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Hope lives in South Africa AIDS clinic By TERRY LEONARD, Associated Press Writer
Fri Dec 1, 1:49 PM ET



ELANDSDOORN, South Africa - Four women emaciated by     AIDS, perilously close to death and abandoned by the state health care system, cling tenaciously to life at a remote clinic where doctors give them one last fighting chance.

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The women, sent home to die by doctors at a state hospital, arrived critically ill. Their immune systems barely registered in tests and their blood was brimming with the virus that causes the disease.

"These are people who were already in the coffin but forgot to fall down," said Dr. Hugo Templeman, the Dutch physician who founded the Ndlovu Medical Center a dozen years ago in this remote and dusty crossroads in the South African countryside.

Remarkably, Templeman said about 85 percent of those admitted to the clinic's small ward in critical condition not only survive but recover. Over months of treatment with antiretroviral cocktails the immune system revives. The patients are not cured, but are restored to the manageable status of     HIV positive.

"This is all about hope," said Templeman.

Here among treeless, rock-strewn hills and the abject poverty of rural townships a hundred miles northeast of Pretoria, the Ndlovu Medical Center offers a blueprint on how to bring a successful AIDS treatment and awareness campaign to remote corners of the African bush.

It also offers something rare in South Africa: a hopeful AIDS program in a country where the president has questioned the link between the virus and the disease and the health minister has been pilloried for questioning the effectiveness of antiretroviral drugs and instead promoting garlic and African potatoes.

"Many people still think that HIV positive is a death sentence, it is the end of their lives," said Dudu Nkosi, 28, who was sent home to die by a state hospital in 2003. At the time, she weighed just 61 pounds and her immune system had collapsed.

Today she counsels patients at Ndlovu, helping them overcome the shock of discovering they are HIV-positive and commit to a lifetime of treatment and monitoring.

"Being HIV-positive is not the end of the world. The patients believe me when I say this because they know I survived," said Nkosi.

The clinic has a laboratory for monitoring treatment and adherence. It has X-ray machines, a pharmacy and a program designed to prevent mother-to-child HIV transmission. Teams provide testing, counseling and treatment to workers on their farms and others take HIV education to schools and remote townships. Some go to patients' homes to count pills and ensure treatment programs are followed.

Templeman and the clinic also carry out research on AIDS treatment with the University of Utrecht in the Netherlands.

Roads leading to the clinic are littered with hand-painted signs with slogans promoting safe sex, HIV testing and adherence to treatment and monitoring.

"We still have two or three deaths a week in the waiting room," said Templeman, adding that the stigma attached to the virus makes many wait too long to seek help.

In October, Deputy President Phumzile Mlambo-Ncguka was appointed to take the lead on AIDS policy, sidelining the health minister, and the government on Friday, World AIDS Day, outlined a new plan to increase access to treatment.

But the government's slow response has contributed to the epidemic's spread, said Templeman.

"They have confused the whole population by not giving the right information. We have lost something because of it," the doctor said. He said many South Africans think antiretroviral drugs "are poison."

South Africa has an estimated 5.4 million people infected with HIV, the second highest in the world after India. AIDS kills more than 900 South Africans a day. The     World Health Organization says about 26 percent of the economically active adults are HIV-positive, but Templeman says the rate is higher among the rural poor.

"The prevalence is over 30 percent among farmworkers. With a prevalence of 30 percent, nobody can keep up," said Templeman. "They are dying like flies out there."

Ndlovu takes its program to farms because so few farmworkers have the means to get to the clinic. With so many workers dying of AIDS, Templeman said farmers have been convinced it is in their economic interest to pay for treatment.

Of 130 births by HIV-positive women at the clinic since 2003, 128 of the newborns were HIV-negative. Templeman said the two women who transmitted their virus to their babies joined the program too late.

Without the treatment protocol, there is a one in three chance the mother will pass the virus on to the child.

HIV-positive women are given prenatal care and put on antiretrovirals immediately to try to reduce the virus to almost undetectable levels in the bloodstream. The babies get antiretroviral treatment and the women are prevented from breast feeding and given a year's worth of formula.

