Indian Medicine

NEW YORK (Reuters Health) - A form of estrogen, estradiol, sprayed on the skin is a safe, effective, and convenient way for post-menopausal women to relieve hot flushes, a study shows.

Evamist, which is marketed by Ther-Rx Corporation, is the first transdermal estradiol spray to be approved by the US Food and Drug Administration for treating moderate-to-severe menopausal symptoms in healthy women, according to the report in the medical journal Obstetrics & Gynecology.

"This estradiol 'spray-on-patch' is a treatment option for women who will benefit from the advantages of transdermal estradiol delivery but are intolerant of or are not inclined to use patches, gels, or emulsions," write Dr. John E. Buster, from Brown University in Providence, Rhode Island, and colleagues.

The spray solution contains estradiol in ethanol, plus a skin-penetrating agent, and is delivered in a precisely metered dose. It is formulated to be retained beneath the skin's surface where is slowly released over 24-hours. The spray is applied to the inside of surface of the forearm and dries clear in 1 minute; it can't be rubbed or washed off and it won't transfer to other people.

In the study, 454 women with eight or more moderate-to-severe hot flushes per day were randomly assigned to receive one, two, or three sprays of estradiol or an inactive placebo daily.

Compared with the placebo groups, all three estradiol groups showed significant reductions in the frequency and severity of hot flushes.

At 12 weeks, patients in the estradiol groups had eight fewer hot flushes per day on average compared to the start of the study. The reduction in the placebo groups was four to six fewer flushes.

Women given three or two sprays of estradiol showed significant reductions in symptom severity at 4 and 12 weeks compared with women given the placebo. Women treated with one spray of estradiol showed a significant reduction in symptom severity at 5 weeks only.

Adverse events were mild and on par with what has been seen with other transdermal products, the authors note.

The results suggest that this new spray "will be an attractive first choice for transdermal estradiol delivery," the authors conclude.

SOURCE: Obstetrics & Gynecology, June 2008.

Copyright © 2008 Reuters Limited.

BENTO GONCALVES, Brazil (Reuters Health) - When they're released from prison, inmates might want to increase their intake of fish or take omega-3 supplements to curb aggressive behaviors and reduce the risk of relapse, a leading psychologist suggested here last week.

"Why not try it? What would be the harm?" said Dr. Adrian Raine, professor of Criminology, Psychiatry and Psychology at the University of Pennsylvania, speaking at the IV Brazilian Congress of Brain, Behavior and Emotions.

"Omega-3 fatty acids...have been shown to improve the functioning of brains and reduce violent behaviors," he told Reuters Health. "And actually, American prisoners eat very little fish."

The proposal is based on a growing but controversial body of evidence that attributes criminality to biological factors, such as a genetically driven dysfunction in the prefrontal cortex. Biological predisposition might explain at least 50 percent of criminal behavior, Raine estimates.

In this context, nutritional intervention in prisoners might become a "naturalistic" way of helping change brains at risk. "It might not only reduce (further) serious offending, but could also make prisoners more amenable to other treatments, such as cognitive behavior therapy," he said.

Raine based his hypothesis upon the results of some "compelling" trials in children and adults, he said. A 2002 study conducted with 231 young English prisoners showed that taking nutritional supplements containing omega-3 fatty acids, for at least 2 weeks, was associated with a 35 percent reduction in offenses after 5 months.

In another study, conducted by Raine and published in the American Journal of Psychiatry in 2003, children aged 3 to 5 participated in an "environmental enrichment" program, including a fish-enriched diet, physical activity and cognitive stimulation. Twenty years later, it was found that the crime rate in the intervention group had been lowered by 35 percent.

A third trial, published in 2005, showed that normal 8-to-11 year-old children reduced their aggressive behavior by taking omega-3 fatty acids supplements for only 4 months.

In addition, a 2001 cross-national ecological analysis found a direct link between seafood intake and lower murder rates.

A nutritional intervention, perhaps combined with some cognitive behavior therapy, might work not only in prisoners but also in aggressive children and others at risk for antisocial behaviors.

"Fish oil and omega-3 fatty acids improve brain structures and attention abilities. And maybe (violent people) need better brains to learn instructions to regulate their emotions," Raine said.

Effective dosages of omega-3 or fish intake to prevent antisocial conduct or criminal relapses are unknown, but about 1 g/d of omega-3 or two to three meals of fish a week might be needed, the investigator added.

Bernard Gesch, researcher in the Department of Physiology, Anatomy and Genetics at Oxford University and director of Natural Justice, an Oxford-based research charity that investigates the social and physical causes of offending behavior, thinks that Raine's suggestion is interesting.

"But nutrition is about balance. Many nutrients, including vitamins and minerals, have already been implicated in behavioral change when lacking in the diet. Omega-3 is but one," Gesch told Reuters Health via email.

Gesch, lead author of the 2002 English trial that investigated the impact of nutritional supplements on the behavior of young prisoners, said that his group is about to start a much larger study with 1000 prisoners, funded by the Wellcome Trust.

"It will take around 2 years to complete. We are not only retesting to see if nutrition affects behavior, but also to explore how it works," he said. "It is a simple approach to prevent antisocial behavior, and the only 'risk' from a better diet is better health."

According to data from the US Department of Justice obtained for 15 states, almost 70 percent of released prisoners are re-arrested for a felony or serious misdemeanor within 3 years. Eventually, 47 percent of all former prisoners are again convicted for a crime, and 25 percent are sent to prison with a new sentence.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - An older person's likelihood of entering a nursing home or other long-term care facility is particularly high immediately after the death of a spouse, new research indicates.

