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Many different factors — from being obese to using vibrating hand tools to having little authority to make decisions in the workplace — seem to influence a person’s risk of developing certain work-related injuries, French researchers report.

Aging, along with on-the-job constraints, “drastically” increased workers’ risk of such injuries, Dr. Yves Roquelaure of the Universite d’Angers, the study’s author, noted in an email to Reuters Health. Given the aging of the workforce and “work intensification” going on in many countries, both industry and government should step up their efforts to prevent these injuries, Roquelaure advised.

The investigators surveyed 3,710 French workers, 472 of whom had been diagnosed with at least one upper extremity musculoskeletal disorder — a collective term for conditions affecting the muscles, joints, nerves and bones of the hands, arms and shoulders. Rotator cuff syndrome and carpal tunnel syndrome are two of the most common types of upper extremity musculoskeletal disorder.

Increasing age and a history of one of these types of disorders emerged as the strongest risk factors for upper extremity muscle disorders in both men and women.

For men, other risk factors included being obese, having a very physically or psychologically demanding job, doing highly repetitive tasks and working while holding the arms at or above shoulder level or flexing the elbows fully.

Risks were different for women, and included having diabetes, “extreme” wrist bending, using vibrating hand tools, and having a low level of decision making authority at work.

The wide variety of risk factors makes it clear that preventing these disorders is a “complicated challenge,” Roquelaure noted.

“The study suggests that multidimensional interventions are needed, including education, correction of individual risk factors if possible (e.g., treatment of diabetes mellitus) and reduction of work exposure to biomechanical constraints and stress,” he added.

Efforts at the individual and organizational level to improve the workplace environment — and engage workers in these efforts — “seem to be an appropriate strategy for reducing the physical demands and the symptoms of musculoskeletal disorders, even if epidemiological evidences of their efficacy are still limited,” the researcher concluded.

Only one-third of adults say they are getting enough sleep every night, a new U.S. government report shows.

Some 50 million to 70 million American adults suffer from sleep and wakefulness disorders, according to the U.S. Centers for Disease Control and Prevention. Not getting enough sleep has been tied to mental distress, depression, anxiety, obesity, hypertension, diabetes, high cholesterol and certain risk behaviors including cigarette smoking, physical inactivity and heavy drinking.

“There is a relatively small percentage of people getting what sleep experts feel is an adequate amount of rest and sleep,” said Dr. Bruce Nolan, director of the sleep center at the University of Miami Miller School of Medicine, who was not involved in the report. “That is a very important physical and mental health concern.”

Getting at least seven hours of sleep results in greater alertness, better work performance and better quality of life, Nolan said. “People who get too little or too much sleep are associated with more health problems, including work problems, performance problems and productivity problems,” he noted.

The report is published in the Oct. 30 issue of Morbidity and Mortality Weekly Report, a CDC publication.

Of the U.S. adults surveyed regarding their sleep in the past month, 11.1 percent said they did not get enough sleep every day of the month.

In addition, CDC researchers found that women (12.4 percent) were more likely than men (9.9 percent) to report not getting enough sleep. There were ethnic differences, with blacks (13.3 percent) saying they got less sleep compared with all other ethnic groups.

There were also geographical differences, which ranged from a low of 7.4 percent of people in North Dakota not getting enough rest to 19.3 percent in West Virginia.

These data were collected from a survey of 403,981 adults living throughout the United States.

The main causes of sleep loss are overlapping and include lifestyle, occupation and specific sleep disorders, the report noted.

In the past, many people thought that sleep was “a waste of time,” Nolan said. “It was to be avoided. And getting seven or eight hours of sleep was a sign of laziness,” he said.

“That kind of thinking is outdated,” he said. “We have lots of evidence that getting good quality sleep is associated with better quality of life.”

People who have trouble sleeping should seek the help of a sleep specialist, Nolan said. Also, your doctor should be aware if you are having sleep problems, he said.

Ways to get better quality sleep, according to the CDC, include:
Keep a regular sleep schedule.
Avoid stimulating activities for two hours before bedtime.
Avoid caffeine, nicotine and alcohol in the evening.
Sleep in a dark, quiet, well-ventilated room.
Avoid going to bed hungry.

In addition, sleep medications can be helpful, the CDC says.