"What we do here is insignificant if it is not reproducible," said Templeman.

With financial help from the United States, the Anglo-American Corp. and Sir Richard Branson's Virgin Atlantic among others, Ndlovu is establishing another clinic at Bushbuck Ridge, 100 miles farther northeast. Eventually it could sponsor up to 20 clinics in rural South Africa. Templeman does not want to expand too rapidly to ensure the success of each new clinic.

The formula, he said, would also be replicated at government community centers all over the country and copied in remote areas in the rest of Africa.

When Lettie Wendy was admitted she could not walk and was little more than skin and bones. Her immune system had collapsed and she had three large bed sores that forced her to lie only on her stomach.

"I was at a government hospital. I was really sick and they sent me home to die," said Wendy, 26. "My aunt brought me here in 2004 and they put me on anti-retrovirals."

Two years later, Wendy is still in a wheelchair, but she has gained weight, her sores have healed, her immune system has rallied and the clinic treats her like a poster child for its treatment.

From her wheelchair, Wendy pointed toward the women in the critical care ward.

"When they see me," she said, "they know you don't have to die of AIDS."

100、Hormone Imbalance Could Spur Some Bed-Wetting By Steven Reinberg
HealthDay Reporter
Fri Dec 1, 7:02 PM ET



FRIDAY, Dec. 1 (HealthDay News) -- An imbalance in a hormone-like substance called prostaglandin could explain tough-to-treat bed-wetting in some children, Danish researchers report.

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Most children have their bed-wetting controlled by a medication called desmopressin, which reduces the amount of urine they produce at night. But about 30 percent of kids don't respond to the drug.


"Our understanding of bed-wetting is continuously improving, and we are getting better in helping children that suffer from the condition." said lead researcher Dr. Konstantinos Kamperis, from the University of Aarhus, Denmark. "How the body treats salt may play an important role in the etiology of the condition."


His team found that children with the type of bed-wetting that does not respond to desmopressin have more salt and urea in their nighttime urine, possibly caused by an imbalance of prostaglandin.


The report is published in the December issue of the American Journal of Physiology-Renal Physiology.


Bed-wetting is a common and bothersome problem. In fact, 5 million to 7 million children in the United States ages six and over wet their beds at night, according to the National Kidney Foundation.


In the study, researchers studied 46 seven-to-14-year-old children suffering from bed-wetting, all of who were treated as outpatients at Aarhus University Hospital. The youngsters had not responded to desmopressin. This group was compared to 15 children of similar age who had no bed-wetting problem.


The children spent two nights at the hospital. The first night was to acclimatize them to the hospital environment. During the second night, the researchers collected blood and urine from the children without waking them.


"We found that bed-wetters excrete larger amounts of salt at night, probably the reason for their bed-wetting," Kamperis said. "Apart from that, these children excrete larger amounts of prostaglandins, and this could explain both the large excretion of salt at night as well as the inability of desmopressin to treat this condition," he explained.


Compared with children who responded to desmopressin, the children who did not respond excreted twice as much urine during the night. In addition, the urine of children who wet their beds during the experiment contained more sodium, urea and prostaglandin than the other children, the researchers found.


"These findings point towards new treatment possibilities for bed-wetting with agents that reduce the amount of salt excreted in urine," Kamperis said. "Such studies are being conducted at the moment. Furthermore, we would be interested in researching the exact etiology of this excess nocturnal salt excretion. That could help our understanding of bed-wetting," he added.


One expert thinks that, while it is possible that prostaglandin might be involved in bed-wetting, the data from this study can't be used to change clinical practice right now.


"This study has some biological plausibility, because some studies suggest that prostaglandin inhibitors are useful in the treatment of bed-wetting," explained Dr. Joseph G. Barone, an associate professor of pediatrics and urology at Robert Wood Johnson Medical School, New Brunswick, N.J. "Prostaglandin inhibitors include Motrin and Advil, but, in my experience, these medications have not been effective against bed-wetting," he added.


