Friday, October 28, 2011

Barrett's Esophagus

VITAL SIGNS; Risk: Clarity on Cancer and Barrett's Esophagus

People with Barrett's esophagus, a complication of acid reflux disease, have a higher risk of developing esophageal cancer. But the risk is far smaller than believed, a study published in The New England Journal of Medicine has found.
Researchers at Aarhus University in Denmark reviewed data gathered over nearly 20 years on more than 11,000 people with Barrett's esophagus. The analysis found that every year, 0.12 percent of the patients with Barrett's esophagus go on to develop cancer of the esophagus, a disease that is particularly lethal.
The figure was much lower than the estimate of 0.5 percent obtained from earlier studies. And the new study comes on the heels of a similar report published this year in The Journal of the National Cancer Institute, which looked at a large population in Ireland. That study found the risk of esophageal cancer in people with Barrett's was 0.13 percent.
According to current guidelines, people with Barrett's esophagus should consider undergoing an endoscopy and biopsy of the esophageal lining every three years. But the new research suggests that patients may not need as many screening procedures.
Dr. Peter Funch-Jensen, a professor of surgery at Aarhus and an author of the study, said he believed endoscopies might be unnecessary after the first year except in cases where doctors find precancerous cells, or when new symptoms occur.
This is a more complete version of the story than the one that appeared in print.
GRAPHIC 

Sunday, September 11, 2011

Ergonomics fitness

WORKSTATION

So Many Gadgets, So Many Aches

LOOK around, they’re everywhere: hunched shoulders, angled necks and wrists, hands twisted like claws. As people harness their bodies to use more electronic devices in more places, they may unknowingly be putting themselves at a greater risk of injury.
Koren Shadmi
Things were much simpler 20 years ago, when employees worked mainly on desktop computers that could be adjusted for maximum comfort. Now people have added laptops, smartphones and tablets to their arsenals, and they’re using — or perhaps misusing — them at work, at home and in trains, planes, hotels and coffeehouses.
Visit any airport waiting area, said Alan Hedge, an ergonomics professor at Cornell, and you can see people using their laptops in awkward and contorted positions. Too much of this activity is bound to take a physical toll.
By positioning themselves improperly, people are at greater risk of eye strain, tendinitisand carpal tunnel syndrome, to name just a few ailments. Repetitive actions that lead to overuse of muscles and tendons can inflame them, causing pain in the hands, shoulders, neck and back.
Laptops are adding to these problems because “they do not meet any of the ergonomic requirements for a computer system,” Professor Hedge said. The keyboard and the screen are connected, so if you place the keyboard at the ideal position for typing, the screen won’t be at the best distance for viewing, he said. Docking stations that provide an extra keyboard or monitor can help solve this problem.
Another lurking danger is touch screens, Professor Hedge said. Keys that move up and down provide more of a cushion for the fingers, whereas the drumming of fingers against screens is harsher and can lead to soreness. For that reason, he said, a tablet should not be used heavily for typing.
And think of our poor thumbs, which have been pressed into a level of service they were never meant to provide. Thumbs are more vulnerable than fingers because they have two bones instead of three, Professor Hedge said.
“If you want to get injured, do a lot of texting,” he added (and that includes the chance that you will collide with something while walking or driving).
  Texting has led to an increase in a condition known as De Quervain’s tenosynovitis, where the tendons become so inflamed that it becomes painful to move your thumb, affecting your ability to hold things, Professor Hedge said.
These days, you can be texting your boss one minute and a friend the next. And this greater mingling of work and personal life is placing more stress on the body. It can also make it harder to pinpoint what is causing a new physical problem.
Adding a device or routine can tip the scales toward an injury, said Carol Stuart-Buttle ofStuart-Buttle Ergonomics in Philadelphia. She gave the example of a client who recently began typing on a propped-up tablet computer at home. That placed extra strain on her wrists so that typing at work — never a problem before — suddenly became painful.
To trace a pain’s origins, you may need to become a detective in your own life. As you seek to lessen or prevent pain, she said, look for any repetitive and sustained activity in all the devices you use.
Don’t discount psychological factors, she added. Mental stress can cause you to tense your muscles, aggravating any existing physical stress.
If you can, consult an ergonomics expert at your company to arrange the best possible setup for your devices at both work and home, along with a discussion of best practices. And notify your employer or consult a doctor if you experience pain or vision problems.
Ms. Stuart-Buttle says a common health issue is vision impairment stemming from a monitor being placed at the wrong distance from the eyes. And she often finds problems like tendinitis because people aren’t supporting their arms when they use a mouse, causing a tighter grip and increasing muscle tension.
IF you are hunched over while working, something is wrong, she said. Look for the things that are pulling you forward and fix them. Sit back in your chair, support your feet if needed and make sure your arms are relaxed as you type. Check that the screen is close enough so that you can see clearly without strain, enlarging the type size if necessary.
Be aware of these factors and try to approximate them as much as possible when you aren’t at your primary workstation.
As you work, “match the technology to the task you want to perform,” Professor Hedge said. “If what you’re doing is a lot of typing, you need a keyboard,” he added. “Don’t try to type ‘War and Peace’ with your thumbs.”
The simplest and most well-worn piece of advice is one that people too often forget to follow: take a break. Separating yourself from your machines gives your muscles, and your mind, a rest that they richly deserve.

