New Sunscreen Promises More Protection
A new sunscreen just approved by the U.S. Food and Drug Administration promises protection for the full range of both ultraviolet A and B rays.
However, that doesn't mean people can disregard standard advice to avoid the sun and still protect their skin, experts stressed.
Anthelios SX, made by L'Oreal, is new in that it contains ecamsule (Mexoryl), an agent that shields skin from short-wave UVA rays -- something sunscreens currently available in the United States are unable to do. The product will be available to consumers this fall.
"There is nothing like this in the U.S.," said Dr. Darrell S. Rigel, a clinical professor of Dermatology at New York University and advisor to L'Oreal. "Basically, it lasts longer, and it gives better protection against UVA."
But a better sunscreen doesn't change the basic rules of skin protection.
"No sunscreen completely protects people against UVA radiation," said FDA spokeswoman Kimberly A. Rawlings. "This product and other sunscreens reducing UVA exposure should be used in conjunction with limiting time in the sun and wearing protective clothing. FDA has not compared this product with other sunscreens capable of reducing UVA exposure."
According to experts, UVB causes sunburn and skin cancer, while UVA causes aging and some skin cancers. Most sunscreens currently contain two active ingredients: avobenzone and octocrylene. Anthelios SX, which has an SPF of 15, contains those compounds as well, but adds in Mexoryl. Sunscreens containing Mexoryl have been available in Europe, Asia and Canada since 1993.
Why it has taken so long for the FDA to approve the product is not clear.
Rigel noted that most UVA protections are not chemically stable and breakdown quickly. "What Mexoryl does is stabilize them and make them last longer," he said.
While the retail price of Anthelios SX is not known, four-ounce sunscreens containing the same ingredients sell elsewhere for about $40.
One expert believes the best sun protection combines physical sun blocks with chemical ones.
"A lot of sunscreens break down in the sun. That's the dirty little secret that no one talks about," said Dr. Jeffrey C. Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine. "In most sunscreens, there are both chemical and physical sun blocks."
Sun blocks such as zinc oxide and titanium physically block the sun from coming in, Salomon said. "Chemical sun blocks break down rapidly in the sun," he said. "You want a sunscreen that blocks both UVA and UVB, that has a high SPF, and that is waterproof."
"It's best to use a sunblock that contains both physical as well as chemical blockers," Salomon advised. Salomon recommends putting a shot-glass-size amount of sunblock on each arm and leg and on the chest and back. In addition, it should be put on at least 30 minutes before going into the sun and reapplied every two hours.
Patient Obesity Is Obscuring Medical Scans
In yet another example of how obesity is playing havoc with Americans' health, a new study finds that the number of inconclusive diagnostic imaging exams has doubled in the last 15 years -- a phenomenon experts attribute to all those extra pounds.
"Obesity is affecting the ability to image these people. We're having trouble finding out what's wrong," explained Dr. Raul N. Uppot, lead author of the study, and an assistant radiologist at Massachusetts General Hospital and an instructor in radiology at Harvard Medical School, both in Boston.
"When they come to the hospital, people are so concerned about the disease they have that they don't realize that being obese could hinder the ability to deliver health care," he said.
In fact, it could hinder it considerably, given medicine's ever-growing reliance on imaging technology such as X-rays and ultrasound.
"In the past 10 years or so, medicine has become so dependent on imaging," Uppot said. "Instead of doing very meticulous clinical examinations, a lot of doctors now rely on CT scans, ultrasounds, etcetera, to tell them what's happening inside the body. What happens when you're too big to fit on a table? Or you can fit on a table but the image is poor quality?"
The new study is published in the August issue of the journal Radiology.
The findings did not come as a surprise to outside experts. "The study shows more systemically what all of us felt was true anyway," said Dr. Levon Nazarian, professor of radiology and vice chairman for education at Thomas Jefferson University Hospital, in Philadelphia.
"Patients may not realize that there are two aspects to being overweight, one of which is the increased risk of a number of different diseases," Nazarian added. "They may not realize that once they actually get sick, their size is going to limit the ability to even tell them what's wrong."
According to official estimates, about two-thirds of adult Americans are overweight or obese, and the effect on individual health and the health-care system is considerable. Obese people are more likely to develop illnesses such as cancer, diabetes and heart disease. Hospitals have also had to "super-size" their wheelchairs and beds to accommodate the new generation of sick and overweight Americans.
To assess the effect of obesity on the quality of imaging exams, the researchers reviewed all radiology records from tests performed at Massachusetts General Hospital between 1989 and 2003. Specifically, they were looking at incomplete exams due to patient size.
"We looked at people who were able to fit on the imaging equipment and get the scan," Uppot said. "When radiologists read the film, they had trouble interpreting the film because the quality of the image was not very good because of [the patient's] size."
In 1989, 0.10 percent of inconclusive exams were due to patient size. By 2003, that number had almost doubled to 0.19 percent.
"What was most alarming was the increase," Uppot said. "The number itself was small."
Difficulties varied according to the type of imaging. By 2003, abdominal ultrasounds exhibited the most difficulty in giving a proper diagnosis (1.9 percent), followed by chest X-rays (0.18 percent), abdominal computed tomography (CT), abdominal X-rays, chest CT and magnetic resonance imaging (MRI).
Ultrasound sends high-frequency sound waves through the patient, where they bounce off internal organs and come back, like a submarine's sonar. But the thicker the fat, the less able the waves are to penetrate. A similar phenomenon is at work with X-rays, the study authors said.
CT scans and MRI have a different problem -- weight limitations of the table that holds the patient and the size of the opening on the imager.
"Many manufacturers have started to address the issue by increasing table weights," Uppot said.
