Tempted to substitute HRT?

 www.jeanhailes.org.au

Women with menopausal symptoms may need guidance, given the lure of bioidentical hormones.

Professor Henry Burger
MD, FRACP, FCP(SA), FRCOG, FRANZCOG, FAA
Endocrinologist, Jean Hailes for Women’s Health

THE multibillion-dollar bio­identical hormone industry is rising in popularity, fuelled by highly successful marketing and the initial findings of the 2002 US Women’s Health Initiative (WHI) study.

Wrongly extrapolated findings from the WHI on the use of menopausal HRT resulted in rates of use dropping by up to 80%. Symptomatic women have been driven to seek alternative therapies, including bioidentical hormones, leaving them at risk of harm or of paying a lot of money for no greater effect than placebo.

GPs are well placed to provide evidence-based information to symptomatic women.

Bioidentical hormones are plant-derived products compounded in pharmacies and may be dispensed over the internet. They are marketed as natural, safe, risk-free, age-reversing, sex-enhancing and cancer-preventing.

However, their variable combinations of oestrogens, progesterone, DHEA, testosterone and sometimes thyroxine, melatonin and growth hormone remain untested for long-term safety and efficacy. They are not approved by the TGA or the US Food and Drug Administration.

In a 2008 Australian population sample, 37% of women on hormone therapy aged 50—59 were using unregistered, imported and unaudited bio­identical hormones made into buccal troches or creams. The oestrogens used can cause endometrial proliferation and the progesterone added (if at all) may not inhibit this endometrial stimulus. Four cases of endometrial cancer (including one subsequent death) have followed the use of unregistered HRT in Australia.

In July 2002, the first results of the WHI randomised, controlled trial (RCT) of combined continuous menopausal hormone therapy were announced, emphasising the finding of a 26% increase in breast cancer risk in treated women.

It was not explained that the 26% increase meant less than one additional case of breast cancer per 1000 women taking menopausal HRT above the baseline risk of about three per 1000 per year, and “technically not statistically significant”.

Little attention was paid to the mostly reassuring results of the oestrogen-only arm of the WHI, published in 2004, that showed a “technically not statistically significant” reduction in breast cancer after seven years of oestrogen-alone HRT.

Also ignored was the finding that 76% of the approximately 8000 participants in each arm of the combined trial had never used HRT previously and, in them, no increase in breast cancer risk was seen. Furthermore, the finding that HRT increased the risk of heart disease across the entire age spectrum, 50—79 years, was later found not to be true.

A number of papers re-analysing the WHI study have found the initial findings to be misleading. LaCroix et al (JAMA, 2011) found among postmenopausal women with prior hysterectomy followed up for 10.7 years, conjugated equine oestrogen use for a median of 5.9 years was not associated with an increased or decreased risk of CHD, deep vein thrombosis, stroke, hip fracture, colorectal cancer or total mortality.

A decreased risk of breast cancer persisted and results were more favourable in the 50- to 59-year age group (Manson et al, JAMA, 2013). Few of the outcomes reported in the latter paper are in fact statistically significant and most risks <1 per 1000 per year.

Rossouw et al (JAMA, 2007) found that the health consequences of hormone therapy may vary by time since menopause, with a decrease in CHD risk for women within 10 years of menopause, and particularly high risks in women who are more than 20 years from menopause and have vasomotor symptoms.

No effect on risk of CHD was found and total mortality was reduced among women aged 50—59. The findings are consistent with current recommendations that hormone therapy be used in the short term for relief of moderate or severe vasomotor symptoms, but not in the longer term for prevention of cardiovascular disease.

It is difficult to document loss of health-related quality of life for the generation of women influenced by the highly publicised but misapplied WHI (2002) claims on the risks of HRT.

Short-term RCTs confirm that HRT is the only therapy that effectively improves health-related quality of life in symptomatic women through a reduction in vasomotor and urogenital symptoms, joint pains and insomnia, while improving sexuality.

References

1.Burger H, MacLennan A, Huang K, Castelo-Branco C. Evidence-based assessment of the impact of the WHI on women’s health. Climacteric: The Journal Of The International Menopause Society [serial online]. June 2012;15(3):281-287. Available from: MEDLINE Complete, Ipswich, MA. Accessed April 22, 2014.

2.Eden J, Hacker N, Fortune M. Three cases of endometrial cancer associated with “bioidentical” hormone replacement therapy. The Medical Journal Of Australia [serial online]. August 20, 2007;187(4):244-245. Available from: MEDLINE, Ipswich, MA. Accessed April 22, 2014.

