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People who grind their teeth at night appear to be more likely to suffer from stress and also likely to use escapism to cope when things become difficult, new research out of Germany suggests.

Researchers led by Maria Giraki, of Heinrich-Heine-University in Dusseldorf, studied 48 people who were known to grind their teeth at night, a condition called “sleep bruxism,” and reported their findings online March 5 in the journal Head & Face Medicine.

Teeth grinding “can lead to abrasive tooth wear, looseness and sensitivity of teeth, and growth and pain in the muscles responsible for chewing,” Giraki said in a news release from the journal’s publisher. “Its causes are still relatively unknown, but stress has been implicated. We aimed to investigate whether different stress-factors, and different coping strategies, were more or less associated with these bruxism symptoms.”

The researchers measured the overnight grinding by placing thin plates in the mouths of the study participants. No particular age range, gender or education levels appeared to be at higher risk of teeth grinding, but those who did it reported more daily stress and stress at work.

“Our data support the assumption that people with the most problematic grinding do not seem to be able to deal with stress in an adequate way. They seem to prefer negative coping strategies like ‘escape,’” Giraki said. “This, in general, increases the feeling of stress, instead of looking at the stressor in a positive way.”

SOURCE: BioMed Central.

Since psoriasis is a chronic lifelong disease that needs to be controlled with a customized treatment regimen, the constant presence of psoriatic lesions or unexpected flare-ups – at times when patients least expect it – can cause a considerable amount of stress and anxiety. In fact, psoriasis has long been known to cause considerable emotional stress for patients, including low self-esteem and feelings of rejection, introspection, weight gain, increased use of alcohol and tobacco, and depression (which in some cases can be severe).

Another study conducted by the National Psoriasis Foundation examining attitudes and beliefs about contagious diseases among the general population of young adults found that approximately one-third (36 percent) of those surveyed were unsure whether psoriasis was contagious. In addition, when asked their attitudes about dating and skin conditions, more than half (62 percent) of the respondents reported that they take the condition of a person’s skin into consideration when first asking someone out on a date. Dr. Menter added that the findings of this survey lend credence to the belief held by many psoriasis patients that their disease can have a negative impact on their personal lives and affect their interpersonal relationships.

“We cannot underestimate the complexity of psoriasis, particularly the psychological impact the disease can have on young people,” said Dr. Menter. “Even at a young age, psoriasis can affect a person’s relationships at home, work or school, and the disease can contribute to an overall poor body image that can be hard to reverse throughout life.

Dr. Menter added that studies conducted regarding the effect of newer biologic medications, such as adalimumab, etanercept and infliximab, on psychiatric symptoms have shown that psoriasis patients may experience significant improvement in fatigue and other symptoms of depression. The newest biologic agent recently approved by the Food and Drug Administration (FDA), ustekinumab, also has been shown to improve sexual dysfunction in patients with moderate to severe psoriasis up to 10 fold.

“Although psoriasis is an incurable disease, it is controllable in the majority of cases with proper treatment,” said Dr. Menter. “Over the past several years, there have been a number of newer therapies introduced that are effective in managing psoriasis, and a patient’s dermatologist can determine which therapy would work best to control each patient’s disease.”

To learn more about psoriasis, visit the PsoriasisNet section of www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

For the approximately 7.5 million Americans affected by psoriasis, the thick, red, scaly, itchy plaques it causes only scratch the surface when it comes to the overall implications of this disease. Now, ongoing research linking psoriasis to other serious medical conditions and the incredible toll it can take on a person’s overall quality of life are shifting the way psoriasis is viewed – from a common skin disease to a complex systemic condition.

Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Alan Menter, MD, FAAD, chair of the Psoriasis Research Unit at Baylor Research Institute in Dallas, addressed the need for psoriasis to be viewed as a serious disease affecting the whole body with significant quality of life issues.

“In the past, psoriasis was viewed primarily as a cosmetic nuisance that was not thought to extend beyond the obvious plaques apparent on the skin,” said Dr. Menter. “With the discovery of multiple genes related to psoriasis, a better understanding of the immune system responses involved in this disease, and the frequent associations with other serious diseases, we know that psoriasis is a much more complex disease that demands continual monitoring and evaluation by a dermatologist and, if necessary, other medical professionals to address related health issues.”