As daylight hours dwindle, people with seasonal affective disorder (SAD) can often feel the onset of wintertime depression, but a new study suggests one type of remedy may work better than another at banishing the SAD blues.

Cognitive behavioral therapy specially designed to treat people with SAD is more effective at preventing recurrences of depression than either light therapy or a combination of the two, the study found.

The psychotherapy may also be a time-saver — potentially welcome news with Daylight Saving Time coming to an end on Nov. 1.

“It’s an up-front investment, three hours of therapy a week in total over six weeks, whereas light therapy is 30 minutes a day and not just for six weeks,” said study author Kelly Rohan, a psychologist at the University of Vermont. “Light therapy depends on a lot of time and effort, a minimum 30 minutes in front of the fixture every day of the symptomatic months every year. I don’t know how many people are willing to do that.”

The study was published in a recent issue of the journal Behavior Therapy.

According to Rohan’s group, this is the first published data on the long-term effects of different therapies for SAD, which is characterized by mood and energy declines between November and April, when light is in short supply in the northern hemisphere.

The treatment of choice for the disorder has traditionally been light therapy, which spurs remission in about 53 percent of cases during the winter.

Light therapy involves exposure to bright light, typically administered using a “light box” — a set of fluorescent bulbs or tubes encased in small, portable devices made of plastic or aluminum. A plastic screen covering the bulbs blocks out potentially harmful ultraviolet rays.

But the authors of this study had also developed and tested a group cognitive-behavioral therapy (CBT) protocol geared to people with SAD.

The treatment addresses attitudes, thoughts and behaviors which contribute to SAD.

For the initial study, 69 people with SAD were randomized to receive light therapy, CBT, a combination of the two or neither (they were wait-listed).

Six weeks after treatment started, 80 percent of those receiving combination therapy were in remission vs. 50 percent for CBT and the same for light therapy. Only 20 percent of those in the control group experienced remission.

The current paper adds data collected a full year after the first treatment.

This time, 5.5 percent of those receiving the combo therapy and 7 percent of those receiving CBT alone had a SAD recurrence, vs. 36.7 percent of those treated with a light box. That represents a sharp drop in the number of people benefiting from light therapy, possibly due to the inconvenience of the method, which must be used every day.

In this study, only four people continued their light therapy into the following winter.

Individuals receiving CBT alone also had less severe depression than either of the other two groups, indicating that CBT may be the way to go.

What’s puzzling is the fact that combining CBT and light therapy didn’t work as well as CBT alone. “There’s something about being initially treated with the combination that seems to water down the effectiveness the next winter,” Rohan said.

This all seems to suggest that CBT could be the way to go.

“It’s [working] from the very first symptom, which for most people is October or November through March or April. The initial time in treatment is less with CBT and it’s also meant to be over and done with — the treatment that keeps on giving,” Rohan said. “Once you’re finished, you don’t have to be in treatment every winter for the rest of your life, whereas you are expected to get the light box out and use it for every day of fall and winter. You undergo [psychotherapy], you learn, you keep using the techniques in the future.”

“I absolutely agree with this study,” said Susan Zafarlotfi, clinical director of the Institute for Sleep/Wake Disorders at Hackensack University Medical Center in New Jersey. “I find CBT more effective in general for depression. Behavioral therapy is resetting a person’s thoughts. In CBT, you take all of the aspects of a person’s thoughts and you rewrite the dictionary in a different way.”

“But don’t minimize the power of light therapy,” Zafarlotfi warned. “It can be useful.”

Rohan is now following a larger sample of patients over two winters.

Immunization with an experimental anti-cocaine vaccine resulted in a substantial reduction in cocaine use in 38 percent of vaccinated patients in a clinical trial supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The study, published in the October issue of the Archives of General Psychiatry, is the first successful, placebo-controlled demonstration of a vaccine against an illicit drug of abuse.

“The results of this study represent a promising step toward an effective medical treatment for cocaine addiction,” said NIDA Director Dr. Nora Volkow.” Provided that larger follow-up studies confirm its safety and efficacy, this vaccine would offer a valuable new approach to treating cocaine addiction, for which no FDA-approved medication is currently available.”

