Some Facts About Sunscreens

Behind the Screen By: Shivani Vora May 14, 2007 - 4:41:20 AM Sunblock has had a few bad years, including class-action lawsuits and new claims that it causes—rather than prevents—cancer. How do you protect yourself this summer? You exercise regularly. You don’t smoke. You always wear your seatbelt. And when you’re in the sun, you never forget your SPF. Bases covered? Not so fast. Researchers at Harvard Medical School recently found that a vitamin D-deficiency—which can result from diligent sunscreen use—is linked to an increased risk of prostate cancer. Meanwhile, a class-action lawsuit is in progress in California against five major sunscreen manufacturers, claiming that their products don’t live up to their label claims of providing protection against UV rays or of being waterproof. Experts, however, warn that this brouhaha isn’t a reason to toss out your sunscreen. “There isn’t an epidemic of vitamin D deficiency,” says Coyle Connolly, a board--certified dermatologist in New Jersey, “but there is an -epidemic of skin cancer from too much sun -exposure.” To maintain adequate levels of vitamin D, says Dr. Connolly, just spend a few minutes in the sun, without sunscreen, over the course of each day. The lawsuits have drawn attention to one dirty secret of sunscreen, however: You have to be a real label hawk to know if your tube is truly “broad spectrum,” meaning that it protects you from both UVA and UVB rays. Any sunscreen with an SPF of 15 will block 94 percent of UVB rays, which penetrate the skin superficially, causing sunburn and skin cancer. UVA rays, on the other hand, cause up to 80 percent of sun-related wrinkles and age spots, and also increase your risk of skin cancer. UVA rays are trickier to fight because they penetrate the atmosphere even on cloudy days, and only four ingredients provide solid protection against them. Two of those ingredients are chemical sunblocks—avobenzone and Mexoryl SX—which work by absorbing and neutralizing UV radiation after it hits your skin, but before it can damage cells. The other two—zinc oxide and titanium dioxide—are physical sunblocks, which form a shield and actually reflect and disperse the radiation before it hits your skin. "Stay away from any sunscreen if it has an SPF of less than 15 or if it does not contain one of these four ingredients,” says Dr. Connolly. Which sunscreen you should grab depends on your needs. Chemical sunblocks are generally more waterproof, but they take 30 minutes to absorb into the skin, while physical sunblocks are effective as soon as you apply them and, because they are made from natural ingredients, can be less irritating. Mexoryl SX has been available in Europe for years, but it was not FDA approved until last year. It provides excellent protection against both short and long UVA rays, whereas the others primarily protect against long UVA rays. No matter which sunscreen you choose, David J. Leffell, MD, professor of dermatology at the Yale University School of Medicine, recommends reapplying it every couple of hours. “Ignore any claims about the longevity of sunscreen,” he warns. Even potions labeled “all day” wear off long before eight hours, he says, and sooner if you’re swimming or sweating. For Your Face Anthelios SX is a daily facial -moisturizer that combines Mexoryl SX and avobenzone to prevent wrinkles, sunspots, and cancer. Chemical sun--screens like these don’t cast a whitish pall over your face like titanium oxide and zinc oxide do. $29, laroche-posay.us.com For Your Lips Men get lip cancer at a much higher rate than women do because lipstick is a physical sunblock. NeoStrata SPF 15 Lip Conditioner ($6.50, neostrata.com) contains titanium dioxide for UVA protection. Most lip products with SPF (including ChapStick) contain oxybenzone for UVA protection, which experts say is not as effective as titanium dioxide, zinc oxide, or avobenzone. For Your Body Jack Black Ultra-Light Spray Sunscreen SPF 25 combines avobenzone for UVA protection with citronella to repel mosquitoes ($18, getjackblack.com). If bug bites aren’t a concern, try UV Expert 20, which combines Mexoryl SX, avobenzone, and titanium dioxide for complete coverage ($39, lancome-usa.com). Recommendations FDA has spent the past 29 years drafting sunscreen standards (FDA 2007), which it urges manufacturers to follow voluntarily. FDA has no public plan for setting a date by which these standards would finally become effective and mandatory. In lieu of enforceable standards, each sunscreen manufacturer decides on test methods, marketing claims, and the level of protection they are willing and able to provide consumers. Health authorities recommend sunscreen, but people are left wondering which of the hundreds of sunscreens on store shelves will best protect their and their families' skin from the sun. Sunscreens are the tip of the iceberg when it comes to ways that the chemical industry and the government are failing to protect public health. An extensive body of scientific literature demonstrates that everyone in the world carries in their body hundreds if not thousands of