American Journal Of Medicine

Oct. 31, 2007 -- Scientists may be one step closer to understanding what happens in the brain when someone has an out-of-body experience.

A certain spot in the brain shows increased activity during out-of-body experiences, Belgian researchers report in The New England Journal of Medicine.

That part of the brain is where the angular gyrus, a brain region involved in self-awareness, meets the supramarginal gyrus, a brain area that affects the body's spatial orientation.

The Belgian scientists studied a 63-year-old man who had had an electrode implanted in his brain to treat tinnitus, in which people experience ringing or other unusual sounds in their ears.

Before getting the electrode implanted in his brain, the man had tried other tinnitus treatments, with no success.

The implant was supposed to use electrical stimulation to suppress tinnitus. But that didn't work.

Besides still having tinnitus, the man had out-of-body experiences during the electrical stimulation.

"His perception of disembodiment always involved a location about 50 cm behind his body and off to the left," write the scientists, who included Dirk De Ridder, MD, PhD, of University Hospital Antwerp.

The man didn't have near-death experiences and he couldn't "see" himself from outside his body during his out-of-body experiences, which lasted for an average of 17 seconds.

De Ridder's team stimulated the man's brain via the implanted electrode.

The man pressed a button with his right hand to indicate when his out-of-body experience began. Meanwhile, he got a brain scan using positron emission tomography (PET).

The scientists noticed a spike in activity in the junction of the angular gyrus and the supramarginal gyrus during the man's out-of-body experiences. But the researchers don't claim to understand everything about out-of-body experiences.

For instance, they don't know if the brain behaves differently when people when people have out-of-body sensations during near-death experiences or in other cases that aren't induced by electrical stimulation. And the findings are just a window on brain activity, not what people feel during out-of-body-experiences.

View Article Sources

SOURCES: De Ridder, D. The New England Journal of Medicine, Nov. 1, 2007; vol 357: pp 1829-1833. WebMD Medical Reference: "Understanding Tinnitus -- the Basics."

© 2007 WebMD, Inc. All rights reserved.

Flying to great-aunt Erma’s house for Thanksgiving? Or taking a leisurely wintertime cruise along the shores of the Mexican Riviera? Boost your chances of healthy travel by taking a few preventive steps. That way, you’ll cut your risk of catching cold and flu from other plane passengers. And you won’t be confined to your cabin on the cruise ship, battling a nasty case of gastroenteritis while other passengers are off enjoying the sights.  

Flu Season Coming

As winter approaches, "the concern right now is influenza," says William Schaffner, MD, a professor at Vanderbilt University School of Medicine and vice president of the National Foundation for Infectious Diseases.

Many people worry that they’re more susceptible to cold and flu germs while sitting inside a plane for hours with hundreds of other travelers. But there’s no strong evidence to show that we’re more vulnerable in the air than on the ground, says Gary Brunette, MD, MS, a medical epidemiologist who serves on the CDC Travel Health Team. "Certainly, [on a plane] people are in close contact for long periods of time, and one would think that there’s a higher likelihood of coming in contact with somebody who’s sick. But there’s nothing to show that it happens any more often than in a normal working environment."  

To trap viruses, bacteria, and fungi most newer airplanes filter the air with HEPA filters similar to those used in hospital respiratory isolation rooms, according to the CDC.

"The planes have very good filtration systems, and they also introduce fresh air into circulation. So any microbes that might be in the air would possibly be filtered out pretty quickly," Brunette says.

Still, filtration isn’t foolproof. "It’s not 100% air exchange all the time, just as it is not in any of our buildings. The fresh air intake is incremental over time, so there’s a fair amount of air sharing over time in the airplane," Schaffner adds.

And you can still catch a cold or the flu if someone near you coughs or sneezes infected droplets that directly enter your eyes or nose. Or you might touch a contaminated armrest or tray table and transfer the germs to your eyes or nose by hand.