Although bed-wetting is very common, there are few basic science studies on this condition, Barone said. "This study adds useful information to the medical literature, and it may lead to further studies. However, clinical recommendations cannot be made based on the results of this study," he said.


Barone noted that desmopressin is not a cure for the problem. "It works in about 50 percent of cases, in my experience," he said. "When desmopressin works, it is not a cure, just a Band-Aid. The theory is that desmopressin reduces the amount of urine at night, and the child does not, therefore, wet the bed."


Bed-wetting continues to be a multifaceted condition that is commonly associated with developmental immaturity, Barone said. "The most compelling evidence that bed-wetting is developmental in nature is the child's natural tendency to outgrow the problem in 99 percent of cases," he said.


More information


There's more on bed-wetting at the National Kidney Foundation.

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ICU Expense Doesn't Affect Length of Stay, Death Risk Fri Dec 1, 11:47 PM ET



FRIDAY, Dec. 1 (HealthDay News) -- The amount of money spent on treating intensive care patients doesn't affect the length of their stay or their likelihood of dying, a U.S. study says.

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Researchers in Cleveland looked at the care costs for nearly 1,200 patients treated by nine intensivists over 29 months in one intensive care unit (ICU). Average daily discretionary costs varied by 43 percent, or $1,003 per admission, between the intensivists who spent the most on patient care and those who spent the least.


The highest-spending doctors spend more on pharmacy, radiology, laboratory, blood banking and echocardiography, the study found.


"In this single ICU, we demonstrated large differences in resource use that are attributable to differences in physicians' practice styles," researcher Dr. Allan Garland, division of pulmonary and critical care medicine, MetroHealth Medical Center in Cleveland, said in a prepared statement.


"Higher-spending intensivists did not generate better outcomes than their lower-spending colleagues, so it may be possible to reduce ICU costs without worsening outcomes by altering their practice styles," Garland said.


Contrary to their expectations, he and his colleagues found that intensivists had a good idea of the ICU costs they incurred when treating patients.


"Perhaps the higher spenders believe their practice style produces better outcomes. Alternatively, practice styles may derive from a complex interaction between training and personality traits, such as response to uncertainty," Garland said.


The study is in the first issue for December of the American Journal of Respiratory and Critical Care Medicine.


The ICU is a major contributor to health care costs in the United States, noted an accompanying editorial.


"The ICU is a resource-intensive environment where new drugs, expensive technologies and specialized clinical care all contribute to dramatic health care expenditures. Reducing the costs of health care in general and intensive care in particular is a priority for physicians, hospital administrators and policy makers," wrote Dr. Jeremy Kahn of the University of Pennsylvania and Dr. Derek C. Angus of the University of Pittsburgh School of Medicine.


"Perhaps the greatest lesson of the Garland study is that cost control is not just the work of the health policy expert or hospital administrator -- it is also the task of individual ICU clinicians. It is now clearer than ever that accepting that task is a difficult but necessary part of critical care in the twenty-first century," they wrote.


More information


The Society of Critical Care Medicine has more about ICU patients.

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ICU Expense Doesn't Affect Length of Stay, Death Risk Fri Dec 1, 11:47 PM ET



FRIDAY, Dec. 1 (HealthDay News) -- The amount of money spent on treating intensive care patients doesn't affect the length of their stay or their likelihood of dying, a U.S. study says.

ADVERTISEMENT

Researchers in Cleveland looked at the care costs for nearly 1,200 patients treated by nine intensivists over 29 months in one intensive care unit (ICU). Average daily discretionary costs varied by 43 percent, or $1,003 per admission, between the intensivists who spent the most on patient care and those who spent the least.


The highest-spending doctors spend more on pharmacy, radiology, laboratory, blood banking and echocardiography, the study found.


"In this single ICU, we demonstrated large differences in resource use that are attributable to differences in physicians' practice styles," researcher Dr. Allan Garland, division of pulmonary and critical care medicine, MetroHealth Medical Center in Cleveland, said in a prepared statement.


"Higher-spending intensivists did not generate better outcomes than their lower-spending colleagues, so it may be possible to reduce ICU costs without worsening outcomes by altering their practice styles," Garland said.


