" you get the idea: In response to physical activity, your brain releases feel-good endorphins that ease your tension. What's more, exercise provides you with time to be alone with your thoughts. For the 30 minutes or hour that you're working out, you can forget your too-big "to do" list and dodge the ever-ringing phone.

2. Take some "me" time.
Between caring for kids, working crazy hours, and making sure the house is clean, you likely can't imagine how you'll ever set aside personal time. But taking even just a half hour away from family and work obligations will allow you to recharge and decrease your built-up stress. You can do something as simple as soak in a long bath or read a good book. Or you can pick up a hobby like crocheting, building model airplanes, or playing a musical instrument. "It's a diversion. It gives you satisfaction," says Swithers. "You must enjoy it and do it well or else you wouldn't do it." In the end, it doesn't matter what you do as long as it gives you release.

3. Visit with pals.
"I had heard a statement long ago that we wouldn't need psychotherapists if we all had good friends," says Swithers, who recommends visiting with loved ones when you feel like you're at the end of your rope. Taking time out of a busy week or month to emotionally connect with another human being can break the day-to-day tension that's built up. Plus, studies have shown that having close friends can help you live longer—and healthier.

4. Wax poetic.
Take out your frustration and anxiety on a piece of paper by journaling your feelings. Writing down how you feel can help you understand and cope with the pressures in your life. Plus, it provides a stress-free time for you to spend alone and in thought.

5. Catch your ZZZs.
When we're stressed and overworked, sleep is often the first thing to suffer. That's because it's easier to put off your bedtime than it is to miss a work deadline. But getting enough rest each night is important to your health and can play a role in your stress management. Quality sleep, says Swithers, allows you to "wake up in the morning [and] feel rested. You did get an adequate amount of sleep so you're better prepared [for the day]." Do yourself a favor and get between 7 and 9 hours each night.

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WHO and UNICEF issue new guidance to promote breastfeeding in health facilities globally

WHO and UNICEF today issued new ten-step guidance to increase support for breastfeeding in health facilities that provide maternity and newborn services. Breastfeeding all babies for the first two years would save the lives of more than 820 000 children under age 5 annually.

The Ten Steps to Successful Breastfeeding underpin the Baby-friendly Hospital Initiative, which both organizations launched in 1991. The practical guidance encourages new mothers to breastfeed and informs health workers how best to support breastfeeding.

Breastfeeding is vital to a child’s lifelong health, and reduces costs for health facilities, families, and governments. Breastfeeding within the first hour of birth protects newborn babies from infections and saves lives. Infants are at greater risk of death due to diarrhoea and other infections when they are only partially breastfed or not breastfed at all. Breastfeeding also improves IQ, school readiness and attendance, and is associated with higher income in adult life. It also reduces the risk of breast cancer in the mother.

"Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last will into adulthood," says UNICEF Executive Director Henrietta H. Fore. "But breastfeeding requires support, encouragement and guidance. With these basic steps, implemented properly, we can significantly improve breastfeeding rates around the world and give children the best possible start in life."

WHO Director-General Dr Tedros Adhanom Ghebreyesus says that in many hospitals and communities around the world, whether a child can be breastfed or not can make the difference between life and death, and whether a child will develop to reach his or her full potential.

"Hospitals are not there just to cure the ill. They are there to promote life and ensure people can thrive and live their lives to their full potential," says Dr Tedros. "As part of every country’s drive to achieve universal health coverage, there is no better or more crucial place to start than by ensuring the Ten Steps to Successful Breastfeeding are the standard for care of mothers and their babies."

The new guidance describes practical steps countries should take to protect, promote and support breastfeeding in facilities providing maternity and newborn services. They provide the immediate health system platform to help mothers initiate breastfeeding within the first hour and breastfeed exclusively for six months.

It describes how hospitals should have a written breastfeeding policy in place, staff competencies, and antenatal and post-birth care, including breastfeeding support for mothers. It also recommends limited use of breastmilk substitutes, rooming-in, responsive feeding, educating parents on the use of bottles and pacifiers, and support when mothers and babies are discharged from hospital.

Note to editors
The Ten Steps are based on the WHO guidelines, issued in November 2017, titled Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services.

Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. Starting breastfeeding early increases the chances of a successful continuation of breastfeeding. Exclusive breastfeeding for six months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections and malnutrition, which are observed not only in developing but also industrialized countries.

Breast-milk is also an important source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy needs between 6-12 months, and one-third of energy needs between 12-24 months. Breast-milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.
Children and adolescents who were breastfed as babies are less likely to be overweight or obese.

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3 in 5 babies not breastfed in the first hour of life

Breastfeeding within an hour after birth is critical for saving newborn lives
31 July 2018 News Release  New York/Geneva
An estimated 78 million babies – or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding, say UNICEF and WHO in a new report. Most of these babies are born in low- and middle-income countries.

The report notes that newborns who breastfeed in the first hour of life are significantly more likely to survive. Even a delay of a few hours after birth could pose life-threatening consequences. Skin-to-skin contact along with suckling at the breast stimulate the mother’s production of breastmilk, including colostrum, also called the baby’s ‘first vaccine’, which is extremely rich in nutrients and antibodies.

“When it comes to the start of breastfeeding, timing is everything. In many countries, it can even be a matter of life or death,” says Henrietta H. Fore, UNICEF Executive Director. “Yet each year, millions of newborns miss out on the benefits of early breastfeeding and the reasons – all too often – are things we can change. Mothers simply don’t receive enough support to breastfeed within those crucial minutes after birth, even from medical personnel at health facilities.”



Breastfeeding rates within the first hour after birth are highest in Eastern and Southern Africa (65%) and lowest in East Asia and the Pacific (32%), the report says. Nearly 9 in 10 babies born in Burundi, Sri Lanka and Vanuatu are breastfed within the first hour. By contrast, only two in 10 babies born in Azerbaijan, Chad and Montenegro do so.*

“Breastfeeding gives children the best possible start in life,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We must urgently scale up support to mothers – be it from family members, health care workers, employers and governments, so they can give their children the start they deserve.”

Capture the Moment, which analyzes data from 76 countries, finds that despite the importance of early initiation of breastfeeding, too many newborns are left waiting too long for different reasons, including:

Feeding newborns food or drinks, including formula: Common practices, such as discarding colostrum, an elder feeding the baby honey or health professionals giving the newborn a specific liquid, such as sugar water or infant formula, delay a newborn’s first critical contact with his or her mother.
The rise in elective C-sections: In Egypt, caesarean section rates more than doubled between 2005 and 2014, increasing from 20% to 52%. During the same period, rates of early initiation of breastfeeding decreased from 40% to 27%. A study across 51 countries notes that early initiation rates are significantly lower among newborns delivered by caesarean section. In Egypt, only 19% of babies born by C-section were breastfed in the first hour after birth, compared to 39% of babies born by natural delivery.
Gaps in the quality of care provided to mothers and newborns: The presence of a skilled birth attendant does not seem to affect rates of early breastfeeding, according to the report. Across 58 countries between 2005 and 2017, deliveries at health institutions grew by 18 percentage points, while early initiation rates increased by 6 percentage points. In many cases, babies are separated from their mothers immediately after birth and guidance from health workers is limited. In Serbia, the rates increased by 43 percentage points from 2010 to 2014 due to efforts to improve the care mothers received at birth.
Earlier studies, cited in the report, show that newborns who began breastfeeding between two and 23 hours after birth had a 33% greater risk of dying compared with those who began breastfeeding within one hour of birth. Among newborns who started breastfeeding a day or more after birth, the risk was more than twice as high.

The report urges governments, donors and other decision-makers to adopt strong legal measures to restrict the marketing of infant formula and other breastmilk substitutes.

The WHO and UNICEF-led Global Breastfeeding Collective also released the 2018 Global Breastfeeding Scorecard, which tracks progress for breastfeeding policies and programmes. In it, they encourage countries to advance policies and programmes that help all mothers to start breastfeeding in the first hour of their child’s life and to continue as long as they want.

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Early initiation of breastfeeding: the best start for every newborn

Overview
The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – is critical to newborn survival and to establishing breastfeeding over the long term. When breastfeeding is delayed after birth, the consequences can be life-threatening – and the longer newborns are left waiting, the greater the risk.