3.LaCroix AZ, Chlebowski RT, Manson JE, et al. Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy: A Randomized Controlled Trial. JAMA. 2011;305(13):1305-1314. doi:10.1001/jama.2011.382

4.Rossouw JE, Prentice RL, Manson JE, et al . Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465 – 77. Erratum in JAMA 2008;299:1426

5.Manson JE, Chlebowski RT, Stefanick ML et al Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative  Randomised Trials JAMA 2013;310, 1353-1368.

Tags: , Cancer, Cardiovascular, Stroke, Womens Health, Research

Breast screens for over-70s of little benefit: study

15th Sep 2014

Sunalie Silva   all articles by this author

AUSTRALIA’S extension of breast cancer screening to women aged 70–75 years has been called into question following findings from an international study that shows it does not cut incidence of advanced disease and leads to overdiagnosis.

In May 2013, free breast cancer screening for Australian women was extended from 50–69 years to 50–74 years, a decision made by the federal government that, at the time, sparked debate among public health experts concerned that it would increase overdiagnosis.

Now Dutch researchers who have investigated the efficacy of the Netherlands' national breast cancer screening program, which extended the upper age limit for breast cancer screening to 75 years in 1998, have concluded that screening women older than 70 as part of a national program has limited benefit.

According to the researchers from the department of surgery at Leiden University Medical Center, a measure of the program’s success would be a decline in advanced-stage breast cancer incidence alongside an increase in the incidence of early-stage disease.

But, after investigating the incidence of early stage and advanced-stage cancer in women aged 70–75 years before and after the extension of the program, they found no strong decrease in incidence in advanced breast cancer while the incidence of early-stage disease did increase.

Using data from the Netherlands Cancer Registry, the study authors tracked all new cases of invasive and non-invasive (in situ) breast cancer, diagnosed in this age group from 1995 up to 2011.

They separated cases into the period before (1995–97), after (2003–11), and in between (1998–2002) the introduction of the national screening program which came to almost 25,500 in all.

They also included 13,000 women aged 76–80, to take account of any changes in breast cancer incidence among older women ineligible for national screening.

Analysis of the data showed that new cases of early-stage breast cancer among 70- to 75-year-olds rose sharply after national screening was introduced, from 248.7 to 362.9 per 100,000 women.

And while there was a significant fall in the numbers of new cases of advanced breast cancer, the absolute decrease was small, dropping from 58.6 cases before the national screening program was introduced to 51.8 cases per 100,000 women after.

Among 76- to 80-year-olds, new cases of early-stage disease fell slightly, but the numbers of new cases of advance breast cancer didn't change, the authors noted.

Based on their findings for every advanced-stage cancer detected by screening among 70- to 75-year-olds, around 20 early-stage – and therefore "overdiagnosed" – cancers were picked up.

According to the researchers, because older women are at increased risk of adverse outcomes from breast cancer treatment, a "considerable proportion” of women would face poor quality of life and physical function.

What’s more, treatment would involve "tremendous health expenditure" in return for little obvious health benefit, they said.

The researchers called on policy makers and doctors to instead weigh the harms and benefits of screening older women on a personalised basis that takes into account remaining life expectancy, breast cancer risk, functional status and patient preference.

Professor Helen Zorbas, CEO of Cancer Australia, said the extension of the older target age group for the BreastScreen Australia program was a decision based on evidence of a reduction in breast cancer mortality.

"While the results of the Netherlands study on breast cancer screening in older women cannot be directly extrapolated to the Australian setting, it provides additional support for the beneficial effects of breast cancer screening in older women, in terms of early detection of breast cancer, " she said.

"The potential benefits and possible downsides of breast cancer screening should be weighed up on an individual basis. This is particularly relevant for older women who may have other health problems or comorbidities."

BMJ 2014; online 15 Sept

Tags: breast cancer, screening, medical news, mammogram, BreastScreen,overdiagnosis, Research

Up to half of Australians with diabetes don’t undergo regular eye checks

August 1, 2014

Amcal and Guardian pharmacies across Australia will spearhead an important health awareness campaign in partnership with the Centre for Eye Research Australia (CERA) for people with diabetes to have more regular eye tests and consider a range of health checks to prevent eye disease that can lead to blindness.

“Currently, over one million Australians have diabetes and this number is expected to double in the next 10 years, posing major public health and economic issues.”, said Dr Peter van Wijngaarden, Principal Investigator at CERA. “We are committed to developing an efficient, cost-effective and sustainable nation-wide diabetic eye screening system for all Australians to detect the early changes of eye disease and start treatment before significant vision loss occurs.”