industrial chemicals at any given moment, the result of exposures to contaminants in air, water, and food, and to ingredients in everyday consumer products. No one understands the health implications of our exposures to complex mixtures of low doses of industrial compounds and pollutants: remarkably, federal health standards do not require companies to test their products for safety before they are sold, including nearly all chemicals in sunscreen and other personal care products, and the federal government approves new chemicals for the market using computer models to predict if they are toxic to humans. These are particularly risky methods given the many studies showing that these pollutants cross the placenta to contaminate babies even before the moment of birth, including a recent study conducted by EWG finding an average of 200 chemicals in umbilical cord blood from 10 newborn babies [read more]. This situation is unacceptable. To protect public health, including the health of the fetus, infant, child and others who are most vulnerable to toxic injury, we recommend: FDA must set mandatory sunscreen safety standards. As mandated by Congress, FDA must complete their safety standards (the "sunscreen monograph"), and establish a date by which these standards will become mandatory. This study confirms the need for mandatory standards — the voluntary system currently in place leaves the public with many sunscreen products that are not as safe and effective as the public needs and expects. FDA must develop UVA standards for sunscreen. While FDA has set guidelines for sunburn (UVB) protection, the agency has not established protocols and requirements for UVA protection. This is a critical gap in public health protection. UVA radiation is deeply penetrating and is linked to skin damage, including premature skin aging, wrinkling, and possibly cancer. FDA is charged with regulating sunscreen and protecting public health, and both of those charges demand that the agency set standards for UVA protection. FDA must approve new, effective and safe sunscreens for use in the U.S. Some sunscreen chemicals have been under review at the Agency for over than a decade. Effective sunscreens not approved in this country are in widespread use elsewhere in the world. FDA sorely needs to streamline and modernize its sunscreen review process to give consumers access to the best products possible. In the larger picture, our system of public health protections allows the vast majority of industrial chemicals to enter commerce with no requirement for premarket safety testing, even for chemicals that will end up in the bodies of Americans from their everyday exposures to ingredients in consumer products. Many state and local organizations and coalitions like the Campaign for Safe Cosmetics are working for important changes that help close the gaps in our system of public health protections. We not only need sunscreens guaranteed to be safe and effective, but we also sorely need policies that would require companies to document the safety of chemicals before they go on the market. And, most importantly, we need policies that would require that chemicals be safe for the fetus, infant, and other vulnerable populations — a simple, commonsense idea completely absent from current federal law. Such advances would dramatically improve our understanding of health impacts from chemical exposures, and would go a long way toward sealing the gaps that leave consumers at risk from a lifetime of exposure to chemicals. U.S. lags behind the world in sunscreen safety and effectiveness. FDA has approved just 17 sunscreen active ingredients for use in the U.S. In Europe 29 have been approved, including some that are more effective than those available here, particularly for blocking UVA. When FDA issued their so-called final monograph for sunscreens (which they subsequently stayed indefinitely at the request of industry), they received multiple petitions urging that they review active ingredients approved for use in Europe. The Agency replied it would "address sunscreen active ingredients that have foreign marketing experience and data at a future time," a hollow promise if their 30-year track record on developing sunscreen standards is any indication. FDA faces pressure from industry, states, and Congress to set UVA standards and approve new UVA sunscreens to protect the public. The industry's trade association petitioned the agency to approve new UVA filters beginning in 2003 (CTFA and CHPA 2003). In a May 2007 letter to FDA's commissioner, six senators urged the agency to finish setting UVA standards for sunscreen (Dodd 2007). They reminded the Commissioner that the agency had missed the Congressisonally mandated deadline of May 2006 for finalizing the draft sunscreen standards, including new UVA standards. "We continue to find this baffling [the lack of UVA standards] since many other countries, including the European Union, have adopted sunscreen standards including UVA to protect their citizens," they wrote. FDA has not reviewed or approved new, effective sunscreens available in other countries.