Also, the air within planes is usually very dry, with 10%-20% humidity, according to the CDC. When your mucous membranes dry out as a result, you’re more susceptible to infection.  

So what can you do to stay one step ahead of cold and flu germs while flying? Experts offered these tips.  

1. Wash hands frequently. To cut down on viruses that hitch a ride on your hands, "frequent hand washing or using hand gels is very important," Schaffner says. An alcohol-based gel hand sanitizer that contains 62% ethanol does the best job at killing germs. After you wash with soap and warm water, you can use some gel to get your hands even cleaner.  Avoid hand contact with your face. 

2. Stay hydrated. "Keep up your fluids," Schaffner says. Avoid or limit caffeine and alcohol, because both can cause dehydration. If you want to indulge in an alcoholic drink or a cup of java, make sure you drink plenty of water before and during the flight. You can also keep your eyes and nasal passages moist with saline eye drops and saline nasal spray.

Flu Season Coming continued...

3. Ask a flight attendant for new seating if a passenger nearby is coughing, sneezing or appears ill.  "Proximity matters," says Schaffner, who once developed a cold within a couple of days after sitting by a sneezing, sniffling plane passenger. "Being very close to the source -- in the same row or two seats in front or back -- those are the folks who are at greatest risk," he says. "After that, the risk tails off very remarkably."

The reason? Large aircraft are designed so that air doesn’t blow from the front to the rear of the cabin, but instead, air circulates "segmentally,"  from ceiling to floor.  "You’re really in your own kind of air zone, with about two rows in front and two in back,"  Schaffner says.

The longer you’re seated near an ill passenger, the greater your risk of exposure, Schaffner adds. "The longer you’re together, the more apt you are to talk with each other, perhaps even touch the same things, and the longer you share the same airspace."

4. Consider getting a flu shot before you travel. Some experts like Schaffner worry that this year’s flu season may be harsher than in the last three years.

It takes two weeks to get maximum immune protection from the flu shot,  Schaffner says. But getting the shot late can still confer some protection. "From the moment you get the inoculation, your immune system begins to rev up in response to the vaccine."

"Although colds are a bother," Schaffner adds, "influenza is the viral infection that will put you into the hospital. It’s the one that can get complicated by pneumonia, it’s the one that year in and year out, on average, causes 36,000 deaths each year. It’s the serious one. Get vaccinated. Protect yourself. Then you’ll be a good citizen on the airplane and at home. You won’t transmit influenza to anyone else, either."

What Doesn’t Help?

Does wearing a mask help to protect you from colds and flu on planes? "I think that’s going a little overboard. I don’t think that’s going to make a difference," Brunette says. "It doesn’t seem realistic to me that people should be wearing masks on an airplane."

Schaffner doesn’t believe that blankets or pillows transmit germs, either. "It’s never been shown, and it’s highly unlikely," he says. If so, "we would be in a hard place. We would be anxious about staying at hotels and being in any kind of group circumstance, if that were the case." 

What about taking popular over-the-counter products, such as Airborne? This herbal cold remedy claims to help prevent colds by boosting the immune system. Its ingredients include vitamin C, zinc, and echinacea.

No need to buy these remedies, according to Schaffner. He says that he's "skeptical" of these types of products because they lack good studies to show effectiveness. "The quip is: 'In God we trust. All others must provide data.'"

Battling Noroviruses on Cruise Ships

If you’re on a cruise, don't ruin your trip with much concern about germs, experts say. But realize that in the semi-confined quarters of a cruise ship, contagious illnesses can spread fast, particularly noroviruses. These viruses cause what many call the "stomach flu." Typical symptoms of nausea, vomiting, diarrhea, and stomach cramping last for one to two days, according to the CDC.

Battling Noroviruses on Cruise Ships continued...

Noroviruses flourish in the winter, but also year round, says Jaret Ames, chief of the CDC Vessel Sanitation Program, which partners with the cruise industry to promote sanitation and minimize the risk of gastrointestinal illness on ships.