Pharmacists will act as front line health partners to provide information to people with diabetes about lowering their risk of diabetic eye disease.

“Up to 50% of Australians with diabetes don’t undergo regular eye checks. That’s a staggering figure given that we know regular diabetic eye check-ups and timely treatment can prevent most vision loss from this condition,’’ said Gary Dunne, Sigma’s Chief Operating Officer.

“Our pharmacists know they can reach out to their patients in a trusting and professional manner with information provided by CERA about the importance of eye tests to prevent eye disease and ensuring they also look after their general health,’’ he said.

Amcal and Guardian pharmacists will present patients with a structured plan to help prevent diabetes related vision loss:

•    The importance of healthy eating
•    The need for regular exercising
•    The critical role played by blood pressure control
•    The need for everyone with diabetes to keep track of their glucose (sugar) levels; and
•    The critical need to have regular eye checks and timely treatment to prevent sight-threatening diabetic eye disease.

Dr Peter van Wijngaarden

View video of Channel 10 news story: Dr Peter van Wijngaarden talks about the importance of diabetes eye disease checks

Does caffeine help with migraine?

2nd Sep 2014

Dr Michael Tam   all articles by this author

Is it worth washing your analgesics down with a cup of coffee?

Clinical scenario

MATT, a 35-year-old lawyer, mentioned in passing that when he had a migraine, he took a couple of tablets of paracetamol with a double-shot espresso. Caffeine is also available in combination over-the-counter analgesics. What is the evidence?

Clinical question

Is paracetamol with caffeine more effective than paracetamol alone for the treatment of migraine headaches?

What does the research evidence say?

Step 1: The Cochrane Library

The Cochrane Library contains a 2012 systematic review and meta-analysis that examines the use of caffeine as an analgesic adjuvant for acute pain (including migraines) in adults^. 1

I conducted a search using TripDatabase and PubMed and could not find a better article to answer this question. The Australian-based eTG Complete guidelines does not mention caffeine at all. ²

Let’s look at the Cochrane systematic review by Ona et al (2012) in detail.

Critical appraisal

I will use the systematic reviews critical appraisal sheet from the Centre for Evidence Based Medicine. ³

What PICO question does the systematic review ask?

In adults with an acute painful condition (Participants); what is the effect of caffeine in addition to a number of oral analgesics (Intervention); compared to the same analgesic without caffeine (Comparator); on the proportion of participants achieving “at least 50% maximum pain relief” (p. 4)¹; (Outcome).

Is it clearly stated?

Yes.

Is it unlikely that important studies were missed?

No. The authors discovered the existence of at least 20 studies with more participants than those included in the review, for which the data for analysis were not obtainable (p. 6).¹ This is the most important limitation of this review.

Were the criteria used to select articles for inclusion appropriate?

Yes. The authors included studies that were double-blind trials that compared the single dose of oral analgesic plus caffeine, with the same dose of the analgesic alone. The caffeine had to be administered at the same time as the analgesic.

Were the included studies sufficiently valid for the question asked?

Probably/Unclear. The authors formally assessed the risk of bias of the included studies, and many were at risk of bias (Figure 1 p. 8).¹

Were the results similar between studies?

Yes. There is little heterogeneity in the results.

What were the results?

Four studies provided data specifically on headaches (migraine and tension-type). The addition of caffeine to the tested oral ­analgesic (paracetamol and others) was associated with a small benefit. More participants achieved at least 50% maximum pain relief after the dose:

• Relative risk (RR) = 1.1 (95% confidence interval [CI], 1.1 to 1.2)
• Number needed to treat (NNT) = 14 (95% CI, 9.5 to 25).

Eight studies provided data on paracetamol with caffeine, as compared to paracetamol alone (for all causes of acute pain). The result was a similar sized benefit (RR = 1.1, NNT = 15).

Conclusion

This paper provides evidence that caffeine used as adjuvant to oral analgesia (including paracetamol) has an impact on acute pain (including migraines). The effect size is an additional 5—10% of individuals getting good pain relief (i.e. NNT of 10—20), with a 100mg dose of caffeine. Interestingly, this is the approximate quantity of caffeine in a double-espresso, or a mug of instant coffee. ⁴ The effect appeared consistent and independent of the type of acute pain or analgesic in the systematic review. ¹

There are significant uncertainties with this review — the fact that so much of the data was unobtainable should make us cautious. Publication bias is a definite possibility. The review only provides evidence on single rather than repeated doses. Some thought should also be given to risks — it is possible to inadvertently take large doses of caffeine in the combination tablet formulations. ⁵

Nonetheless, the manner in which Matt used caffeine with paracetamol for his migraines (a one-off cup of coffee) is safe and possibly effective. I don’t think that I’ll recommend this often, but it may be an option for some patients.