Fake Colgate Toothpaste

Jun 15 - Colgate-Palmolive Co. said on Friday that counterfeit toothpaste falsely labeled as "Colgate" posed a low health risk, and the company said it was picking up the suspected fakes from small independent stores in four U.S. states. Colgate has contacted all of its accounts to ensure they have no fakes, the company added. The counterfeit toothpaste, containing the toxic chemical diethylene glycol, is labeled as being manufactured in South Africa and comes in a 5-ounce tube, a size Colgate does not sell in the United States.

Higher Risk of Stroke in Women

June 21, 2007 — A new study using data from the National Health And Nutrition Examination Survey (NHANES) shows the risk for stroke among US women between the ages of 45 and 54 years is more than double that of men the same age. Independent predictors of stroke risk in this age group included the presence of coronary artery disease and increased waist circumference, suggesting that poor risk-factor control in these women may be to blame for the increased risk. "Women aged 45 to 54 had twice the odds of having experienced stroke compared with men of the same age, and the transition from age 35 to 44 to 45 to 54 marks the steepest rise in stroke prevalence for women," lead author Amytis Towfighi, MD, from the Stroke Center and department of neurology at the University of California, Los Angeles, told Medscape. Their study also showed that from 1999 to 2004, stroke prevalence rates rose in women while they declined in men. The results are published online June 20 in Neurology. Their findings were presented earlier this year at the American Stroke Association International Stroke Conference 2007 and reported by Medscape at that time. Poor Risk-Factor Control? Although the majority of strokes occur in older age groups, those in midlife, between the ages of 35 and 64 years, are still at risk, Dr. Towfighi pointed out. Women under the age of 65 years have risk factors particular to their gender, including risks associated with pregnancy, the use of oral contraceptives and hormone replacement therapy, and a higher prevalence of migraines. "Understanding gender-specific differences in the frequency and predictors of stroke in midlife years is important, which is what prompted us to look into this," Dr. Towfighi said. For this study, they used NHANES data from 1999 to 2004 on 17,061 men and women to look at sex differences in stroke prevalence and identify independent risk predictors among middle-aged individuals. Stroke was identified through the in-home interview portion of the survey, where subjects were asked if they had ever been told by a physician that they'd had a stroke. Of the 17,061 men and women surveyed, 15,309 responded to the question about stroke (90%). Of these, 606, or 4%, reported having experienced a stroke, 51% of whom were men and 49% women. Based on these data, they found that women between 45 and 54 years had significantly higher odds of having had a stroke compared with men of the same age group.

The Cost of Diabetes Treatment

The staggering cost of treating diabetes and the number of diabetes-related programs highlight a need for a national diabetes coordinator to ensure results," Haza said. "We are spending as much on diabetes as we are on the entire Department of Education, but no one is leading the effort." A report by Medco Health Solutions Inc. issued last month found that the growing diabetes epidemic and more aggressive treatment could result in soaring costs to treat the disease over the next three years. An analysis of Medco's 2007 Drug Trend Report found that, by 2009, spending just on medicines to treat diabetes could soar 60 percent to 68 percent from 2006 levels. The sales of diabetes drugs in the United States reached $9.88 billion in 2005, according to data from IMS Health Inc. "Coordinating America's response to diabetes should be mandatory," said Lana Vukovljak, CEO of American Association of Diabetes Educators. "Over the next 30 years, diabetes is expected to claim the lives of 62 million Americans. Surely this health crisis warrants the appointment of a manager charged with aligning budgets and programs for diabetes at the federal level," Vukovljak said in a statement. Uncontrolled diabetes can result in a wide variety of serious health complications, including heart disease, stroke, vision loss, amputation of extremities and kidney disease. "Our findings suggest that there are many missed opportunities for the federal government to enhance its impact on diabetes prevention, detection, treatment and management of complications," Marsha Gold, who led Mathematica's research team, said in a statement.