The Link between Psoriasis and Other Serious Medical Conditions
Over the years, multiple studies have found that psoriasis is associated with a number of potentially serious medical conditions, including cardiovascular disease, cancer and lymphoma, obesity and metabolic syndrome (also known as “Syndrome X”), autoimmune diseases (Crohn’s disease and diabetes mellitus I and II, for example), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD) and even increased mortality. Dr. Menter explained that the majority of these diseases can have a significant impact on a patient’s overall health and affect psoriasis patients in different degrees of severity.

“It is important to note that while we are unsure whether psoriasis causes other diseases or that these other diseases cause psoriasis, the fact that an association exists at all is critically important in treating psoriasis patients,” said Dr. Menter.

One recent observational study of 3,236 patients with psoriasis and 2,500 patients without psoriasis who served as the controls concluded that patients with psoriasis experienced an increased incidence of ischemic heart disease (where the blood vessels are blocked leading to the heart), cerebrovascular disease (where the blood vessels are blocked leading to the brain), and peripheral vascular disease (the obstruction of arteries in the arms and legs), and mortality.

Another study examining the increased risk of mortality in psoriasis patients suggests that patients with severe psoriasis may have shorter life expectancies by an average of three to five years than individuals who are not affected by psoriasis.

In addition, other studies have shown that psoriasis patients are more likely to consume excessive amounts of alcohol and cigarettes, both of which can negatively impact a psoriasis patient’s health. These detrimental behaviors can further aggravate other conditions associated with psoriasis, such as heart disease and COPD.

Over 2,600 senior citizens suffer serious elevator-related injuries each year in the United States, and three-quarters of them are women, according to the results of the first large-scale study of these events.

Slips, trips and falls accounted for more than half of the injuries, and about one-third were caused by elevator doors closing on a person. The third most common cause of injuries were those related to the wedging of walkers in elevator door openings, the researchers reported in the January issue of the Journal of Trauma Injury, Infection and Critical Care.

The study authors analyzed elevator-related injuries that were serious enough to send a person aged 65 years or older to an emergency department. Almost half of the injuries were “soft-tissue” injuries such as sprains and bruises, they noted.

“Elevator-related injuries are not accidental; they are easily preventable. Individuals of any age, but especially older adults, who often have vision or balance issues, should not stick an arm or leg or walker into the path of a closing elevator door,” Greg Steele, associate professor of epidemiology in the department of public health at the Indiana University School of Medicine, said in a university news release.

He had another suggestion to improve rider safety. “Elevator open buttons should be made twice the size of the other elevator buttons so they are not hard to find by passengers who want to stop the door from closing on an approaching individual,” Steele said. “This would be very inexpensive to change because electronics don’t have to be altered, just the button. Certainly all newly installed or updated elevators should have such buttons.”

SOURCE: Indiana University School of Medicine, news release

New research suggests that people who are infected with both HIV-1, a strain of the AIDS virus, and herpes simplex virus type 2 could benefit in more than one way by taking a herpes drug called acyclovir. In addition to treating herpes, the medication appears to also slow the progression of HIV.

“While the HIV-disease ameliorating effect we have observed is modest, it could add one more tool to help people with HIV infection stay healthy for longer,” study co-author Dr. Jairam Lingappa, of the University of Washington, said in a news release from The Lancet.

The study, published online in the journal, analyzed what happened to almost 3,400 people in Africa who were infected with both diseases.

Half were assigned to take 400 milligrams of acyclovir twice a day, and the others took a placebo. Researchers tracked their progress for up to 24 months.

The risk of HIV progression was reduced by 16 percent in those who took acyclovir, the study found.

However, other research has suggested that acyclovir does not prevent transmission of HIV to heterosexual partners by people who take the drug, the scientists said.

The researchers said that other AIDS drugs would have a greater impact on the progression of HIV in those who were infected. But , acyclovir could be an option for people who had not progressed far enough to need antiretroviral therapy, they said.

SOURCE: The Lancet

Minority patients in New York City receive less specialized surgical care than white patients, according to a new study.

Specifically, Yale University researchers found that minorities were less likely to have an operation performed by surgeons, and were less prone to getting cared for at facilities that performed a large number of similar procedures.

The study included almost 134,000 people who had one of 10 procedures in which the number of such surgeries performed by a surgeon or at a hospital is known to influence patients’ short-term risk of death. Procedures included cancer, cardiovascular and orthopedic surgeries.