This report presents the global situation of early initiation of breastfeeding and describes trends over the past ten years. Drawing from an analysis of early initiation rates among babies delivered by skilled birth attendants, the report describes key findings and examines the factors that both help and hinder an early start to breastfeeding. The report outlines key learnings from countries where rates of early initiation have improved or deteriorated and concludes with recommendations for policy and programmatic action.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life – meaning no other foods or liquids are provided, including water. From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to two years and beyond.

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Hepatitis A

Key facts
Hepatitis A is a viral liver disease that can cause mild to severe illness.
The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.
Almost everyone recovers fully from hepatitis A with a lifelong immunity. However, a very small proportion of people infected with hepatitis A could die from fulminant hepatitis.
The risk of hepatitis A infection is associated with a lack of safe water, and poor sanitation and hygiene (such as dirty hands).
Epidemics can be explosive and cause substantial economic loss.
A safe and effective vaccine is available to prevent hepatitis A.
Safe water supply, food safety, improved sanitation, hand washing and the hepatitis A vaccine are the most effective ways to combat the disease.
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation and poor personal hygiene.
Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people1. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Geographical distribution
Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A virus infection.

Areas with high levels of infection
In developing countries with poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years 2. Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.

Areas with intermediate levels of infection
In developing countries, countries with transitional economies, and regions where sanitary conditions are variable, children often escape infection in early childhood and reach adulthood without immunity. Ironically, these improved economic and sanitary conditions may lead to accumulation of adults who have never been infected and who have no immunity. This higher susceptibility in older age groups may lead to higher disease rates and large outbreaks can occur in these communities.

Areas with low levels of infection
In developed countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, men who have sex with men, people travelling to areas of high endemicity, and in isolated populations, such as closed religious communities. However, when the virus gets introduced in such communities, high levels of hygiene stops person-to-person transmission and outbreaks die out rapidly.

Transmission
The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

Symptoms
The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Hepatitis A sometimes relapses. The person who just recovered falls sick again with another acute episode. This is, however, followed by recovery.

Who is at risk?
Anyone who has not been vaccinated or previously infected can get infected with hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors in intermediate and high endemicity areas include:

poor sanitation;
lack of safe water;
use of recreational drugs;
living in a household with an infected person;
being a sexual partner of someone with acute hepatitis A infection; and
travelling to areas of high endemicity without being immunized.
Diagnosis
Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, and may require specialised laboratory facilities.

Treatment
There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months. Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.

Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention
Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

adequate supplies of safe drinking water;
proper disposal of sewage within communities; and
personal hygiene practices such as regular hand-washing with safe water.
Several injectable inactivated hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than 1 year of age. In China, a live oral vaccine is also available.

Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after injection of a single dose of vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend 2 vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.

Millions of people have received injectable inactivated hepatitis A vaccine worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travellers.

Immunization efforts
Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context. The proportion of susceptible people in the population and the level of exposure to the virus should be considered. Generally speaking, countries with intermediate endemicity will benefit the most from universal immunization of children. Countries with low endemicity may consider vaccinating high-risk adults. In countries with high endemicity, the use of vaccine is limited as most adults are naturally immune.

Countries with immunization schedules that include hepatitis A
As of June 2016, 16 countries used hepatitis A vaccine in routine immunization of children nationally (including 6 countries in the American region, 3 in the Eastern Mediterranean region , 4 in the European region and 3 in the Western Pacific region.

While the 2 dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

users of recreational drugs;
travellers to countries where the virus is endemic;
men who have sex with men; and
people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).
Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific. The feasibility of rapidly implementing a widespread immunization campaign needs to be included.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.

WHO response
In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.

To support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030 WHO is working in the following areas:

raising awareness, promoting partnerships and mobilizing resources;
formulating evidence-based policy and data for action;
preventing transmission; and
scaling up screening, care and treatment services.
WHO also organizes World Hepatitis Day on 28 July every year to increase awareness and understanding of viral hepatitis.

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What is causing this headache?

Headaches are one of the most common medical complaints; most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.
The World Health Organization (WHO) reports that almost half of all adults worldwide will experience a headache in any given year.

A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.

Causes
[headache]
Headache is a common complaint worldwide.
A headache can occur in any part of the head, on both sides of the head, or in just one location.

