From ScienceDaily.com

Physicians prescribe antibiotics for more than half of children with sore throat, exceeding the expected prevalence of strep throat, and used nonrecommended antibiotics for 27 percent of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA.

Pharyngitis (inflammation of the throat) accounts for 6 percent of visits by children to family medicine physicians and pediatricians, according to background information in the article. The most common manifestation of acute pharyngitis is sore throat. The main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci (GABHS). GABHS are cultured from 15 percent to 36 percent of children with sore throat. To improve diagnostic accuracy and reduce unnecessary antibiotic treatment, it is recommended that a GABHS test be conducted prior to treating children with an antibiotic. Penicillin is the recommended antibiotic, but acceptable alternatives include amoxicillin, erythromycin (for penicillin-allergic patients), and first-generation cephalosporins.Jeffrey A. Linder, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the change in the rate and type of antibiotics prescribed to children with a chief complaint of sore throat, and the frequency of GABHS testing.

From BrightSurf.com

Use of the antibiotic amoxicillin during infancy appears to be linked to tooth enamel defects in permanent teeth, according to a study in the October issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Dental fluorosis, a result of exposure to excessive fluoride during enamel formation, is one of the most common developmental enamel defects, according to background information in the article. The clinical signs range from barely noticeable white flecks, to pits and brown stains. Amoxicillin is one of the most common antibiotics used among pediatric patients, mainly for treatment of otitis media-infection and inflammation of the middle ear. There has been some evidence that amoxicillin use could be associated with dental enamel defects, and, the authors suggest, even a small effect on dental enamel could have a significant effect on the public’s dental health because of the widespread use of amoxicillin.

Liang Hong, D.D.S., M.S., Ph.D., of the University of Iowa, Iowa City, and colleagues assessed the association between dental fluorosis and amoxicillin use during early childhood. (Dr. Hong is now with the Department of Dental Public Health and Behavioral Science, University of Missouri - Kansas City.) The researchers analyzed data from the Iowa Fluoride Study, a prospective study investigating fluoride exposures, biological and behavioral factors, and children’s dental health. They followed 579 participants from birth to 32 months, using questionnaires every three to four months to gather information on fluoride intake and amoxicillin use.

“The results show that amoxicillin use during early infancy seems to be linked to dental fluorosis on both permanent first molars and maxillary central incisors,” the authors report. “Duration of amoxicillin use was related to the number of early-erupting permanent teeth with fluorosis.”

By the age of one year, three-quarters of the subjects had used amoxicillin. By 32 months, 91 percent of participants had used amoxicillin. “Overall, 24 percent had fluorosis on both maxillary central incisors,” the authors write.

Amoxicillin use from three to six months doubled the risk of dental fluorosis. “The significantly elevated risk for dental fluorosis associated with amoxicillin use during early infancy was found at all levels of statistical analyses, even after controlling for other potential risk factors, such as fluoride intake, otitis media infections, and breastfeeding,” the authors report.

The authors emphasize that additional laboratory and clinical studies-including controlled animal studies with specified amoxicillin dosages, chemical analysis and histological examination of affected teeth, and additional well-designed epidemiological studies-are needed to confirm the results.

“The findings suggest that amoxicillin use in infancy could carry some heretofore undocumented risk to the developing teeth,” they conclude. “While the results of this one study do not warrant recommendations to cease use of amoxicillin early in life, they do further highlight the need to use antibiotics judiciously, particularly during infancy.”

From ScienceDaily

MIT scientists propose that blood may help us think, in addition to its well-known role as the conveyor of fuel and oxygen to brain cells.

“We hypothesize that blood actively modulates how neurons process information,” explains Christopher Moore, a principle investigator in the McGovern Institute for Brain Research at MIT, in an invited review in the Journal of Neurophysiology. “Many lines of evidence suggest that blood does something more interesting than just delivering supplies. If it does modulate how neurons relay signals, that changes how we think the brain works.”

According to Moore’s Hemo-Neural Hypothesis, blood is not just a physiological support system but actually helps control brain activity. Specifically, localized changes in blood flow affect the activity of nearby neurons, changing how they transmit signals to each other and hence regulating information flow throughout the brain. Ongoing studies in Moore’s laboratory support this view, showing that blood flow does modulate individual neurons.