References

1. Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009281. DOI: 10.1002/14651858.CD009281.pub2

2. Acute migraine attack (etg42 March 2014) [website]. eTG Complete. Last updated: 2014 Mar (Retrieved: 2014 Jul 21). http://etg.tg.com.au/ip/desktop/tgc/nrg/2142.htm

3. Systematic Review: Are the results of the review valid [MS Word document]? Centre for Evidence Based Medicine, University of Oxford. Last updated: 2008 Oct 1 (Retrieved: 2014 Jul 21) http://www.cebm.net/critical-appraisal/

4. Basic Report: 14210, Coffee, brewed, espresso, restaurant-prepared [website]. National Nutrient Database for Standard Reference, release 26, Agricultural Research Service, United States Department of Agriculture. Retrieved: 2014 Jul 21. http://ndb.nal.usda.gov/ndb/foods/show/4291?fg=&qlookup=espresso

5. Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies [website]. NPS RADAR. 2010 Aug 1. http://www.nps.org.au/publications/health-professional/nps-radar/2010/august-2010/brief-item-paracetamol-with-caffeine

6. Dubben H-H, Beck-Bornholdt H-P. Systematic review of publication bias in studies on publication bias. BMJ 2005;331. DOI: 10.1136/bmj.38478.497164.F7

Tags: , Guidelines, Research, Research Update

An extra nipple rarely causes concern

16th Sep 2014

Dr Ian McColl   all articles by this author

Accessory nipples rarely cause a problem.

THEY can range from a flat discolouration through to a fully developed nipple with underlying areola and breast tissue, and occur in both males and females in about 1–2% of the population.

They originate from bilateral milk lines which in embryogenesis stretch from the axillae through the breasts to the groin and can be seen anywhere along these lines. They become more prominent in pregnancy.

They have been mistaken for melanoma and been excised. A rare case of a ductal adenocarcinoma has been reported in an accessory nipple and spreading to axillary glands. However, routine excision of accessory nipples is not recommended.

There is a rare association of genital malignancies such as seminoma of the testis. Sometimes there is a family history inherited as an autosomal dominant disorder.

www.skinconsult.com.au

Tags: , Pregnancy, Dermatology

Father's vaccination boosts infant pertussis protection

16th Sep 2014

Sunalie Silva   all articles by this author

INFANTS younger than four months whose parents have both been immunised against pertussis have the greatest chance of avoiding infection with the disease, Australian researchers say.

Protection was greatest when both parents had been vaccinated at least four weeks before their child was born, according to the investigators. 

The vaccine is funded on the National Immunisation Program in a three-dose schedule for infants at two, four and six months of age, with a booster at four and at 10–15 years.

In 2009 the government funded the vaccine free of charge to mothers, fathers, grandparents and other close relatives of infants younger than 12 months following an outbreak of infant pertussis.

But the program was discontinued in 2012 after health authorities reported that the epidemic was waning and amid new evidence emerging that maternal vaccination pre-pregnancy offered greatest protection.

However, data published this week showed that vaccinating a mother before pregnancy and vaccinating a father at least four weeks before a baby was born reduced the risk of a baby being infected with pertussis by 51%. 

The study of 217 NSW cases of infants aged four months or younger who contracted pertussis found 14% of the mothers were vaccinated before delivery, compared with 26% of 585 case-matched controls.

When both parents were immunised at least four weeks before their child’s birth, the risk of infection before four months was reduced by 51% compared to vaccinating neither parent. 

The study didn’t find any additional impact of father and grandparent vaccination after accounting for maternal vaccination status however vaccination status of older siblings was a significant risk factor for infant pertussis, highlighting the importance of kids getting their booster vaccinations on time.

Dr Helen Quinn, a research fellow at the National Centre for Immunisation Research and Surveillance where the study was conducted, said the findings provide evidence that cocooning does work and supports a push for fathers to be vaccinated, even though pre-pregnant maternal vaccination is increasingly being accepted as safe and the most effective way of preventing infant pertussis.

“Clearly the current evidence suggests you get higher efficacy with pre-pregnancy maternal vaccination but even in states where this strategy is funded our study shows that fathers should also go along and get vaccinated.”