People in the study, who had their surgeries between 2001 and 2004, included almost 101,000 whites and17,500 blacks, over 4,200 Asians and more close to 11,300 Hispanics. For all 10 types of surgeries included in the study, white patients were more frequently treated by high-volume surgeons and at high-volume facilities than were minority patients.

“Even after adjusting for a broad range of relevant factors, compared with white patients, treatment at high-volume hospitals by high-volume surgeons was lower by 11.8 percentage points for black patients, 8 percentage points for Asian patients and 7 percentage points for Hispanic patients, on average, across the 10 study procedures,” wrote Andrew J. Epstein, of Yale’s School of Public Health, and colleagues.

One possible reason for the racial and ethnic differences could be that minority patients don’t have access to or are not familiar with information about surgeon/hospital quality, the researchers suggested.

“In addition to efforts to improve the quality of care among providers serving minority patients, policymakers and clinicians may be able to improve outcomes by encouraging minority patients and their surrogates to consider comparative performance information when choosing hospitals and surgeons,” the researchers concluded.

The study is published in the February issue of the Archives of Surgery.

Every hour spent watching TV each day may increase your risk of an early death from cardiovascular disease by as much as 18 percent, Australian researchers say.

What’s on the television is not the problem; it’s the time spent sitting while watching.

“This research provides another clear link between too much sitting and death from disease,” said lead researcher David Dunstan, head of the Physical Activity Laboratory at the Baker IDI Heart and Diabetes Institute in Victoria.

“The findings have serious implications for Americans and Australians when you consider that aside from sleeping, watching television is the behavior that occupies activity of four hours viewing a day,” he added.

The good news is research has shown that moving the muscles frequently throughout the day is one of the most effective ways of managing weight and protecting against disease, Dunstan added.

“We tend to underestimate the value of incidental, non-sweaty activity throughout the day when we are either not sleeping or exercising — the more you move, the greater the benefits for health,” he noted.

Dunstan pointed out that while obesity can add to these problems, even normal-weight people can have increases in blood sugar and cholesterol if they sit too much.

The report was released online Jan. 11 in advance of publication in an upcoming print issue of Circulation.

For the study, Dunstan’s team collected data on the lifestyles of 8,800 healthy men and women aged 25 years and older. In addition to lifestyle habits, the researchers tested participants’ cholesterol and blood sugar levels. Over more than six years of follow-up, 284 people died. Among these deaths, 87 were due to cardiovascular disease and 125 from cancer.

The participants were grouped into three TV-watching categories: those who watched less than two hours a day; those who watched two to four hours a day; and those who watched more than four hours a day.

The researchers found that every hour of daily TV watching increased the risk of dying from any cause by 11 percent. For cardiovascular diseases the increased risk was 18 percent, and for cancer it was 9 percent. Compared with those who watched less than two hours per day, those who watched TV for more than four hours each day had an 80 percent increased risk of dying early from cardiovascular disease and a 46 percent increased risk of dying from any cause.

The association between TV watching and death remained even when the researchers took into account risk factors for cardiovascular disease such as smoking, high blood pressure, high cholesterol, unhealthy diet, excessive weight and exercise.

Although the study was done in Australia, the findings are applicable to Americans, Dunstan said. Average daily television watching is about three hours in Australia and the United Kingdom, and up to eight hours in the United States, where many people are either overweight or obese, he noted.

“What we are now starting to understand is that the risks associated with sedentary behavior are not necessarily offset by doing more exercise,” Dunstan said.

“In other words, irrespective of how much exercise you do, if you sit watching television for four hours on a daily basis you still have a substantially increased risk of early death from all causes and a much greater risk of cardiovascular disease,” he said.

Experts agreed that to stay healthy you need to keep on the move.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that “regular exercise has been consistently demonstrated to result in improved cardiovascular health and lower risk of heart attacks, stroke, diabetes and premature death.”

He added that “reducing time spent inactive may be of benefit in reducing the risk of cardiovascular disease and should be considered as part of a comprehensive approach to improve cardiovascular health.”

David Bassett Jr., a professor of health and exercise science at the University of Tennessee, said that “when one looks at time trends in physical activity over the past century, it is clear that people are doing more structured, purposeful exercise than before.”

However, what has changed is that people are doing less walking, household chores and manual labor than in the past, he said. “We are also spending more time in sedentary activities like television watching, computer use and desk jobs,” Bassett explained.

“This study adds to a growing body of evidence that the amount of time spent in sedentary activity, as distinct from the amount of time spent in purposeful exercise, can affect your health,” he said.