Moore’s theory has implications for understanding brain diseases such as Alzheimer’s, schizophrenia, multiple sclerosis and epilepsy. “Many neurological and psychiatric diseases have associated changes in the vasculature,” says Moore, who is also an assistant professor in MIT’s Department of Brain and Cognitive Sciences.

“Most people assume the symptoms of these diseases are a secondary consequence of damage to the neurons. But we propose that they may also be a causative factor in the disease process, and that insight suggests entirely new treatments.” For example, in epilepsy people often have abnormal blood vessels in the brain region where the seizures occur, and the hypothesis suggests this abnormal flow may induce epileptic onset. If so, drugs that affect blood flow may provide an alternative to current therapies.

The hypothesis also has important implications for functional magnetic resonance imaging, or fMRI, a widely used brain scanning method that indicates local changes in blood flow. “Scientists looking at fMRI currently regard blood flow and volume changes as a secondary process that only provides read-out of neural activity,” explains Rosa Cao, a graduate student in Moore’s lab and co-author of the paper. “If blood flow shapes neural activity and behavior, then fMRI is actually imaging a key contributor to information processing.”

Again, studies in Moore’s lab support this interpretation. For example, his fMRI studies of the sensory homunculus - the brain’s detailed map of body parts like fingers, toes, arms, and legs- show that when more blood flows to the area representing the fingertip, people more readily perceive a light tap on the finger. This suggests that blood affects the function of this brain region and that information about blood flow can predict future brain activity. This finding does not undermine prior studies, but adds another, richer layer to their interpretation and makes fMRI an even more useful tool than it already is.

How could blood flow affect brain activity? Blood contains diffusible factors that could leak out of vessels to affect neural activity, and changes to blood volume could affect the concentration of these factors. Also, neurons and support cells called glia may react to the mechanical forces of blood vessels expanding and contracting. In addition, blood influences the temperature of brain tissue, which affects neural activity.

To Moore’s knowledge, the Hemo-Neural Hypothesis offers an entirely new way of looking at the brain. “No one ever includes blood flow in models of information processing in the brain,” he asserts. One historical exception is the philosopher Aristotle, who thought the circulatory system was responsible for thoughts and emotions. Perhaps the ancient Greeks were on to something.

This work was funded by Thomas F. Peterson, the Mitsui Foundation and the McGovern Institute for Brain Research at MIT.

From HealthDay

Women who undergo hysterectomies for benign conditions more than double their risk of needing subsequent surgery for stress urinary incontinence, a new study finds.

This was true regardless of what type of surgical technique was used for the hysterectomy, the researchers noted.

The article is published in the Oct. 27 issue of The Lancet, and although the study contradicts previous research, some experts said they are inclined to believe the current study.

“The authors have a lot of experience from previous studies, and they conducted this study using a very tight registry in Sweden. They had the opportunity to analyze the data almost in a unique way,” noted Dr. Gil Levy, director of urogynecology at the Pelvic Floor Dysfunction and Reconstructive Surgery Center at Maimonides Medical Center in New York City. “When they come up with these results, it should be taken very seriously,” he said.

According to background information in the study, many women opt to have a hysterectomy, because it can cure irregular heavy menstrual bleeding, uterine prolapse and postmenopausal bleeding. One in five British women will have undergone a hysterectomy by the time they reach 55. In the United States, 600,000 hysterectomies are performed each year, 90 percent of them for a benign indication (as opposed to cancer).

Studies regarding how a hysterectomy might affect lower-urinary-tract function have been inconsistent, however.

Female stress urinary incontinence is defined as involuntary leakage of urine upon effort or exertion. About 40 percent of women in most industrialized countries have the condition, with considerable effect on daily function as well as sexuality and psychological well-being.

This 30-year study, conducted between 1973 and 2003, involved more than 165,000 Swedish women who had undergone a hysterectomy and more than 479,500 women who had not.

The risk of having to undergo surgery for stress urinary incontinence was 2.4 times higher in the hysterectomy group than in the control group, regardless of what type of surgical technique was used for the hysterectomy.

The highest risk was during the first five years after the hysterectomy, when the risk was 2.7 times higher.

The lowest risk was more than 10 years down the line, when the risk was only 2.1 times higher for patients who had undergone a hysterectomy compared with those who had not.

The most logical explanation for the association, according to the authors, was surgical trauma that can occur when the uterus and cervix are detached from the pelvic-floor supportive tissues during a hysterectomy.

