806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years. That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn, “Every country that has developed a registry has been able to reduce failure rates significantly.” Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

With the number of U.S. seniors with Alzheimer’s skyrocketing, much research is underway to determine how to stave off this mental deterioration, keeping people physically and mentally sound as they age.

A recent report in the December Journals of Gerontology: Medical Sciences found that older women who volunteered for Experience Corps – tutoring elementary school children, had increased brain activity in regions important to cognitive function after a period of six months.

What was exciting about these results, is that it shows a direct correlation between community-based programs and improved cognitive functions. Until now, much study has been done on the brain-boosting power of cognitive, physical and social leisure activities, but little was known about the effectiveness of community-based service.

“This finding is best captured by a personal observation from one of the volunteers, who stated that ‘it [Experience Corps] removed the cobwebs from my brain.” wrote Michelle C. Carlson, of Johns Hopkins Bloomberg School of Public Health.

The seventeen women enrolled in this study were low-income African-Americans with little education, aged 65 and older, and deemed high-risk for cognitive declines, based on a mental state evaluation. Eight of the women actually participated in the tutoring program in Baltimore elementary schools, while the other nine served as the control.

Via functional magnetic resonance imaging, researchers assessed neural activity in the brain prior to the volunteering experience, and again after six months. Based on the fMRI assessment, the women who actively participated in Experience Corps saw improvements in mental function compared with those in the control group.

There you have it, doing your civic duty and assisting others is highly rewarding to all participants. These meaningful activities seem to be more enriching than highly stimulating activities performed alone

There is a definite association between “covert coping” in the face of unfair treatment in the workplace. Men who tend to walk away from conflict at work could be setting themselves up for a myocardial infarction and cardiac death.

In a prospective study of Swedish workers, those who used “covert coping” techniques when they felt they had been unfairly treated were more likely to have an MI or die of ischemic heart disease. Constanze Leineweber, PhD, of Stockholm University in Sweden, and colleagues in the Journal of Epidemiology and Community Health, expanded on research indicating that covert coping – or walking away from a conflict and dealing with the anger “indirectly and introvertly” – increases cardiovascular risk factors. They cautioned that the study didn’t pin down a causal relationship between covert coping and cardiovascular disease. Instead, they said, it raises “an interesting hypothesis, which needs to be confirmed or refuted by future studies.” The researchers analyzed data from a long-running prospective cohort study in Stockholm, the Work, Lipids, and Fibrinogen study, dubbed WOLF for short.

Covert coping was measured by questionnaire, in which the participant was asked about how he or she dealt with unfair treatment from either a boss or a fellow worker. The questionnaire did not measure whether or not the participant experienced unfair treatment at work nor how often covert coping mechanisms were used.

The participants were asked whether they sometimes, often, seldom, or never:

Let things pass without saying anything
Walk away
Feel bad — developing a headache, for instance
Get into a bad temper at home

The results yielded a covert coping score that could range from 8 to 32; the researchers stratified covert coping as low if the score was 8 through 14, medium if it was 15 through 18, and high if it was 19 or more.

They also categorized immediate responses – to the first two options – as low, medium, or high.

Compared with those who had low covert coping scores, the researchers found:

When the unfair treatment came from a boss, those who sometimes or often walked away were three times as likely to have an MI or ischemic death. (The hazard ratio was 3.05, with a 95% confidence interval from 1.23 to 7.58.).

Letting things pass showed a nonsignificant trend to more cardiovascular outcomes for those who did so more often. When the unfair treatment came from a co-worker, the pattern was similar, except that those who said they seldom walked away also had a significant risk for cardiovascular outcomes. The hazard ratio for those who seldom walked away was 4.08, compared with 4.45 for those who said they did so sometimes or often. Both ratios were statistically significant. Neither of the delayed reactions had any association with cardiovascular outcomes – feeling bad or becoming ill-tempered at home – either for unfair treatment from a boss or a co-worker.

Future research, Leineweber and colleagues said, should look at “whether interventions designed to reduce covert coping would alter risk of myocardial infarction and cardiac death.”

Everyone knows that breakfast’s good for you. How good just became a little clearer. A team of British Researchers have pinpointed scientifically how your brain craves high calorie food when you skip your morning meal.

Utilizing MRI’s of the brain, they studied 20 healthy, thin people who went without breakfast that day. When those people were exposed to an array of food photos, both high and low fat, their brains become more active at the sight of the high-calorie options than when they saw low calorie foods. When this test was repeated on another day 90 minutes after they ate breakfast, there was no significant difference in their brain’s reaction to different caloric foods

Corresponding to the MRI findings, were ratings of appealing food pictures. After skipping breakfast, participants found calorie laden food choices to be much more tempting. After eating, however, the group did not show a strong preference for the high-calorie foods.

According to Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London, “Our results support the advice for eating a healthy breakfast as part of the dietary prevention and treatment of obesity, When people skip meals, especially breakfast, changes in brain activity in response to food may hinder weight loss and even promote weight gain.”

As the Baby Boomer generation ages, there is a swelling populaton of people suffering from osteoarthritis. Arthritis pain seems to go hand in hand with insomnia, with joint pain keeping awake 60% of those with osteoarthritis

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

By Nechama Drillick

Will those stinging booster shots be a thing of the past, fading into oblivion together with walkmans, analog TV and Kodak film? With the advent of a new Band-aid-like painless patch lined with microneedles, our grandchildren may never know the ouch of a needle at an annual checkup.

Scientists have developed a patch that can simply be applied to a patient in place of using hypodermic needles, a big boon to diabetics and others suffering from diseases that require frequent pricks. This was presented at the 238th National Meeting of the American Chemical Society in Washington, D.C.

“If you can move to something that’s as easy to apply as a Band-Aid, you’ve now opened the door for people to self-administer their medicine without special training.” said Mark Prausnitz of Georgia Tech, one of the developers.

This development was enabled by advances in the electronics industry, which has microminimized all forms of technology – opening the door for the creation of needles that are only a few hundred microns long, about the width of a few strands of human hair.

Researchers are hopeful that the patch which will initially be used in a clinical setting could ultimately be self applied at home, replacing many other needle injections – even flu shots!

By Nancy Smith

Today’s medical announcement would be astounding if it wasn’t almost intuitive; the results clearly demonstrate that lifestyle behaviors do contribute to stroke risk independently of the intermediate risk factors.

We are all aware that the following four behaviors are beneficial to one’s health. Physical activity, moderate alcohol consumption, no smoking, and the daily consumption of five or more servings of fruits and vegetables a day can only have a positive impact. The strength of that impact was recently bolstered by a defining EPIC (European Prospective Investigation of Cancer) study conducted in England.

20,040 men and women ages 40 to 79 had a physical exam and completed a detailed health and lifestyle questionnaire upon enrolling in the study. This data determined which participants smoked, drank, were physically active, and whether they ate their fruits and vegetables. The risk of stroke for those who did not practice any of the above mentioned behaviors increased twofold compared with individuals who adopted all four.

“These results provide further incentive and support for the notion that small differences in lifestyle can have a substantial potential impact on risk,” the authors concluded.