In July this year Qld Health began funding the vaccine for women in their third trimester of pregnancy. 

WA Health said it is continuing to assess the evidence for the effectiveness of pertussis vaccination in pregnant women and “is actively considering implementing such a strategy”, while NSW Health and SA Health said they would closely monitor the Queensland program.

Pediatrics 2014; online 15 Sept

Tags: pertussis, prescribing, pregnancy, postpartum, vaccination, immunisation,Medical News, Infectious Diseases, Research

Children's Eye Health Tips

Contrary to popular belief, eye disease is not just an affliction of the elderly, it can cause vision loss in babies, children, teenagers and adults alike. The first eight years of a child’s life are critical for eye development.

If problems are not picked up during this time, damage and vision loss can be permanent. The good news is that by being aware and informed, parents can detect the signs of their children's potential vision problems. As having a family history of eye disease puts you at greater risk, it's important for parents to discuss their family eye health history with their parents and grandparents on both sides of the family and if necessary, seek an eye test for the whole family.

Here are 5 tips from The Eye Foundation for your child’s eye health:

- Be Eye Aware: Early detection and treatment is the best defence against eye disease. Symptoms to watch out for include rubbing of eyes, poor hand-eye co-ordination, lack of concentration and complaining of headaches, blurred or double vision;

- Green is Good: Provide your child with a balanced, nutritious diet rich in fruit and vegetables. Dark green leafy vegetables such as spinach and yellow vegetables such as pumpkin and carrot will help to keep your child’s eyes healthy;

- Hats Help: Make sure that your child always wears a broad-­‐brimmed hat when playing outside as this will reduce the amount of UV reaching your child’s eyes by up to half;

- Specs Appeal: When in the sun, make sure your child wears sunglasses with UV to protect their eyes from damaging UV rays;

- Balls Galore: Ensure appropriate safety procedures are covered with your child prior to playing sports that include high velocity ball action. Example sports include: tennis, soccer, basketball, squash and hockey. 

Gaps in good birth control

29th Jul 2014

Dr Deborah Bateson   all articles by this author

Contraceptive use varies by age and culture. Here is an update on women’s choices in Australia.

TWO-thirds of Australian women of reproductive age report currently using contraception.

The recently published Reproductive and Sexual Health in Australia report ¹highlights that oral contraception remains the most common method (up to 34%), followed by condoms (23%), vasectomy (11%) and tubal ligation (8.6%).

By contrast, the least used are intrauterine methods (3%) and the contraceptive implant (3%). Withdrawal is reported by 2.4% of women and the proportion reporting they had ever used emergency contraception is 27%. 

While limitations to the data are acknowledged, it is notable that Australia lags behind similar high-income countries in the uptake of long-acting reversible contraception (LARC).

This is an effective and safe choice for women across the reproductive life course, including young nulliparous women.

LARC, including contraceptive implants, intrauterine devices (IUDs) and the contraceptive injection, provides highly effective contraception and does not require user input.

Despite these proven benefits, LARC uptake remains low with barriers existing at the level of the healthcare system, providers and the community. Lack of awareness, misinformation, concerns about side effects, lack of access to trained providers and relatively high upfront costs may contribute to the low uptake.

Increasing uptake of LARC has been identified as a public health priority to decrease unintended pregnancy and abortion in many countries, including the UK and the US.

Contraceptive use by age group

Contraceptive use increases from teenage years into the 20s and declines at ages 30—35 years prior to another increase. The dip most likely reflects a desire to conceive given that the average maternal age in Australia is 30 years.

Young women, who have the highest fertility, tend to use the least effective contraceptive methods, including condoms and oral contraception, while women approaching menopause have a higher uptake of intrauterine and permanent methods.

While evidence points to insufficient awareness of age-related infertility, an underestimation of fertility may also contribute to unintended pregnancy in women in their 40s. LARC will likely replace permanent methods for this group in the future.

Dual protection

Condoms are highly effective at preventing STIs but have a high failure rate in preventing unintended pregnancy. Promoting dual use of condoms and other effective methods of contraception is important for women of all ages who are at risk of contracting an STI. 

Emergency contraception

Despite increased accessibility to the emergency contraception pill (ECP), there has not been a reduction in unintended pregnancy or abortion rates.

This failure may be attributable to lack of knowledge that ECP is available without a prescription and that its effectiveness extends beyond 24 hours to up to 96  hours after unprotected intercourse.