There could be various reasons for this, Elina Nihtila, of the department of sociology at the University of Helsinki, Finland, who led the research, told Reuters Health.

"It may be related to the loss of social and instrumental support, in the form of care and help with daily activities such as help in cooking, cleaning, and shopping formerly shared with the deceased spouse," Nihtila said.

"Second, grief and spousal loss may cause various symptoms, such as depression and anxiety, loss of appetite, sleep disturbances, fatigue and loss of concentration that could increase the need for institutional care." She added. "Furthermore, grief may cause increased susceptibility to physical diseases."

The research team analyzed how the death of a spouse affects the likelihood of entering institutionalized care among nearly 141,000 Finnish adults aged 65 and older. All of them were living with a spouse at the beginning of the study and were followed for five years.

"The data were unique in that they covered a large number of persons bereaved during the follow-up and gave the dates of bereavement and of first admission into institutional care," Nihtila and colleagues explain in the American Journal of Public Health.

Results showed that the risk of entering long-term institutional care was higher among older adults who had lost their spouse than among those living with their spouse. "The excess risk of institutionalization was highest during the first month after the spouse's death -- more than three times higher among both men and women -- and decreased with time from bereavement, stabilizing at approximately 20% to 50% higher over 1 to 5 years," Nihtila noted.

The researcher thinks home help services "should be targeted to the bereaved immediately after a spouse's death to reduce the need for institutional care."

SOURCE: American Journal of Public Health, July 2008 (online May 29, 2008).

Copyright © 2008 Reuters Limited.

WASHINGTON (Reuters) - The number of uninsured U.S. young adults, who already represent a major chunk of the American population without health coverage, rose again in 2006, according to a study released on Friday.

Based on census data, 13.7 million people aged 19 to 29 had no health insurance, either public or private, in 2006, up from 13.3 million in 2005, according to a report by the Commonwealth Fund, a private foundation that researches health policy.

Men and women in this age group accounted for 17 percent of the under-65 U.S. population, but made up almost 30 percent of the uninsured, according to the report. At age 65, people enter the federal Medicare insurance program.

"There has been a steady upward climb in the number of young adults without health insurance coverage," Sara Collins, an author of the report, said in a telephone interview.

Reducing the number of Americans who lack health insurance has emerged as an issue in this year's U.S. presidential campaign. The government estimates that 47 million people have no health coverage in a country of about 300 million.

"If you ask young adults, as we do in our survey, if you've ever had problems accessing health care because of cost -- not filling a prescription, not seeing a specialist -- two thirds of uninsured young adults say yes," Collins said.

Hispanic and black young adults were at greater risk of being uninsured than whites, the report showed. While 23 percent of whites ages 19 to 29 lacked insurance, the figure was 36 percent of blacks and 53 percent of Hispanics.

Those aged 19 to 29 represent one of the largest and fastest-growing segments of the U.S. population lacking health insurance, the report said.

The U.S. uninsured rate rises dramatically at age 19 -- from 12 percent of children up to age 18 up to 30 percent among men and women aged 19 to 29, according to the report.

They often are dropped from public insurance programs at 19 or from parents' private insurance policies once they finish their education, either graduating high school or college.

Many jobs available to young adults tend to be low-wage or temporary, the type often unlikely to provide health coverage.

The report showed that 38 percent of high school graduates who do not attend college and 34 percent of college graduates spend some time uninsured in the year after graduation.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Among people with rheumatoid arthritis, heavy smokers appear to have a greater loss of muscle mass than those who smoke fewer cigarettes or do not smoke, study findings suggest.

On the other hand, people with rheumatoid arthritis are prone to gain weight when they stop smoking, and this may negatively impact their quality of life, report Dr. Antonios Stavropoulos-Kalinoglou and colleagues.

"In any case, though, smoking is a bad habit for rheumatoid arthritis patients," said Stavropoulos-Kalinoglou of the Dudley Group of Hospitals NHS Trust, in West Midlands, UK.

Smokers with rheumatoid arthritis should couple smoking cessation with weight management and lifestyle counseling to counteract or minimize weight gain, he told Reuters Health.

Stavropoulos-Kalinoglou and colleagues compared measures of body mass, body fat, waist circumference, and muscle mass among 392 patients (290 female) who had rheumatoid arthritis for 4 to 18 years. They were 63 years old on average.

Overall, 69 participants were current smokers, 147 were ex-smokers, and 176 had never smoked, the researchers report in the medical journal Arthritis Research & Therapy.

Current smokers had significantly lower body mass and body fat than ex-smokers and never-smokers. The groups had similar overall muscle mass, with the exception of heavy smokers who had the lowest muscle mass values.

The investigators also found that 50 percent of ex-smokers were obese, compared with 39 percent of never-smokers and 30 percent of current smokers.

These findings should be confirmed in a study that follows the impact of smoking, smoking intensity, and smoking cessation on the body composition of people with rheumatoid arthritis over time, the investigators note.

Nonetheless, "it is very important for rheumatoid arthritis patients to stop smoking," Stavropoulos-Kalinoglou stressed. To achieve the most benefit from smoking cessation, he added, "they should also keep an eye on their weight."

SOURCE: Arthritis Research and Therapy, May 2008

Copyright © 2008 Reuters Limited.