There are different ways to define headaches.

The International Headache Society (IHS) categorize headaches as primary, when they are not caused by another condition, or secondary, when there is a further underlying cause.

Primary headaches
Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive.

This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain.

Common primary headaches include migraines, cluster headaches, and tension headaches.

Secondary headaches
Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause.

A wide range of different factors can cause secondary headaches.

These include:

alcohol-induced hangover
brain tumor
blood clots
bleeding in or around the brain
"brain freeze," or ice-cream headaches
carbon monoxide poisoning
concussion
dehydration
glaucoma
teeth-grinding at night
influenza
overuse of pain medication, known as rebound headaches
panic attacks
stroke
As headaches can be a symptom of a serious condition, it is important to seek medical advice if they become more severe, regular, or persistent.

For example, if a headache is more painful and disruptive than previous headaches, worsens, or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes, and stiffness in the neck, a doctor should be contacted immediately.


Types
There are different types of headache.

Tension headaches
[brain freeze]
Eating something very cold can lead to a "brain freeze."
Tension headaches are the most common form of primary headache. Such headaches normally begin slowly and gradually in the middle of the day.

The person can feel:

as if they have a tight band around the head
a constant, dull ache on both sides
pain spread to or from the neck
Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but it can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.

Migraines
A migraine headache may cause a pulsating, throbbing pain usually only on one side of the head. The aching may be accompanied by:

blurred vision
light-headedness
nausea
sensory disturbances known as auras
Migraine is the second most common form of primary headache and can have a significant impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days.

Rebound headaches
Rebound or medication-overuse headaches stem from an excessive use of medication to treat headache symptoms. They are the most common cause of secondary headaches. They usually begin early in the day and persist throughout the day. They may improve with pain medication, but worsen when its effects wear off.

Along with the headache itself, rebound headaches can cause:

neck pain
restlessness
a feeling of nasal congestion
reduced sleep quality
Rebound headaches can cause a range of symptoms, and the pain can be different each day.

Cluster headaches
Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years.

The pain caused by cluster headaches is:

one-sided
severe
often described as sharp or burning
typically located in or around one eye
The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny.

Thunderclap headaches
These are sudden, severe headaches that are often described as the "worst headache of my life." They reach maximum intensity in less than one minute and last longer than 5 minutes.

A thunderclap headache is often secondary to life-threatening conditions, such as intracerebral hemorhage, cerebral venous thrombosis, ruptured or unruptured aneurysms, reversible cerebral vasoconstriction syndrome (RVS), meningitis, and pituitary apoplexy.

People who experience these sudden, severe headaches should seek medical evaluation immediately.

Treatment
The most common ways of treating headaches are rest and pain relief medication.

Generic pain relief medication is available over the counter (OTC), or doctors can prescribe preventative medication, such as tricyclic antidepressants, serotonin receptor agonists, anti-epileptic drugs, and beta-blockers.

It is important to follow the doctor's advice because overusing pain relief medication can lead to rebound headaches. The treatment of rebound headaches involves the reducing or stopping pain relief medication. In extreme cases, a short hospital stay may be needed to manage withdrawal safely and effectively.

Alternative treatments
[acupuncture for headache]
Acupuncture is an alternative therapy that may help relieve headaches.
Several alternative forms of treatment for headaches are available, but it is important to consult a doctor before making any major changes or beginning any alternative forms of treatment.

Alternative approaches include:

acupuncture
cognitive behavior therapy
herbal and nutritional health products
hypnosis
meditation
Research has not provided evidence to confirm that all these methods work.

Sometimes, a headache may result from a deficiency of a particular nutrient or nutrients, especially magnesium and certain B vitamins. Nutrient deficiencies can be due to a poor quality diet, underlying malabsorption issues, or other medical conditions.


Home remedies
A number of steps can be taken to reduce the risk of headaches and to ease the pain if they do occur:

Apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures.
Avoid stressors, where possible, and develop healthy coping strategies for unavoidable stress.
Eat regular meals, taking care to maintain stable blood sugar.
A hot shower can help, although in one rare condition hot water exposure can trigger headaches. Exercising regularly and getting enough rest and regular sleep contributes to overall health and stress reduction.