Like vaccines against infectious diseases such as measles and influenza, the anti-cocaine vaccine stimulates the immune system to produce antibodies. Unlike antibodies against infectious diseases, which destroy or deactivate the disease-causing agents, anti-cocaine antibodies attach themselves to cocaine molecules in the blood, preventing them from passing through the blood-brain barrier. By preventing the drug’s entry into the brain, the vaccine inhibits or blocks the cocaine-induced euphoria.

This study included 115 patients from a methadone maintenance program who were randomly assigned to receive the anti-cocaine vaccine or a placebo (inactive) vaccine. Participants were recruited from a methadone maintenance program because their retention rates are substantially better than programs focused primarily on treatment for cocaine abuse. Participants in both groups received five vaccinations over a 12-week period and were followed for an additional 12 weeks. All participants also took part in weekly relapse-prevention therapy sessions with a trained substance abuse counselor, had their blood tested for antibodies to cocaine, and had their urine tested three times a week for the presence of opioids and cocaine.

Participants differed in the levels of antibodies generated in response to vaccination. Thirty-eight percent attained blood levels of anti-cocaine antibodies thought to be sufficient to block cocaine’s euphoric effects. During weeks 9 to 16 (when antibody levels peaked), these participants had significantly more cocaine-free urines than those who received the placebo or those with active vaccine but low levels of anti-cocaine antibodies. Participants with the highest antibody levels had the greatest reductions in cocaine use. No serious adverse effects were associated with vaccine treatment.

“Fifty-three percent of participants in the high-antibody group were abstinent from cocaine more than half the time during weeks 8 to 20, compared with only 23 percent of participants with lower levels of antibodies,” said Thomas Kosten, M.D., of Baylor College of Medicine in Houston, the study’s principal investigator.

“In this study immunization did not achieve complete abstinence from cocaine use,” added Dr. Kosten. “Previous research has shown, however, that a reduction in use is associated with a significant improvement in cocaine abusers’ social functioning and thus is therapeutically meaningful.”

Dr. Kosten led the study in collaboration with colleagues from Yale University School of Medicine, the Connecticut Veterans Administration (VA) Healthcare System, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center.

Older people poorly understand most of the important warning signs of stroke and factors that increase risk for this medical emergency, researchers from Dublin, Ireland, have found.

Among 2033 older men and women, fewer than half knew that dizziness, numbness, weakness, and headache are common warning signs of stroke, report Dr. Anne Hickey, of Royal College of Surgeons in Ireland and colleagues.

Just 54 percent listed slurred speech as an indicator of stroke, the researchers report in the online journal BMC Geriatrics.

When asked to list the most common risk factors for stroke, about three-quarters of the men and women accurately listed high blood pressure. By contrast, 40 percent or fewer knew high cholesterol and smoking also increase stroke risk. Only about 10 percent knew diabetes and alcohol use are also risk factors for stroke.

These findings highlight the significant gaps in elders’ understanding of early stroke warning signs and risk factors, Hickey and colleagues report. “As such, many older adults may not recognize early symptoms of stroke in themselves or others,” they warn. Thus, they may lose “vital time” in getting help.

On average, the study sample was 74 years old and 57 percent female. Overall, 25 percent of the men and women had a history of heart disease and 6 percent reported a prior stroke.

Another 36 and 17 percent were past and current smokers, respectively, and this group was more likely to identify smoking as a stroke risk factor than never smokers.

However, consistent with the findings of other investigators, this study revealed the generally poor understanding elders have regarding factors leading to or indicative of stroke, Hickey and colleagues note.

Since effective stroke care requires rapid identification and medical intervention, Hickey’s group suggests the need for substantially improved public education with regard to stroke prevention.

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Extavia (interferon beta-1b) has been approved by the U.S. Food and Drug Administration to treat multiple sclerosis, drug maker Novartis said Monday.

The drug was approved for people in whom the autoimmune disease has just relapsed, or for those in whom MS is newly diagnosed, the company said in a news release.

MS affects about 400,000 people in the United States, Novartis said, of whom about 80 percent have the relapsing-remitting form. In people with MS, the body’s immune system attacks the protective tissue surrounding nerve fibers that transmit electric signals to the brain. Symptoms may include problems with muscle control, vision, balance, sensation and mental function.

Interferon beta 1-b has been used as a standard treatment for MS for more than 16 years, Novartis said.

Common adverse reactions among Extavia users include injection site reactions, flu-like symptoms, headache and pain. The medication should be used with caution in people with depression, the drug maker said.