“This is a big, well done and population-based study,” noted one outside expert, Dr. Tristi Wood Muir, assistant professor of obstetrics and gynecology, Texas A&M Health Science Center College of Medicine and director of female pelvic medicine and reconstructive surgery for Scott & White in Temple. “Certainly, the uterus and bladder are intimately related, and, certainly, dissecting the bladder off can cause problems down the road. When we do a hysterectomy, we have to reestablish support, and it may be that a lack of support is causing the stress urinary incontinence. But it could also be a whole host of other reasons. It could be any number of things.”

According to the accompanying comment article, several other reasons might explain the incidence of stress urinary incontinence, some of which might have nothing to do with the hysterectomy.

Regardless of the cause, most of the experts agreed that hysterectomy is not something to be undertaken lightly.

“With any sort of surgical intervention, there are possible risks and side effects, and the way the body tissues and nerves react to incisions and stitches is quite variable between patients,” said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. “This is something to consider when patients are thinking about surgery like a hysterectomy for a benign indication. There will always be some sort of need for hysterectomy whether it’s for cancer or for severe bleeding or severe pain, but patients need to realize that while it can cure some problems, it can also be the source of other problems, so it is something patients will need to talk about with their doctors.”

From MedPage Today

Half of physicians from ages 50 to 65 are frustrated with their practices and plan to sharply cut back or abandon patient care within the next three years, according to a survey.

Fifty-two percent of these older physicians said they find medicine has become less satisfying over the past five years, according to a survey by Merritt Hawkins & Associates, a national physician search and consulting firm.

Only 10% of nearly 1,200 responding physicians said the practice of medicine is “very satisfying,” down from 20% in earlier surveys.

What’s more, 44% of the surveyed physicians said they wouldn’t choose medicine as a career if they were starting out today and 57% would discourage their children or other young people from doing so.

These doctors don’t intend to remain unhappy for much longer, though. Almost half of survey respondents said they will retire over the next three years, seek nonclinical jobs, work part time, close their practices to new patients (18% have already done so), or significantly reduce the number of patients they see.

If that trend continues, patient access to health care could be severely jeopardized. “Almost half the physicians in the United States are 50 years old or older,” said Mark Smith, executive vice-president of Merritt Hawkins. “An exodus of older doctors from medicine would be a disaster for patient care in this country.”

The Council on Graduate Medical Education (COGME), a panel of health care authorities, has endorsed a study predicting a shortage of 96,000 physicians by the year 2020. If only 20% of physicians in the 50 to 65 age bracket opt for retirement or nonclinical roles in the next three years, nearly 60,000 physicians would be removed from the clinical workforce, the survey noted.

“The tens of millions of patient encounters these physicians handle would have to be absorbed by younger physicians or by those older physicians remaining in clinical practice.”

Why do physicians claim to be so disgruntled? Reimbursement issues were cited by 33% of doctors as their greatest single source of professional frustration, followed by malpractice worries (18%) and long hours (15%).

That represents a significant shift. In the 2004 Merritt Hawkins survey, malpractice worries were the main source of frustration (28%). Reimbursement issues were cited by only 16%.

“When Baby Boom doctors entered medicine, they had control over how they practiced and the fees they charged,” noted Smith. “But the rules changed on them in midstream and now many are looking for a ticket out.”

These older physicians don’t have much regard for the work ethic of their younger counterparts. More than two-thirds of respondents said physicians being trained today are less dedicated and hard-working than they are.

Recently trained physicians may put a higher premium on “quality of life” issues than senior physicians often do. “We find that younger physicians today generally prefer and expect fixed hours, a good call schedule with reliable coverage, and regular vacation time,” the survey report noted.

A much higher percentage of young physicians today are female than was the case in the past, and female physicians work 18% fewer hours per week than male physicians, according to the AMA. For these reasons, it may take two younger physicians to replace a more senior doctor.

On a more positive note, six in 10 older physicians said patient relationships are their single greatest source of professional satisfaction.

Also, 48% of physicians indicated that the quality of health care in the United States has generally improved over the last 20 years, compared with 33% who indicated it has generally declined.

So, the survey authors concluded, although the practice of medicine may have become problematic for many older physicians, patient care has generally improved.

The survey was mailed to 10,000 physicians across the nation and 1,175 participated, a 12% response rate. Surgical and internal medicine subspecialists comprised 47% of respondents, followed by primary care physicians (36%) and hospital-based doctors (17%).