SOURCES: David Dunstan, Ph.D., professor and head, Physical Activity Laboratory, Baker IDI Heart and Diabetes Institute, Victoria, Australia; David Bassett Jr., Ph.D., professor, health and exercise science, University of Tennessee, Knoxville; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Circulation, online

Researchers believe they know why light exacerbates the already debilitating pain of migraines, even in some blind people.

A report published online Jan. 10 in Nature Neuroscience reveals how visual and pain pathways in the brain converge to produce this phenomenon.

Although the findings are unlikely to help migraine patients in the near future, “this gives us a little better insight as to the theory and mechanism behind migraine,” said Dr. Michael Palm, an assistant professor of neuroscience and experimental therapeutics and internal medicine at Texas A&M Health Science Center College of Medicine, College Station, and director of the Parkinson’s and Headache programs at Texas Brain and Spine Institute in Bryan.

“We are making progress in understanding this phenomenon,” he said.

The Boston-based researchers report there are cells in a part of the brain called the thalamus “where information from the visual system and information from the pain system converge, and that anatomic convergence provides the first available explanation for how it could be that light makes pain worse,” added Dr. Richard Lipton, director of the Montefiore Headache Center and professor of neurology and epidemiology at Albert Einstein College of Medicine in New York City.

About 85 percent to 90 percent of all migraine sufferers report having photophobia, which is when light makes the pain worse, said study senior author Rami Burstein, a professor of anesthesia and neuroscience at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

“We had no clue in the world where in the world light and pain talk to each other in the brain,” Burstein said. “They have completely different pathways in the brain.”

“For light to make pain, those pathways would have to converge at some level,” Lipton noted.

To solve the paradox, the team studied 20 blind individuals, all of whom suffered from migraines. Six participants had no light perception at all and no functioning optic nerve. These individuals also experienced no photophobia.

The remaining 14 people could sense light and dark and also experienced photophobia.

“This told us that the optic nerve is critically needed in order to produce photophobia or exacerbation of the headache by light,” Burstein explained.

The researchers next discovered that a set of photoreceptors called melanopsin project onto neurons on the thalamus that also process pain signals.

“If we wanted to understand how light makes the pain worse, we needed to follow in the brain the pathways that lead from the eye into the brain using the third group of photoreceptors,” Burstein said. “That is the connection so at that point we shifted to animals.”

The thalamus is the brain’s sensory switchboard, receiving sensory signals from different parts of the body then redirecting them to various sensory, motor and cognitive areas of the cortex.

“We identified a new pathway in the brain that originates in the eye and goes to the brain areas where neurons are found that are active during migraine attacks,” Burstein said. “The light can increase the electrical activity in neurons that are active to begin with.”

The findings should put to rest any thoughts that patients exaggerate their sensitivity to light, Lipton said. “This provides an anatomic and physiological basis for a common experience — that light makes pain worse, not because you’re a whiner, but because there is an anatomic pathway that links the visual system to the pathway that produces head pain,” Lipton said. “That odd bit of clinical symptomatology has a firm basis in brain science.”

SOURCES: Rami Burstein, Ph.D., professor, anesthesia and neuroscience, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston; Richard Lipton, M.D., director, Montefiore Headache Center, and professor, neurology and epidemiology, Albert Einstein College of Medicine, New York City; Michael Palm, M.D., assistant professor, neuroscience and experimental therapeutics and internal medicine, Texas A&M Health Science Center College of Medicine, College Station, and director, Parkinson’s and Headache programs, Texas Brain and Spine Institute, Bryan; Jan. 10, 2010, Nature Neuroscience, online

Younger hunters, those 15 to 34 years old, are most likely to suffer serious injuries while using treestands, U.S. researchers have found.

The analysis of national data showed that about 46,860 treestand-related injuries occurred between 2000 and 2007. Injury rates were 55.7 per 100,000 for hunters aged 15 to 24 years, 61 per 100,000 for those aged 25 to 34 years, and 22.4 per 100,000 for those older than 65. Male hunters were twice as likely as females to be injured.

The most common types of treestand-related injuries were fractures, most likely in the hip or lower extremities, followed by injuries to the trunk, shoulder and upper extremities. While head and spinal injuries were less common, they were still significant, said the researchers at the University of Alabama at Birmingham Center for Injury Sciences.