The weight limit for CT scans has been increased from 450 pounds to 550 pounds. For MRI, the weight limit went from 350 to 550 pounds, he said.
But that doesn't solve the bigger problem. "We are now able to fit people on the machine. Then the issue is, what do you do?" Uppot said.
The imaging power can be increased on standard X-ray and CT machines, but this leads to an increase in radiation dose as well, he said.
"What we're realizing is that not only do obese people have increased health problems but our ability to deliver quality diagnostic imaging to them is limited," Uppot said. "A large patient can no longer walk into a hospital and say, 'I want the best quality care, let me get imaged and operated on.' If you're that big, there will be issues."
The problems don't stop with diagnosis. "It puts stress on personnel," said Dr. Jorge Guerra, professor of radiology at the University of Miami Miller School of Medicine. "X-ray personnel will be more prone to injury. We receive patients who are 400, 500, 600 pounds. It paralyzes our ability to provide care for other patients. We need special equipment, special beds, the imaging is lower quality so it takes longer to complete." Size also affects interventional radiology, or procedures meant to treat a patient, which is Guerra's specialty.
And as the University of Miami builds a new hospital, it is having to take into account that more than one-third of the patient population will be more than 350 pounds, he said.
Proteins Hold Clues to Chronic Pain
Low blood levels of two anti-inflammatory proteins could be key to chronic pain, researchers report.
Low concentrations of two cytokines, IL-4 and IL-10, were found in patients with chronic widespread pain, according to a German study published in the August issue of Arthritis & Rheumatism.
Cytokines are proteins that act as messengers between cells.
The study included 40 patients who'd received intravenous immunoglobulin (IVIG) as a novel treatment for pain that hadn't responded to standard therapy and another 15 patients who did not receive IVIG. The study also included a control group of 40 healthy people.
Blood samples were collected from all the study volunteers, and the pain patients were asked to rate their pain, fatigue, mood and cognitive function.
Compared with the control group, the 40 pain patients had significantly lower levels of IL-4 and IL-10. The 15 patients in the second group had similar results, although the difference in their levels of IL-10 compared to people in the control group was not statistically significant.
Several factors may be involved in low levels of these cytokines and how they influence pain, the study authors said. They noted that previous studies have shown that IL-10 reduces sensitivity to pain and that IL-4 can also dull pain response.
Genetic variations in different cytokine genes are associated with certain diseases. For example, IL-4 gene variations are associated with asthma, Crohn's disease and chronic polyarthritis, the researchers said.
"The low levels of IL-4 and IL-10 we observed in the patients with chronic widespread pain might therefore also be caused by genetic alterations either in the cytokine genes themselves or in regulatory elements, although other factors may be involved," they explained.
Health Tip: Considering a Chiropractor?
Chiropractors usually treat musculoskeletal conditions, which include pain in the bones, joints, muscles, tendons or ligaments.
According to the U.S. National Center for Complementary and Alternative Medicine, one of the most common conditions treated by chiropractors is chronic lower back pain. Other conditions that may be suited to chiropractic include headaches, neck pain, arthritis, sports-related injuries and muscle strains.
Chiropractors typically treat patients with one or more "adjustments" -- by applying a controlled, sudden burst of force on a joint to increase mobility and decrease pain.
Other forms of chiropractic therapy include use of heat, ice, therapeutic massage and rehabilitative exercise.
Chiropractors are regulated by each state, and most require the practitioners to earn continuing education credits to maintain their licenses. Chiropractors are not licensed in any state to perform major surgery or prescribe drugs.
Health Tip: About Tubal Ligation
Tubal ligation is a form of female sterilization, often referred to as having your "tubes tied."
In this procedure, a woman's fallopian tubes are blocked to prevent fertilization of a woman's egg by a man's sperm. The woman is typically able to go home a few hours after the procedure.
According to the U.S. National Library of Medicine (NLM), risks associated with tubal ligation include bleeding, infection and damage to other organs during surgery. If the fallopian tubes are not completely sealed off, the potential for pregnancy still exists.
Although the procedure sometimes is reversible, women who have tubal ligation should consider it a permanent form of sterilization, the NLM says. Only 50 percent to 80 percent of women eventually become pregnant after tubal ligation reversal, it adds.
Health Tip: Addressing Acne
Acne is a problem for many teens -- and for some adults, as well. These clusters of pimples and blemishes usually occur on the face but also on areas such as the back and shoulders.
While the causes of acne aren't fully understood, heredity and hormonal changes are thought to be prime culprits. Many people believe that greasy foods or fatty sweets such as chocolate may cause an outbreak, but the National Institute of Arthritis and Musculoskeletal and Skin Diseases says that's a myth. Another common myth is that dirty skin causes acne, the institute says.
Other factors, while they don't cause acne, can make it worse. These include use of oil-based cosmetics, stress, tight clothing or hats, and abrasive facial cleansers. The institute warns against popping, squeezing or picking at acne, which are likely to worsen the skin's appearance.
Health Tip: Using Generic Drugs
As the cost of prescription drugs continues to soar, patients and doctors alike are turning to generic alternatives. But are they the same?
Yes, says the U.S. Food and Drug Administration. Generics are chemically identical to their brand-name counterparts, and are equally safe and effective.
Like brand-name drugs, prescription generics must also be approved by the FDA.
Brand-name drugs are more expensive because the manufacturers must pay hefty fees for creating and patenting new drugs, says the FDA. A new drug is protected by patent for a number of years, but once that patent expires, other drugmakers are able to produce the bioequivalent generic at a lower cost.
If you're currently taking a brand-name prescription drug, ask your doctor or pharmacist about whether there's a generic alternative.
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