Since 2001, more outbreaks of gastrointestinal illness have been reported, including those from noroviruses, according to the CDC’s web site. The reasons? More passengers, more ships and an average cruise length of seven days -- ample time for people to mingle and come in contact with infectious germs. However, the risk of gastrointestinal illness is still small: less than 1% during an average week-long cruise, the CDC says. 

Once noroviruses contaminate surfaces, some may remain after routine cleaning. "If anything, the importance of hand washing is greater than ever on a cruise ship," Schaffner says. "You may think you’re in an idyllic, somewhat protected environment -- you don’t have to be as careful. Au contraire. We’d like you to be even more careful than you are at home."

Passengers can fall ill if they touch objects or surfaces contaminated with norovirus -- among them, doorknobs, railings, elevator buttons, or counters -- and then place their hand in their mouth. People can also be infected if they have direct contact with a sick person or consume food or drink that is contaminated with norovirus. If an ill person vomits or has diarrhea in a whirlpool bath or swimming pool, others who come in contact with the water can be infected, too. 

Some tips to reduce the risk of gastrointestinal illness on a cruise ship:

• Wash your hands for at least 20 seconds before eating or smoking. Also wash hands after using the restroom, returning to your cabin, changing a diaper, helping a sick person, or touching surfaces that a lot of other passengers have touched, such as doorknobs and railings. 
• After you’ve washed your hands in a restroom, dry your hands with a paper towel and use the towel to turn off the faucet and open the door. 
• Washing with warm water and soap is best, but if you can’t do so during an excursion, use an alcohol-based gel hand sanitizer that contains 62% ethanol.  
•  Notify cruise staff about sick passengers.

Oct. 31, 2007 -- More than a third of adults living with epilepsy reported being too physically disabled to hold a job in a new survey, and one in four said they did not take medication even though they had active seizures.

Based on the results, researchers with the CDC and the UCLA School of Public Health estimated that about 1% of Californians, or 300,000 residents, have a history of epilepsy and 0.7%, or 182,000, have active seizures or take medicine to control seizures.

People with epilepsy had more physical and mental health problems than people without the disorder.

The study, published in the October issue of the journal Epilepsia, was conducted to better understand the burdens of adults living with epilepsy in the community, CDC public health advisor and study co-author Rosemarie Kobau, MPH, tells WebMD.

"We confirmed that the burden of impaired quality of life is substantial, as is the burden of unemployment and poverty," Kobau says. "It is clear that adults with epilepsy need better access to specialized medical care to control seizures and the effects of living with seizures."

Living With Epilepsy

The findings were derived from data collected in the 2003 California Health Interview Survey (CHIS), the nation’s largest state health surveys and one of the most comprehensive.

Among the adults with epilepsy, 36% of those with active epilepsy reported being physically disabled or unable to work, compared with 5% of the population at large. Twenty-two percent of people who were ever told they had epilepsy rated their overall health as poor, compared with 4.5% of the general population.

And 45% of those ever told they had epilepsy reported having annual household incomes of less than $25,000, compared with 29% of the general population.

The researchers also found a greater percentage of people with a history of epilepsy or who were having active seizures to be active smokers and to never walk for transportation or exercise.

Adults with recent seizures reported between nine and 12 days during the previous month of impaired physical or mental health, or days when their daily activities were limited, compared with only two to four days among people without the disorder.

Many Patients Aren’t Treated

Among people who reported still having seizures, 26% also said they took no medications to control them.

CDC epidemiologist David J. Thurman, MD, says it is clear from the finding that a substantial minority of adults with epilepsy are not getting optimal or even minimal care.

"We think that two-thirds of patients can be completely controlled, meaning no seizures at all, with appropriate medications and that the remaining one-third could have the frequency of their seizures greatly reduced," he tells WebMD.

While most adults with active epilepsy reported having health insurance and having access to regular care, Thurman says the responses may not reflect the true picture of what is going on.

"Our concern is that access issues may keep many people from getting optimal care with appropriate medications," he says. "People who receive care only from hospital emergency departments are likely to run out of medication from time to time. This is not optimal care."