Improved access to the copper IUD, which provides highly effective post-coital contraception and can be continued in the long term, is likely to have an impact on reproductive health outcomes.

Contraceptive use in Aboriginal communities

Contraceptive use among Aboriginal women is lower than among non-Aboriginal women (64% vs 71% ), with higher rates of tubal ligation (14% vs 4.1%) and lower uptake of oral contraception (23% vs 35%).

Both the implant and injection are used more commonly by Aboriginal women (7% and 8% respectively) than the national average (less than 2% for both methods). 

Lack of access to culturally sensitive services, transport and affordability as well as a positive attitude to pregnancy at a young age have been identified as factors limiting contraceptive uptake. 

Contraceptive use among women from non-English speaking backgrounds

Contraceptive use among this group of women is much lower than among women from Australia or other English-speaking countries (50% vs 71%), which is likely to be related to sociocultural factors in relation to family size as well as issues of access to culturally and linguistically appropriate information and services, and affordability.

Practice Points

• Australia has relatively low LARC uptake despite proven advantages of it.
• Dual protection against unintended pregnancy and STIs can be achieved through the use of condoms and an effective contraceptive method.
• Knowledge that emergency contraception can be obtained without a doctor’s visit and is effective up to 96 hours after unprotected intercourse remains low.
• Older women need evidence-based information, both in relation to declining fertility and the chance of a successful pregnancy through ART, and the need for contraception to prevent unintended pregnancy. 
• The lower uptake of contraception by Aboriginal women and by women from non-English speaking countries is likely to be related to sociocultural factors, access barriers and affordability.

References

1. Family Planning NSW. Reproductive and sexual health in Australia. Ashfield, Sydney: 2013; http://www.fpnsw.org.au/688423_21_13559012.html

Tags: , Pregnancy, Sexual Health, Womens Health, Research

Poor diet in kids linked to depression

15th Sep 2014

Clare Pain   all articles by this author

The Deakin University review found four out of five studies showed a significant relationship between an unhealthy eating pattern (such as a Western diet, or a snack-dominated diet) and worse scores on questionnaires examining depression and anxiety. CHILDREN and adolescents with unhealthy eating patterns are more likely to suffer from depression and anxiety, a systematic review of 12 epidemiological studies has found.

However, it was less clear that healthy food patterns were linked with better mental health, the authors said.
For those studies that calculated a dietary quality score, rather than looking at a dietary pattern, a “consistent trend” was found, with children eating nutrient-rich “high quality” diets exhibiting less anxiety and depressive illness.

The review included results from nearly 83,000 children and adolescents, with studies from seven countries, including Australia, China and the US.

This is the first such review in children and adolescents, said the authors. Studies on adults had indicated that better-quality diet was associated with better health outcomes, they noted.

However, the review in children and adolescents had revealed the paucity of data available, they remarked. Because of this, the evidence for the associations was limited, and more research using longitudinal designs was needed.

The majority of the studies were cross-sectional, with only three prospective studies included, the authors said. The findings of the prospective studies were conflicting, they added.

It was not possible to rule out reverse causation, with depressed and anxious children possibly adopting unhealthy diets as “a form of self-medication”, they said.

On the other hand, there was biological plausibility in diets deficient in nutrients being linked to poor mental health.

Other research had shown dietary intake of folate, zinc and magnesium to be inversely associated with depressive disorders, they said, while dietary long-chain omega-3 fatty acids were linked with a reduction in anxiety disorders.

Am J Pub Health 2014; in press

Tags: diet, mental health, children, adolescents, systematic review, Research, MedicalNews

Experienced cosmetic acupuncturist---from Japan---every Wednesday 9am to 2pm!

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Migraine link to Parkinson’s

12th Sep 2014

Rada Rouse   all articles by this author

PEOPLE who experience migraine with aura have more than twice the risk of developing Parkinson’s disease in later life, according to findings from a large population-based study.

Given that previous studies have associated movement disorders with individuals who suffer from migraine, researchers involved with a large cohort study in Iceland examined the association in participants over 25 years.

Among 5620 people aged 33–65 at baseline, about 1000 had headaches, 430 had migraine with aura and 238 had migraine with no aura.

Parkinsonian symptoms were more common in participants with mid-life headache compared to those with no headache, with participants experiencing migraine with aura having more than three times the likelihood of symptoms. 

A total 1.2% of participants self-reported a diagnosis of Parkinson’s disease. 

The rate was highest among people with migraine with aura (2.4% compared to 1.1% among those with no headaches), the study showed.