Symptoms
Headaches can radiate across the head from a central point or have a vise-like quality. They can be sharp, throbbing or dull, appear gradually or suddenly. They can last from less than an hour up to several days.

The symptoms of a headache depend to some extent on what type of headache it is.

Tension headache: There may be general, mild to moderate pain that can feel like a band around the head. They tend to affect both sides of the head.

Migraine headache: There is often a severe throbbing pain in one part of the head, often the front or the side. There may be nausea and vomiting, and the person may feel especially sensitive to light or noise.

Cluster headaches: These can cause intense pain, often around one eye. They usually happen around a particular time of year, possibly over a period of 1 to 2 months.


Diagnosis
A doctor will usually be able to diagnose a particular type of headache through a description of the condition, the type of pain, and the timing and pattern of attacks. If the nature of the headache appears to be complex, tests may be carried out to eliminate more serious causes.

Further testing could include:

blood tests
X-rays
brain scans, such as CT and MRI
The WHO points out that headaches are often not taken seriously because they are sporadic, most headaches do not lead to death, and they are not contagious.

They call for more resources to be allocated for the treatment of headache disorders, because of the huge health burden they represent.

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The Most Frequently Asked Questions on Oral Health

Does cleaning of teeth make them loose?

Teeth will not become loose because of the cleaning procedure. The teeth are held firmly in place due to the gums and the bone around them. The tartar gathered around the teeth causes infection of the gums and bone. This infection leads to receding of bone and gum levels and thus creates gaps between teeth. This tartar, if not removed periodically (once in every 6 months) can cause loosening of teeth. The cleaning procedure will help remove tartar and stop the gum and bone from receding.

Is root canal treatment painful?

Root Canal treatment is advised in cases where the nerve within the tooth is affected either due to decay, trauma or fracture. It involves the removal of the damaged or diseased pulp or nerve, cleaning and shaping the root canal and subsequently filling the canals with a suitable material. This treatment is done under Anaesthesia and hence painless.

Can I change the color of my teeth?

Yes, it is possible to brighten your teeth by a procedure called Teeth Whitening. It is simple procedure with predictable results and can be done at the dental clinic (Office Bleaching) and followed by a Home Bleach treatment if required. Superficial stains caused by smoking or excess intake of tea/coffee, wine can be effectively and conservatively removed for an instantly brighter smile.

Why do my gums bleed?

There could be various reasons why one would face a problem of bleeding gums like accumulation of tartar around the necks of teeth, using a hard bristle tooth brush, intake of certain medications like anti-epileptic drugs. It calls for immediate attention by a dental professional to detect the cause and suggest suitable treatment options.

What do I do to get rid of bad breath?

Bad breath or halitosis is a common oral health problem which could be prevalent not only due to dental problems but also some systemic diseases like diabetes, stomach upsets etc. Bad breath can arise due to negligence of oral hygiene, pyorrhoea in gums, food lodgement in decayed teeth, unclean tongue. You could be either suggested the use of a mouthwash, taught proper brushing/flossing techniques and /or treated for dental decay or gum problems.
Is a mouthwash necessary to be used everyday?
There are many mouthwashes available in the market, which are nothing but mild antiseptics that refresh the mouth. These can be used as temporary solutions to combat bad breath. Prolonged usage of a mouthwash is however not advisable.

Why is dental treatment so expensive?

Dental treatment needs to be rendered by a skilled professional using quality equipments and materials. This combined with a follow up of instructions after treatment results in betterment of dental health and the overall health of the patient. The treatment may require one or multiple visits to the dentist. Thus considering the longevity of the results obtained benefits far outweigh the cost involved.

Is removing a wisdom tooth always painful?

Tooth removal is always performed under local anesthesia, hence it is painless. Wisdom tooth removal is unique in that the teeth are situated posterior most in the mouth and carry the risk of spreading infections into adjacent areas. Also sometimes the shape and position of these may necessitate surgical removal.

How often should I visit a dentist?

One should visit the dentist at least twice a year for regular check-ups. However, if there is toothache, bleeding gums, sensitive teeth or any dental problem, one is advised to visit the dentist immediately.

Is sugarless gum healthy for teeth?