View Article Sources

SOURCES: Kobau, R., Epilepsia, October 2007; vol 48: pp 1904-1913. Rosemarie Kobau, public health advisor, Division of Adult and Community Health, CDC, Atlanta. David J. Thurman, MD, medical epidemiologist, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta.

© 2007 WebMD, Inc. All rights reserved.

Oct. 31, 2007 (Los Angeles) -- Older men with prostate cancer who chose treatment with radiation seed implant therapy or surgery cut their risk of dying of the disease by more than half, compared with those who opt for close observation, researchers report.

"This is the first time it’s been shown that seed implants are better than watchful waiting in terms of survival," researcher Ester H. Zhou, MD, PhD, of Case Western Reserve University School of Medicine in Cleveland, tells WebMD.

The study involved about 11,000 men 65 and older with newly diagnosed cancer that was confined to the prostate or that had only spread to nearby tissues.  About 30% chose a strategy of "watchful waiting," which involves close monitoring for tumor growth.

Over the next seven years, those who got seed implants within six months of being diagnosed were about 55% less likely to die of the cancer than those who chose watchful waiting. Surgery to remove the prostate cut the risk of dying of the disease by up to 75%.

The findings were presented at the American Society for Therapeutic Radiology and Oncology’s (ASTRO) annual meeting.

To Treat or Not to Treat

There has been a long debate in the medical community about the value of treatment to destroy cancer cells vs. watchful waiting, also known as active surveillance.

Because prostate cancer often grows so slowly it may never become life-threatening, many of these men, particularly older men, may die of causes other than the cancer. But in some men, the cancer will spread beyond the prostate without treatment. Then it may no longer be curable.

Treatment usually involves surgical removal of the prostate, external beam radiation therapy, or radiation seed implants.

In external beam radiation therapy, a beam of high-dose radiation is aimed at the prostate to kill cancer cells.

In radiation seed implant therapy, or brachytherapy, surgeons implant tiny radioactive seeds into the prostate gland. The seeds deliver high-dose radiation directly to the prostate for a predetermined length of time.

Watchful waiting consists of close monitoring with periodic digital rectal exams, biopsies, and PSA (prostate-specific antigen) blood tests. Rising PSA levels can be a sign of prostate cancer spread in men with early cancer.

Watchful Waiting Still Good Option

Anthony Zietman, MD, a prostate cancer specialist at Harvard Medical School and a spokesman for ASTRO, says that the men who weren’t treated in the study may have had other conditions that prevented them from getting active treatment.

"These men may have been sicker to begin with, so you can’t really conclude that active treatment is better," he tells WebMD.

"Active surveillance is especially important for men with other conditions such as heart disease that could kill them within a few years anyway," Zietman says.

For otherwise healthy men, active surveillance is also "a perfectly acceptable option," he adds.

"If you watch men closely and the cancer proves to be a tiger, you’ll know in the first few years and you can still treat them to cure before it’s too late.

"If it’s a pussycat, the PSA will never go up, a biopsy a year or two later will show no changes, and you can avoid treatment. That’s a beautiful thing," Zietman says.

Phillip M. Devlin, MD, a cancer specialist at Harvard Medical School and a spokesman for ASTRO, says that he thinks any man with prostate cancer who is in otherwise good health should opt for active treatment, regardless of age.

Active treatment is the only way to ensure a cure, Devlin tells WebMD.

View Article Sources

SOURCES: American Society for Therapeutic Radiology and Oncology (ASTRO) 49th Annual Meeting, Los Angeles, Oct. 28-Nov. 1, 2007. Ester H. Zhou, MD, PhD, department of epidemiology, Case Western Reserve University School of Medicine, Cleveland. Phillip M. Devlin, MD, ASTRO spokesman; assistant professor, department of radiation oncology, Harvard Medical School. Anthony Zietman, MD, ASTRO spokesman; department of radiation oncology, Harvard Medical School.