Symptoms of Ovarian Cancer

In response to reports by patients with ovarian cancer of the symptoms they experienced, Dr. Goff and others have found that certain symptoms are much more frequent in women with ovarian cancer than in women in the general population. These symptoms include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms of urgency or frequency. "The symptoms are not specific, and all of us have had 1 or more of these symptoms from time to time," Dr. Goff says. "What's different about the symptoms of ovarian cancer is that they are new symptoms, not symptoms you have had all your life; they occur regularly, either daily or every other day; and they persist more than several weeks." The consensus panel recommended that women who experience these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist, because prompt medical attention might allow diagnosis at the earliest possible stage of ovarian cancer, when prognosis is better. Because there is no effective screening test for ovarian cancer, symptom recognition and regular pelvic examinations are essential for early detection. "We are not 100% sure that identification of symptoms will lead to earlier detection of ovarian cancer, but because there is a potential for that, we need more research to see what effect implementing this statement will have on outcomes," Dr. Goff says. "Even in stage 1, which is associated with a 90% cure rate, women have these symptoms. If women are having these symptoms even in early stages, then with recognition of these symptoms, we may be able to diagnose ovarian cancer in early stages when chance of cure is 70% to 90%, as opposed to the 20% to 30% chance of cure in advanced stages." Although other symptoms are often reported by women with ovarian cancer, such as fatigue, indigestion, back pain, pain with intercourse, constipation, and menstrual irregularities, these symptoms are not as helpful in diagnosing ovarian cancer because they are found in equal frequency in women without ovarian cancer in the general population. A nationwide poll conducted by GCF in May 2007 revealed that women agree that it is important to know the symptoms of ovarian cancer, but 65% did not feel sufficiently informed. There is therefore a great need for information dissemination and education of women and healthcare providers. "By highlighting these symptoms and their potential association with ovarian cancer, more women may seek medical attention, especially if these symptoms persist over a few weeks," Dr. Barakat said. "Since ovarian cancer is much less common than other cancers, such as breast and lung cancer, patient education has lagged behind. Increasing public awareness could potentially lead to more patients being diagnosed with early-stage disease, and potentially lead to fewer deaths from ovarian cancer." Dr. Barakat also highlighted the need for additional research on laboratory screening tests. "One of the most important areas of research in this disease should be the development of novel biomarkers that can detect early ovarian cancer," he says. "Currently, the best test we have is a CA-125 blood test. This tumor marker is only elevated in 50% of patients with early ovarian cancer and has not been shown to be an effective screening tool in this disease." "Our goal is not to scare people, but to arm people with the knowledge that if these symptoms persist, they could be a sign of ovarian cancer or other serious condition," Dr. Goff concludes. "If ovarian cancer is suspected because of these symptoms and a suspicious mass is detected, it is very important for the woman to see a gynecologic oncologist. In that situation, if there is ovarian cancer, women are significantly more likely to have the right surgery and a higher chance of cure, so it could mean the difference between life and death."

FDA Site for Tweens - Reducing Obesity

Spot the Block Using the Nutrition Facts Label to Make Healthy Food Choices -- A Program for Tweens http://www.cfsan.fda.gov:80/~dms/spotov.html

New, Continuous 7-Day Blood Sugar Tracking

FDA Approves Continuous 7-Day Glucose Monitoring System The U.S. Food and Drug Administration today approved a device that measures glucose levels continuously for up to seven days in people with diabetes. While a standard fingerstick test records a person’s glucose level as a snapshot in time, the STS-7 Continuous Glucose Monitoring System (STS-7 System) measures glucose levels every five minutes throughout a seven-day period. This additional information can be used to detect trends and track patterns in glucose levels throughout the week that wouldn’t be captured by fingerstick measurements alone. However, diabetics must still rely on the fingerstick test to decide whether additional insulin is needed. “The STS-7 System supplements standard fingerstick meters and test strips, providing diabetics ages 18 and older with a way to see trends and track patterns,” said Daniel Schultz, M.D., director of FDA’s Center for Devices and Radiological Health. “It can help detect when glucose levels drop during the overnight hours, show when glucose levels rise between meals and suggest how exercise and diet might affect glucose levels.” The STS-7 System, manufactured by DexCom Inc. of San Diego, Calif., uses a disposable sensor placed just below the skin in the abdomen to measure the level of glucose in the fluid found in the body’s tissues (interstitial fluid). Sensor placement causes minimal discomfort and can easily be done by patients themselves. The sensor must be replaced weekly. An alarm can be programmed to sound if a patient’s glucose level reaches pre-set lows or pre-set highs. Diabetes is caused by the body’s inability to produce or use insulin, a hormone that unlocks the cells of the body, allowing glucose (sugar) to enter and fuel them. An estimated 20.8 million people in the United States—7 percent of the population—have diabetes. Most have type 2 diabetes, a condition in which the body does not properly use insulin. An estimated 5 percent to 10 percent of people with this chronic disease have type 1 diabetes, which results from the body's failure to produce insulin. People with type 1 diabetes must take insulin every day. Diabetes can lead to wide fluctuations in blood sugar levels. Over time, abnormally high levels of glucose can damage the small and large blood vessels, leading to diabetic blindness, kidney disease, amputations of limbs, stroke, and heart disease. While there is no known cure, studies have shown that patients who regularly monitor and regulate their blood glucose levels have lower incidences of complications associated with the disease. FDA’s approval of the STS-7 System was based on results of a study conducted by DexCom of 72 patients with diabetes at five clinical sites in the United States. The study demonstrated that the STS-7 System was safe and effective for detecting trends and tracking patterns in glucose levels in adults. A three-day version of the device, the STS Continuous Glucose Monitoring System, was approved in March 2006.