The researchers, from the US and Iceland and funded in part by the US National Institutes of Health, found people with a history of headache were also more likely to develop restless legs syndrome.

The researchers said it was possible that there was a shared cerebral vulnerability between patients with migraine and those with movement disorder.

“Dopaminergic dysfunction, common to both parkinsonism and [restless legs syndrome], has been hypothesised as a causal factor in migraine pathogenesis for many years,” the authors wrote.

Symptoms of migraine such as excessive yawning, nausea and vomiting are thought to be related to dopamine receptor stimulation, they said.

Neurology 2014; in press

Tags: migraine, aura, neurology, parkinsonism, Research, Medical News

Sex position research may reduce back pain

12th Sep 2014

Sunalie Silva   all articles by this author

A STUDY using motion capture technology provides new information on sexual positions that may exacerbate back pain in some men.

The findings could help men with lower back pain (LBP) to avoid the triggers that cause pain during sex which can eventually lead to less intimacy with partners.

Researchers from the University of Waterloo, Ontario, said a lack of evidence-based guidelines on how to avoid triggering back pain during sex prompted the research.

Ten healthy male and female couples who had been in their relationship for four years or more were recruited for the study and filmed using an electromagnetic motion capture system while they had sex. 

The researchers were in a separate booth where they could hear, but not see, the participants.

Couples were randomised to one of five different coitus positions – missionary, sidelying and two variants of quadruped (rear-entry, in which the female is in the quadruped position and the male is kneeling behind her). 

Interestingly, the researchers found that the sidelying or ‘spooning’ position – the position most commonly recommended for all people with LBP – actually produced the greatest strain on the male partner's spine if he was flexion-intolerant.

For men with that particular back pain trigger, the study suggested that the quadruped position was far less likely to aggravate the back problem.

In general, the researchers found that the person on top – whether male or female – was most responsible for motion.

For men who are motion intolerant, all positions included in the study were found to aggravate back pain. Researchers said these patients should be advised to try coital movements that were more hip-dominant rather than spine-dominant.

This technique may also be beneficial for the flexion – and extension-intolerant patient, but the effectiveness of this movement pattern intervention will require further investigation, they said.

The study also found that even a seemingly subtle change in posture – for example, the male supporting his upper body with his elbows during different variations of the missionary position – altered the spine movement profile significantly and was among the more spine-conserving coital positions.

However, supporting the upper body with the hands while in the missionary position was among the least spine conserving for flexion-intolerant patients.

Even a slight adjustment in the female partner's posture – for example, the female supporting her upper body with her elbows or her hands during different variations of the quadruped position affected the male spine movement profile, the authors said, which might suggest that the partner may be an integral factor in the intervention.

The researchers said they hoped that their data would help doctors to provide specific recommendations to the male LBP patient, including specific coital positions and movement strategies, to avoid LBP triggers during sex.

Spine 2014; online 15 Sept

Tags: pain, lower back pain, sexual health medical news., Guidelines, Research

介绍几种眼科保健茶

鉴于最近临床发现很多人都有眼睛不舒服的现象，在此介绍一些简单方便的护眼小的配方茶，感兴趣的同学可以试试，大家一起来爱护眼睛。

养眼茶：菊花2-3克，枸杞子3-5克。长期服用，保护眼睛。
清眼茶： 野菊花 2-3克，决明子2-3克。适合便秘，眼屎多的人。
祛风茶：密蒙花2克，玫瑰花2克，木賊草2克。眼睛怕光，眼红，眼痒，多泪，看电脑多，喝一两天就能缓解。
缓解眼压：野菊花3克，蔓荆子2克，决明子2克。适合青光眼，可降低眼压。
舒肝茶：菊花2克，玫瑰花3克。｀适合眼睛胀，眼角有白色的分泌物。
助眼茶：菊花2克，枸杞子4克，西洋参3克，炙黄芪4克。适合视疲劳，用眼过度引起的气血虚弱。
润眼茶：菊花2克，麦冬4克，胖大海2-3个。适合干眼症。

关于 野菊花和杭白菊：如果有红肿，眼睛感染，一般选野菊花；普通没有什么热象的，一般使用可选杭白菊或贡菊。

祝大家爱护眼睛，身体健康！

针刺手法的精妙－－－“飞经走气”

近来临证，常常能体会针下气穴传导的精妙。经气的感觉可以从一穴，导引经气到另一处。因此，针刺手法帮助得气催气和守气，是能够帮助并达到“明乎若见苍天”的美妙感觉。

小记一下，与各位针灸同道共勉。

Vision Care in My Acupuncture

Notice: all words here come from Binbin Zhang, if you want to forward, please let me know. Thank you.