© 2007 WebMD, Inc. All rights reserved.

Oct. 31, 2007 -- Extra pounds mean extra cancer risk -- even if you're not overweight.

The finding comes from a vast international research effort headed by a panel of experts in obesity, nutrition, cancer, public health, and epidemiology. Funding came from the nonprofit World Cancer Research Fund.

The panel's detailed, 537-page report -- Food, Nutrition, Physical Activity, and the Prevention of Cancer -- can be summed up in one sentence, says panel member W. Philip T. James, MD, DrSc, chairman of the London-based International Obesity Task Force.

"The single message is how much obesity affects cancer risk," James tells WebMD. "The message is absolutely clear as a bell: The relation of cancer to obesity is so robust, it is going to rank close to the smoking problem in America pretty soon."

High-Normal Weight Still Risky

Here's worse news: You don't have to be obese to be at increased risk of cancer.

"The risk is lowest not in the crude normal-weight range. Actually, it is better to be slim, to be lean," James says. "This is what the science shows. Even if you are fortunate in being in the upper-normal range of body weight, you still have cancer risk if you are not doing physical activity."

James says the panel went to great lengths to ensure that their findings were based solely on scientific evidence. To this end, researchers working on the project reviewed every published study on weight and cancer to come up with the 7,000 studies on which they base their conclusions and recommendations.

"You could say, 'We've heard this before.' But you never had this kind of statement backed up by mathematical analysis of 7,000 studies," James says. "This is not a report from a select group of people who have their own biases. It has been done in a three-tier system to make sure it is as rigorous and up to date and savagely analyzed as any group could do."

The panel didn't stop at analyzing cancer risk. It also came up with 10 recommendations for cutting risk.

10 Ways to Cut Cancer Risk

"Risk isn't fate. The evidence clearly shows that risk can be changed," panel member Walter J. Willett, MD, PhD, professor of medicine at Harvard University, said in a news release.

To this end, the panel came up with 10 recommendations for cutting cancer risk:

1. Be as lean as possible within the normal range of body weight. Not everyone can become lean, but everyone can stop gaining weight. "Don't put an inch on your waistline or a pound on the scale," James says.
2. Be physically active as part of everyday life. Get at least 30 minutes of moderate activity, such as brisk walking, every day. And cut back on couch-potato activities such as watching television.
3. Eat fewer energy-dense foods. Avoid sugary drinks. Cut way back on fast food -- avoid it if possible.
4. Eat mostly foods of plant origin -- at least five portions (14 ounces) of various nonstarchy vegetables and fruits every day. Eat unprocessed grains and/or legumes (beans) with every meal. Limit refined starchy foods.
5. Limit intake of red meat -- beef, lamb, and pork -- to less than 18 ounces a week. Avoid smoked, cured, or salted meats.
6. Limit alcoholic drinks. Zero alcohol is best for cancer prevention. But as moderate alcohol has heart benefits, limit intake to no more than two drinks a day for men and one drink a day for women.
7. Limit sodium consumption to 2.4 grams per day. Avoid salty foods. And watch out for imported foods that may be made from moldy grains -- they contain cancer-causing aflatoxins.
8. Dietary supplements are not recommended for cancer prevention. "We looked at this issue in great detail," James says. "The current evidence that the use of supplements can lower cancer rates is explicitly not there."
9. Breastfeeding protects both the mother and the child against cancer. Aim to breastfeed infants exclusively up to age 6 months, and supplement baby food with breastfeeding thereafter.
10. Cancer survivors should receive nutritional care from a qualified professional. The recommendations for diet, healthy weight, and physical activity are particularly important for cancer survivors.

View Article Sources

SOURCES: World Cancer Research Fund and American Institute for Cancer Research: Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, 2007. W. Philip T. James, MD, DrSc, FRCP, FRSE, chairman, International Obesity Task Force, London. News releases, American Institute for Cancer Research.

© 2007 WebMD, Inc. All rights reserved.