Bone drugs for women

September 7, 2011, 2:52 PM

F.D.A. Staff: 5 Years May Be Enough for Bone Drugs

Most women who take bone-building drugs like Fosamax can safely stop taking them after five years, the Food and Drug Administration said Wednesday in a staff report leading up to a broad safety review scheduled Friday by two scientific advisory committees.
Studies show that the drugs do have proven benefits in preventing osteoporosis fractures for the first three years of treatment, but continuing beyond five years does not demonstrate such benefits over no drug use at all, the report said. And women who stop taking the drugs after five years have similar levels of increased bone density and reduced fracture risk as those who continue taking them, it said.
“These results suggest no significant advantage of continuing drug therapy beyond 5 years,” according to agency’s 45-page review of scientific evidence.
As for side effects, the report said, there is no solid evidence the drugs, called bisphosphonates, cause unusual breaks of the femur bone, a jaw injury called osteonecrosis, or esophageal cancer. At the same time, the agency said, those rare but dangerous outcomes cannot be ruled out because it has been so difficult to study them for various reasons.
“The safety of long-term bisphosphonate therapy continues to be unclear as study results are conflicting,” according to the F.D.A. report.
The drugs under review include Fosamax from Merck, first approved in 1995, Boniva from Roche Therapeutics, Actonel and Atelvia from Warner Chilcott, and generic copies. The F.D.A. has never conducted a broad review of the long-term safety and efficacy of the drugs.
A so-called “drug holiday” may be warranted for many of the women who take the drugs for longer terms, the report said, but adding a note of caution: “There are no substantial data available to inform decisions regarding the initiation or duration of a drug holiday.”
Between 5.1 million and 5.7 million patients in the United States have received prescriptions for the drugs for each of the years 2005 through 2009, the agency said, citing drug tracking from the data firm SDI. Most patients were over 55 years old. At least one in 11 women in that age group received the bone drugs, the agency said.
Sally Fullman, 69, of Murray Hill, N.J., started taking Fosamax in 2006 after being diagnosed with osteoporosis. She stopped taking it last year partly because of concern about the possible side effects.
“I’m troubled by all the confusion and the stress that’s out there with respect to the advisability of taking them,” Ms. Fullman said in an interview shortly before the F.D.A. issued its report. “I’m still on a drug holiday. But when I talk to people, everybody is confused and angry about this.”
Perhaps the F.D.A. safety review will help patients like Ms. Fullman – at least more than media reports on conflicting studies, anecdotal cases and lawsuits. “When I read articles or see things on TV, what I hear are side effects that are taken out of context,” she said. “So they’re catchy and they kind of scare you a little bit, but they don’t really tell you the risks of not taking the medication.”
Drug makers including Merck issued their own safety reports on Wednesday at the F.D.A.’s request.
The Merck report, using the chemical name for Fosamax, said: “The available data support a favorable benefit to risk profile during long-term (10-year) treatment with alendronate in osteoporotic patients who remain at risk of osteoporotic fracture and who have not experienced adverse reactions that required discontinuation of therapy.”
But Merck also said it would support the notion of taking a break from the bone drugs.
“A drug holiday may be considered for patients who have previously received long-term treatment and are no longer considered to have a sufficiently high fracture risk,” the company said.