Chewing sugarless gum stimulates flow of saliva. Saliva works as a natural mouthwash by dissolving the volatile sulphur molecules, which make the breath smell bad. Saliva also neutralizes acids produced by plaque bacteria and helps to clear the mouth of food that plaque bacteria usually feast on.

Why do children get cranky when they are teething?

Yes children do get cranky when teething since they may experience the signs like drooling, irritability, restlessness, and loss of appetite. Fever, illness, and diarrhoea are not symptoms of teething. If your child presents with the latter signs, they need to be evaluated by your doctor. The best solution to comfort the child is to have the child chew on a cold or frozen rubber teething ring. Topical anesthetics/ gels are NOT advisable.
How do braces work and how long does it take to straighten teeth with braces?
The braces apply continuous, slow pressure over a period of time on the teeth and help in moving them into the proper positions. Bands, wires and elastics are placed on the teeth to move them in the right direction. Moving teeth into a functional and an esthetically pleasing position can take a few months to years depending on the amount of correction required, the age, the severity of the case and also the motivation levels of the patient.

Which toothpaste is ideal for use?

All toothpastes work as foaming agents that help to clean your teeth of plaque and food remnants. The choice of most toothpastes is governed by their medicinal content and flavour. Any fluoridated toothpaste is a good general toothpaste for the family. Medicated toothpastes are available for specific purposes and should be used under the advice of your dentist only.

What is the right method of brushing?

The primary means to oral hygiene is proper and methodical brushing of teeth. This cleans away the plaque on a daily basis and also helps to keep the breath fresh. Brushing teeth at least twice a day using fluoridated toothpaste is recommended to keep them clean. The fluoride in the toothpaste makes the enamel more resistant to attack by the decay-forming acids in the mouth. The toothbrush selected should have a firm, comfortable grip with soft rounded bristles on a contoured head and replaced every 3-4 months for best results or as soon as the bristles are frayed.

Step 1: Place bristles along the gum line at a 45o angle. Bristles should contact both the tooth surface and the gum line.
Step 2: Gently brush the outer tooth surfaces of 2-3 teeth using a vibrating back and forth rolling motion. Move brush to the next group of 2-3 teeth and repeat.
Step 3: Maintain a 45o angle with bristles contacting the tooth surface and gum line. Gently brush using back, forth, and rolling motion along all of the inner tooth surfaces.
Step 4: Tilt brush vertically behind the front teeth. Make several up and down strokes using the front half of the brush.
Step 5: Place the brush against the biting surface of the teeth and use a gentle back and forth scrubbing motion. Brush the tongue from back to front to remove odour-producing bacteria.

Is flossing important?

Though brushing cleans the teeth, the toothbrush cannot clean the plaque which is stuck within the gaps between two teeth and under the gum line. Flossing daily keeps the teeth clean and prevents the build-up of plaque in the difficult areas. Dental floss is a special cord made of nylon which helps remove food particles stuck between two adjacent teeth and near the gums. Approximately 18 inches (40 cms.) of floss is wrapped securely around the index fingers. With the help of the index fingers and thumbs the floss is gently guided between two teeth and eased up and down, going below the gum line to dislodge the plaque and food particles.

Do babies with not many teeth need any dental care?

Yes. One could clean the baby's mouth with wet gauze and give them water after every meal to ensure that the mouth is free of any food remnants. Also, regular tongue cleaning using a soft cloth is advised.

What is smile designing?

A good smile involves in it more than just healthy teeth and gums. It is a blend of symmetry, color, shape and lines that create a balanced harmonious smile. Many of us have good and healthy teeth as well as gums but are yet unhappy with our smiles. In such an instance we can go in for a smile evaluation to an esthetic dentist who will evaluate the smile for its missing, predominant or underplayed features and then proceed with their correction through various means. This process is called Smile Designing.

What is the right age for braces treatment?

The misconception that braces can only work for kids is not true, as people of any age can avail for this type of treatment. The treatment time may however be longer for adult patients as the bone is denser in them. But with newer treatment options like invisible, ceramic and lingual braces, esthetics and time of treatment are also not a problem.

How is smoking bad for teeth and gums?