Calcium to Prevent Osteoporosis - Take More!

The totality of the evidence indicates that high calcium intake is important both for prevention and management of osteoporosis, and recent negative trials do not refute the much larger body of positive studies. The challenge is not to haggle over exactly how much is enough but, as the Surgeon General's report on osteoporosis put it, to recognize that current intake is far below optimal values. It is imperative to take action to augment calcium intake, both in the general population and particularly in persons being treated for osteoporosis. For many patients, calcium supplements are the most appropriate choice to ensure adequate intake. A number of different calcium compounds are used in supplements; the 2 main forms are calcium carbonate and calcium citrate. Although absorption of calcium citrate is similar to calcium carbonate, a calcium carbonate supplement contains 40% calcium vs the 21% found in calcium citrate.[52] Because formulations may contain different amounts of calcium, the number of tablets needed to obtain a recommended dose may vary. Figure 6 depicts the amount of calcium found in common compounds. Patients often erroneously believe that they are obtaining sufficient calcium through their diet. However, it is known that the median calcium intake in postmenopausal women in North America is substantially below existing recommendations.[11] Because milk and milk products provide the majority of dietary calcium in the United States, if a person is lactose-intolerant, a vegan (consuming no animal products), or avoids dairy products for other reasons, it may be especially challenging to obtain adequate amounts of calcium solely through diet.[50] In addition to being aware of the amount of dietary calcium they are ingesting, it is important that patients understand that absorption from foods can be affected by a number of factors, many of which have already been well described. These include age, vitamin D, pregnancy, and plant substances in the diet. Oxalates (found in chocolate and spinach) and phytate (found in whole grains) are among dietary substances that impair absorption. Therefore, 8 cups of spinach are needed to obtain the same amount of calcium obtained from an 8-ounce serving of milk or 1 cup of yogurt, which contain calcium in an easily absorbable form.[51] Vitamin D. Although vitamin D status has been discussed as a potential confounder of results in calcium studies, the importance of vitamin D in its own right must also be emphasized. It has long been recognized that vitamin D is important for calcium absorption, and recent studies have demonstrated that absorption efficiency increases with improving vitamin D status up to serum 25(OH)D levels of about 80 nmol/L (32 ng/mL).[43,44] Postmenopausal women, as reported in many studies, tend to have average serum 25(OH)D values ranging from 50 to 55 nmol/L (20 to 22 ng/mL)[43,45] and are therefore absorbing the calcium they ingest with reduced efficiency. Protein. As with vitamin D, protein plays an important role in its own right. Although North Americans are considered to consume generous amounts of protein it is also true that many fragile elderly individuals have low protein intake. If these same individuals are our osteoporosis patients, then they will probably not respond well to pharmacotherapy until their nutritional status is repaired. If deficient in calcium, vitamin D, and protein, many will be unresponsive to monotherapy, whether nutritional or pharmacologic. This is seen most obviously in patients with hip fracture, whose outcomes have been shown to improve dramatically with protein supplementation.[46] Exercise. Bones are designed to bear loads and to resist mechanical forces. Maintenance of adequate bone mass requires continued mechanical loading. Nutrition alone may slow the progress of disuse bone loss, but it will not block its full, ultimate expression. Optimal exercise regimens are uncertain, but impact loading appears to be more osteotrophic than, for example, weight lifting or swimming. In general, patients with osteoporosis need to maintain as vigorous an exercise program as is compatible with their bone fragility status. Good online sources of information for patients about calcium and or bone health include the National Institutes of Health, Office of Dietary Supplements;[51] American Osteoporosis Foundation;[54] and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.[53]