“The elevated injury rate among younger hunters is significant, because debilitating injuries in younger people are far more devastating than for older individuals because of the potential long-term effects that create both physical and financial hardships for patients and their families,” study senior investigator Gerald McGwin Jr., associate director for research at the Center for Injury Sciences, said in a university news release.

Younger hunters may be more prone to injury because they’re more likely to take risks, have less exposure to safety information, and spend more time hunting than older hunters, McGwin said.

Safety education campaigns that recommend the use of safety harnesses and regular maintenance of treestands are among the ways of preventing injuries, the study authors noted.

“In addition to a broad safety education campaign regarding the use of treestands, the vulnerable young hunter population should be specifically targeted to decrease the number of preventable injuries,” McGwin said.

“Manufacturers of treestands can aid in prevention by providing more support for the hunters, particularly for the minimalistic stands such as climbing or ladder stands,” he added. “Although treestand-related injuries are a major cause of injury among the hunting population, they are preventable.”

The study was published online recently in the Journal of Trauma Injury, Infection and Critical Care.

A small study finds that even adults who know what medicines they take at home can’t accurately name the drugs they’re getting in the hospital.

Forty-four percent of patients believed they were receiving a medication in the hospital that was not actually prescribed. A patient who normally receives a blood pressure medicine, for example, may have thought the medicine was continued when, in fact, it was not.

Ninety-six percent of patients failed to recall one or more of the medicines that they had been prescribed during their stay, according to the study, which is published Dec. 10 in the Journal of Hospital Medicine.

“I don’t think that’s surprising at all. I think that that’s the natural consequence of the way in which hospital culture is designed. Patients are given their medicines and they take their medicines,” said study author Dr. Ethan Cumbler, an assistant professor of medicine at the University of Colorado Denver and director of the University of Colorado Hospital Acute Care for the Elderly Service.

“It’s actually a very different culture than what goes on in the outpatient setting, where patients actually are expected to know what they were taking, when they’re supposed to take it and for what reason,” he explained.

But the stakes are just as great — if not greater — in the hospital.

Say an antibiotic was prescribed. If the patient was allergic to a particular antibiotic and knew which drug he or she was about to receive, that person could play a role in averting the medication error before the drug was administered, Cumbler reasoned.

Or, a kidney transplant patient normally takes certain medicines to prevent rejection of the organ, but a dose might be accidentally skipped.

“If the patient knows what medicines they’re supposed to be getting and when, then they’re sort of one extra layer of protection to make sure that things go well,” he said. “If they don’t know what medicines they’re supposed to be getting or when, then they are dependent on hospital systems to work flawlessly, and the sad fact is that hospital systems in any hospital don’t work flawlessly.”

Kevin Colgan, corporate director of pharmacy at Rush University Medical Center in Chicago and immediate past president of the American Society of Health-System Pharmacists, was surprised that so many patients did not know what drugs their doctor has prescribed.

“It means that evidently it was not well-communicated with them what their plan of care was,” he said.

To catch medication errors, patients first have to know something about the medicines they’re taking. So for this study, Cumbler and colleagues surveyed 50 adults between the ages of 21 and 89 at the University of Colorado Hospital. All were knowledgeable about the medicines they were taking before admission.

Patients were then asked to write down all the medicines they thought doctors were prescribing for them while they were in the hospital. Researchers compared that list to the actual medication administration record — the list of medications that were being given to them in the hospital.

Medicines prescribed but not listed by the patient counted as errors of omission, while medicines listed by the patient but not actually prescribed counted as errors of commission.

On average, patients omitted 6.8 medications, most commonly antibiotics (17 percent), cardiovascular medications (16 percent) and antithrombotics (15 percent), the researchers found.

Only 28 percent of patients said they’d seen their hospital medication list, although 78 percent would like to have been given such a list, and 81 percent said it would improve their satisfaction with their care, the study authors noted.

“There are a group of patients that want to be more involved,” Cumbler noted, “and I think this raises the question, ‘How can we help them be more involved?’”

What’s more, for some patients, especially those who are older and cognitively impaired, more involvement may not be desirable and, in fact, may have disadvantages, he noted.

Colgan described a number of things patients can do to get more involved in their own medication management:
Keep a list of medications you take so you can provide an accurate medication history when you check into the hospital.
During your stay, ask: “What’s that name of the drug you’re giving me? What will it do? And what adverse drug reactions should I expect?”
Before discharge, learn about any medications you’ll be taking at home.