One of the most devastating effects of tobacco is the development of oral cancer. The risk of oral cancer increases with the number of cigarettes smoked each day and the number of years that the person has been smoking. Some of the other oral side effects of tobacco are tooth stains, delayed healing of oral wounds, increased severity of gum disease and bad breath.

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Treatment Options For Joint Pains From Arthritis

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms.

Pain Killers 

Painkillers help with pain and stiffness but they don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints . They are well tolerated because very little is absorbed into your bloodstream.

Nutritional Supplements 

Glucosamine and chondroitin are nutritional supplements. Studies in animals have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months.

Hyaluronic acid injections, which help to lubricate your knee joint, are sometimes given but recent evidence that it works isn’t convincing.

Surgery 

May be recommended if you have severe pain and/or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint,an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves involves replacing a damaged, worn or diseased joint withan artificial joint made of special plastics and metal.

For most people, a replacement knee will last for at least 15 to 20 years, especially if the new knee is cared for properly and not put under too much strain.

There are two main types of surgery, depending on the severity of arthritis:

• total knee / hip replacement – both sides of your knee / hip joint are replaced

• partial (half) knee replacement (PKR) – only one side of your knee joints replaced in a smaller operation where more of the undamaged knee is preserved with a shorter hospital stay and recovery period.

Other surgical options for arthritis

Arthrodesis or Joint fusion

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old.

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Love Your Bones - Say No to Osteoporosis

World Osteoporosis Day which is being celebrated on October 20th of every year since 1997, is actually a year long campaign to create awareness about the disease. It is important, as the need of the hour for people to understand the immense burden caused by osteoporosis and the ways to overcome it.

Osteoporosis is a medical condition which leads to reduced bone mass with micro architectural deterioration and hence increasing the risk of fracture. So such fractures which occur due to trivial trauma (eg: falling from a walking height) are called fragility fractures. The sites more prone are spine, femur andradius. Osteoporosis  is usually known as the "silent killer" as it doesn’t show any prior symptoms and the person comes to know about it only after he sustains a fracture.

We have so many diseases in our country so why is this so important? The current population of India is around 1.2 billion. By 2020, there will be around 76 million people with their age greater than 65 years, which is quite a significant number.Worldwide it seems every 3 seconds one sustains an osteoporotic fracture. Approximately one in three women and one in five men aged over 50 years will suffer an osteoporotic fracture in their remaining lifetime. A prior fracture is associated with a 86% increased risk of any fracture. More than 50% of hip fractures in the world will occur in Asia by 2050 and the mortality rate is around 20-24% in the first year. Aren’t these statistics quite alarming?

The most sad part is  that we all have accepted this as a natural process of ageing. Whatever be our age, we shouldn’t break our bones with a trivial fall. If we do, then our bones are weak and it is not normal. It can be detected early and a fracture can be prevented with adequate treatment.

It’s widely known that osteoporosis usually affects the older people. But it’s actually a disease of the young with consequences in the older age. We usually attain the peak bone mass at 20 – 30 years of age, after which there is a gradual decline in the bone mass. So in the earlier stages of life, with the help of a good diet and healthy lifestyle one can attain the maximum bone mass. If they do so, the chances of them having a low bone mass  later in life will be less.

Similarly it’s usually thought as a disease of postmenopausal women. Yes of course the women are at a higher risk but men are no safer and are at a greater risk of getting a prostate cancer. Actually the mortality and morbidity post fracture is more in men. ‘Usually women maintain their health whereas men just go for repairs’. This attitude should change among men and they should also screen for osteoporosis rather than getting medical attention after a fracture. There are a lot of secondary causes for osteoporosis like drugs, various rheumatological,endocrine diseases etc. which have to be thought of particularly in males and those with fragility fractures at a younger age.

So it’s high time everybody becomes aware about this disease and its consequences. It can be screened effectively by DEXA scan. After detecting osteoporosis it can be effectively managed with the likes of Calcium, Vitamin D, Bisphosphonates,Parathormone analogues, Monoclonal antibodies etc. As we all know ‘prevention is better than cure’, one should try to maintain a healthy lifestyle by regular exercises, requisite sun exposure, adequate dietary intake of calcium and vitamin D. So let’s promote the caption ‘Love your bones’ i.e. the global symbol of bone health.

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