All About Sleeping Better

Insomnia: Once you and your doctor have ruled out any medical problems that may be causing your insomnia, you might try self-care methods. "Good sleep hygiene" refers to practices you can follow to help ensure adequate, quality sleep. For good sleep hygiene, try to do the following: Stick to a regular bedtime schedule. Get out of bed at the same time each morning, even if it's a weekend or holiday. Avoid napping during the day. Avoid stressful activities and vigorous exercise for two hours before going to bed. Before going to bed, try relaxation techniques, such as deep breathing, yoga, or meditation. Make sure your bedroom is dark, quiet, and cool. Use earplugs or eye shades if needed. Leave the bedroom if you can't sleep. Go into another room and read or do something relaxing and quiet. Exercise regularly. Avoid substances that contain caffeine (such as coffee, tea, soft drinks, or diet pills). Avoid alcohol and nicotine before bed. Snoring: If your snoring is light, try these self-care techniques: Sleep on your side. Avoid alcohol, and don't smoke. Avoid sleeping pills and other sedatives. Also, seek treatment for any allergies or nasal obstructions you may have. Sleep apnea: Weight loss can improve but may not adequately treat sleep apnea. Avoiding alcohol and sleeping pills can also help. You may want to talk to your doctor about a technique called continuous positive airway pressure (CPAP). With CPAP, each night you wear a mask that increases the air pressure inside your throat. This prevents your airway from becoming too narrow and may allow you to sleep without interruption. Except in very carefully selected cases, surgery does not adequately treat anything more than the mildest degrees of sleep apnea (though it may be more effective for troublesome snoring). A dental brace that holds your lower jaw forward during sleep is an increasingly available option for snoring and mild to moderate sleep apnea. Pregnancy and sleep: Pregnant women who experience insomnia during pregnancy may find relief by taking afternoon naps, drinking warm milk, or taking a warm (not hot) bath before bedtime. Exercise during the day should help too. Expectant mothers may find it more comfortable to sleep on their side, with pillows supporting their head, abdomen, and topside knee. Women who are pregnant should not take sleeping pills or herbal sleeping remedies without talking with their doctor first. Narcolepsy: Often, naps help relieve narcolepsy but cannot be relied on exclusively. Your doctor may prescribe stimulants (such as Ritalin or dextroamphetamine) to make you more alert. Antidepressants may be used to treat cataplexy (drop attacks) or sleep paralysis, if present. Restless leg syndrome: Cutting your caffeine intake may help. Other self-help measures may include a warm bath or relaxation exercises before bed. Hot or cold packs on your legs may provide relief. Several effective medications are available. Restless leg syndrome is a very treatable condition. Nightmares/night terrors: If your child has a nightmare or night terror, the best medicine is comfort. If the dreams reoccur frequently, talk with your child's doctor about the problem. Age: The lighter sleep patterns of older adults can sometimes lead to sleep problems. However, studies show that older adults who exercise and keep active sleep better than those who don't. Elderly people who don't sleep well at night may find afternoon naps helpful. However, excessive naps will disrupt sleep at night. Getting adequate light during the day, particularly in the morning, is important. Lifestyle: You'll sleep better if you have good sleep hygiene and avoid caffeine, alcohol, nicotine, and heavy meals before bed. Regular exercise can improve sleep, as long as the exercise is performed at least two hours before bedtime. Medication: If you think prescription or over-the-counter medication may be causing your sleep problems, talk with your doctor. You may need to have your medication dose adjusted or may need to take a different kind of medication. Depression and anxiety: If depression or anxiety is keeping you up for more than a few nights, talk to your doctor about treatment. Heart failure and lung problems: If you experience breathlessness when you lie down to sleep or awaken in the night feeling breathless, you should see your doctor. You could have problems with your heart or lungs.

Hearing Loss and Aides

Technological advances in hearing aids and HATS have expanded the range of options available to improve the success of a device use. Today's hearing aids differ significantly from their analog predecessors because the application of digital signal processing has permitted many adaptive and/or automatic features. In the past decade, hearing instrument technology has developed to the point that digital hearing aids now constitute nearly 90% of all hearing aid sales in the U.S.[21] This growth has permitted decreases in the cost of digital technology so that digital hearing aids now span the range from entry-level prices to high-end pricing, thus allowing all users the option of digital technology. Included in the benefits of digital hearing aids are improved sound quality; multiple listening programs for different listening environments; advanced noise reduction strategies; acoustic feedback reduction; compatibility with remote control options; and flexibility in manipulation of the frequency, compression, and gain ( Table 1 ). These developments allow the audiologist considerable flexibility in choosing appropriate technology for the varied needs of older adults. Such features as automatic function of the telecoil (a hearing aid component for use with the telephone or for coupling to HATS) and multiple programs ensure that even those with limited manual dexterity or cognitive impairments can wear a device that optimizes performance across a broad range of listening environments. It is no longer necessary to find the switch or remember to return to a listening program when the conversation has ended for effective telephone use. Difficulty understanding speech amid noise is a common complaint for hearing aid users. Directional microphone technology has advanced to optimize the directional responsiveness of the hearing aid microphone in order to reduce the level of noise when the noise source is from an angle that is behind or beside the hearing aid user. Automatic directional systems are intended to accurately switch between directional and omnidirectional modes, and this option is available even in the lower-priced entry-level digital devices.