Do eyes problems can be healed by alternative way?

YES. When I do a lot of research about how acupuncture can help people’s eyes in natural way, most report shows it does work well. According to Chinese medicine system, eyes problems are related to the whole body, not only eyes.

Does it working well? Why you do eyes acupuncture?

Yes.

My first experience which is acupuncture for visions care since 2006 in Beijing, I was a practitioner in an eyes acupuncture clinic in Beijing, they are specialised in Myopia and Amblyopic. Since then, I am interested in eyes acupuncture.

I do more practice about acupuncture for more eyes problems (like dry eyes, eyes fatigue…) is started my family members first, and then my friends and regular patients…… the result is surprising. So it does working well.

Maybe it is new for Australian, but I get more support. According to more and more people support my acupuncture to treat eyes problems; I hope it can help more and more people with eyes problems in natural way in Australia. 

               www.myacupuncture.org              Binbin Zhang


There are more than 5000 years for people use Acupuncture and Chinese medicine to treat eyes diseases in China.

Acupuncture treats patients through energy pathways called meridians in the body. The practice aims to restore the body's normal balance and flow of energy, so that organs and systems can work together in harmony to repair the body and maintain health.

In Australia, people turn to acupuncture and other holistic remedies to treat numerous conditions such as allergies, migraines, digestive problems and more, but what about the eyes? When people are faced with an eye condition like myopia or dry eyes, a holistic treatment probably isn't the first thing that comes to mind. 

“For many who suffer from these degenerative eye conditions, acupuncture and Oriental medicine may be the last and only hope. Conventional medicine has little to offer people suffering with conditions such as macular degeneration, glaucoma, and retinitis pigmentosa. 

Acupuncture can offer so much and it is our duty as active practitioners to educate the public about the benefits. The more people know, the more people we can help. 

Putting drugs in, and/or taking organs out is just not acceptable mainstream therapy anymore. People want more, and they deserve better. Through acupuncture and natural healing "cure" can be achieved without drugs, without surgery.”

In My Acupuncture clinic, Binbin uses acupuncture and Chinese medicine to help people improve their vision. Your vision is our mission.


What kinds of problems can be used in your acupuncture in My Acupuncture clinic?

Well, right now in MY ACUPUNCTURE clinic, we use acupuncture to treat Myopia, Amblyopic, Dry Eyes, Asthenopia (eyes fatigue), Optic Neuritis, Diabetic Retinopathy, Optic Nerve Atrophy, Macular Degeneration, and Glaucoma.
• Myopia 近视
• Amblyopic 弱视
• Dry Eyes  干眼症
• Asthenopia (eyes fatigue) 视疲劳
• Optic Neuritis  视神经炎
• Diabetic Retinopathy  糖尿病视网膜病变
• Optic Nerve Atrophy  视神经萎缩

• Macular Degeneration    黄斑病变
• Glaucoma     青光眼
• Potsis     上睑下垂

How many times pr week I come to do acupuncture for my eyes problems?

Best result is 3 times pr week to improve fast. For protect your eyes, you come 1-2 times pr week is fine. 

Do I have to bring my eyes examination results?

If you have, please bring your result when you come for your initial consultation. The eyes examination results like your past Optometrist Diagnosis or eyes specialist’s diagnosis is needed.


How long should I take for one session?

20~30 minutes for one session.

Will you put your needle inside my eyes?

No, no needle inside your eyes, mostly on your hands and feet. 

How many sessions should I do?

It depends on your eyes condition.

Where is your clinic?

It located in Shop1A/102-106 Boyce Road, Maroubra, 2035, which is in the corner of Boyce Road and Bruce Bennettes Place. Contact Binbin 0451262035.

Healthy eyes tips

http://www.nei.nih.gov/healthyeyes/eyehealthtips.asp

Your eyes are an important part of your health. There are many things you can do to keep them healthy and make sure you are seeing your best. Follow these simple steps for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don抰 realize they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or widen, the pupil to allow more light to enter the eye the same way an open door lets more light into a dark room. This enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you抮e seeing your best.

Know your family抯 eye health history. Talk to your family members about their eye health history. It抯 important to know if anyone has been diagnosed with a disease or condition since many are hereditary. This will help to determine if you are at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You抳e heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy, too.ⁱ Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.^ii, iii

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun抯 ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.

Clean your hands and your contact lenses梡roperly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.

Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your coworkers to do the same.