New Cardiopulmonary Resuscitation Guidlines (CPR)

CPR consisting of chest compression plus mouth-to-mouth ventilation is a major element in the chain of survival for people with cardiac arrest. However, although bystander CPR improves the likelihood of survival, it is attempted in less than one third of patients who collapse, partly due to the reluctance of bystanders to undertake mouth-to-mouth ventilation. In CPR guidelines, according to the current authors, cardiac-only resuscitation by bystanders is recommended in dispatch-assisted resuscitation or if a rescuer is unwilling or unable to do mouth-to-mouth ventilation, but this technique is not generally known or taught to the public. One study has shown that cardiac-only resuscitation results in better survival without neurologic impairment.

Saline Nasal Irrigations for Chronic "Sinus" Symptoms

Nasal irrigation previously has been demonstrated to be an effective, safe, and well-tolerated means to treat frequent or chronic rhinosinusitis. The current authors reported results from a randomized controlled trial of 6 months of therapy with 2% saline nasal irrigation vs usual care in the December 2002 issue of the Journal of Family Practice. The authors found that the use of saline was associated with fewer sinus symptoms, improved sinus-related quality of life, and reduced use of antibiotics and nasal sprays. A follow-up study to this trial demonstrated that participants in the original randomized trial continued to use nasal irrigation as a successful modality to treat rhinosinusitis. Given the apparent clinical success of nasal irrigation for frequent or chronic rhinosinusitis, the authors sought to examine qualitative data regarding the everyday benefits and drawbacks of irrigation from study participants. Their results are summarized in the "Study Highlights." Study Highlights Participants from the researchers' primary study were invited to participate in structured 30-minute interviews to explore their experience with nasal irrigation for rhinosinusitis. Patients included in the original study had either 2 episodes of acute sinusitis or 1 episode of chronic sinusitis in the past year. In addition, participants reported a moderate-to-severe overall daily quality-of-life burden associated with rhinosinusitis. Participants randomized to receive nasal irrigation had an educational session that included lessons on rhinosinusitis and individual coaching on the practice of nasal irrigation. 28 of the original 35 subjects who received nasal irrigation agreed to participate in the interviews for the current study. Their clinical data were similar to the original cohort as a whole. 4 main content themes emerged from these interviews: Patients felt empowered in being able to access, monitor, and adjust treatment with nasal irrigation on their own. They were pleased to be less reliant on clinician visits and antibiotics. Patients were enthusiastic regarding the efficacy of nasal irrigation in reducing sinus symptoms and improving their quality of life. Many subjects reported improvement within the first or second use of nasal irrigation. Patients cited fear of having water in the nasal cavity, initial unpleasant sensation of water in the nasal cavity, having to learn how to perform nasal irrigation effectively, the time to perform nasal irrigation, and occasional mild adverse effects as potential barriers to the use of nasal irrigation. Adverse effects included saline drainage and nasal burning, but these events were not strong enough to stop the practice of nasal irrigation. Patients noted that the initial education session, particularly individual coaching on the practice of nasal irrigation, was effective in overcoming many of the barriers to the use of nasal irrigation. In addition, their experience at home with adjusting the schedule, salinity, and temperature of nasal irrigation allowed for effective and well-tolerated treatment. Pearls for Practice Nasal irrigation with saline solution has been demonstrated to improve symptoms of rhinosinusitis, sinus-related quality of life, and the use of other medications for rhinosinusitis. This treatment appears effective over the long term. The current study demonstrates that patients with frequent or chronic rhinosinusitis may have some initial trepidation regarding the use of saline nasal irrigation, but some coaching on how to use irrigation along with self-adjustment of therapy allowed patients to overcome potential barriers to treatment. Patients find the use of nasal irrigation empowering and effective.