Contrary to their expectations, he and his colleagues found that intensivists had a good idea of the ICU costs they incurred when treating patients.


"Perhaps the higher spenders believe their practice style produces better outcomes. Alternatively, practice styles may derive from a complex interaction between training and personality traits, such as response to uncertainty," Garland said.


The study is in the first issue for December of the American Journal of Respiratory and Critical Care Medicine.


The ICU is a major contributor to health care costs in the United States, noted an accompanying editorial.


"The ICU is a resource-intensive environment where new drugs, expensive technologies and specialized clinical care all contribute to dramatic health care expenditures. Reducing the costs of health care in general and intensive care in particular is a priority for physicians, hospital administrators and policy makers," wrote Dr. Jeremy Kahn of the University of Pennsylvania and Dr. Derek C. Angus of the University of Pittsburgh School of Medicine.


"Perhaps the greatest lesson of the Garland study is that cost control is not just the work of the health policy expert or hospital administrator -- it is also the task of individual ICU clinicians. It is now clearer than ever that accepting that task is a difficult but necessary part of critical care in the twenty-first century," they wrote.


More information


The Society of Critical Care Medicine has more about ICU patients.

103、Japan to compensate victims of leprosy Sat Dec 2, 12:20 AM ET



SEOUL, South Korea - Japan will compensate former leprosy sufferers in     South Korea who were forced into isolation during Tokyo's colonial rule, South Korea's Foreign Ministry said Friday.

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The Japanese government will pay $69,000 each to 64 people forced to live in a sanatorium on a small island, bringing to 155 the number of South Korean beneficiaries of such compensation, the ministry said.

Japan's Health, Labor and Welfare Ministry confirmed the number, adding that 282 South Korean victims were yet to receive compensation.

Japan ruled the Korean Peninsula as a colony from 1910 to 1945, and Taiwan from 1895 to 1945.

In February, Japan enacted a law clearing the way to grant compensation to sufferers of leprosy forced into segregation.

A leprosy compensation law was enacted in 2001 after a landmark ruling that Japan's segregation of people with leprosy was unconstitutional. The law entitles people forced into leprosariums to compensation, regardless of nationality.

But in 2004, the government rejected compensation claims from leprosy patients who were isolated in colonies in South Korea and Taiwan because the law did not cover people in overseas camps.

Last year, the Tokyo District Court handed down contradictory rulings on overseas claims, granting compensation to Taiwanese victims but rejecting similar demands from South Koreans.

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Milk May Be Pleasant Alternative for CT Scans By Randy Dotinga
HealthDay Reporter
Fri Dec 1, 11:47 PM ET



WEDNESDAY, Nov. 29 (HealthDay News) -- Undergoing a scan of one's intestines isn't a pleasant experience for patients with conditions like Crohn's disease, especially since it means downing a concoction made with barium.

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But a new study suggests there may be a more palatable alternative: milk.


Researchers found that milk coats the intestines well enough so that radiologists can properly view the organ in a CT scan.


The milk alternative "is interesting, and it's certainly cheap enough. Reading this, I might try it on regular patients," said Dr. Laurence Needleman, chief of CT at Thomas Jefferson University Hospital in Philadelphia.


Still, Needleman -- who's familiar with the study findings -- said milk may not be ideal for all patients, especially since it seems to produce images that are less precise.


Specific types of CT scans are often used to examine the intestines along with the liver and spleen, Needleman explained. Patients typically ingest one chemical and are injected with another; the two combine to create contrast and allow radiologists to better view the inside of the body.


In cases of Crohn's disease and other conditions, the purpose of these scans is to detect kinks or obstructions in the intestines, Needleman said.


Patients commonly drink a "contrast agent" called VoLumen, which includes barium. "I've tried it. It's one of the things I made sure I did," Needleman said. "It's not pleasant. It's not a positive experience to drink it. Drinking four glasses of milk probably will be easier."


In the new study, researchers compared VoLumen to milk in patients who were about to undergo CT scans of the abdominal/pelvic area.


Of those, 62 drank VoLumen, while 106 drank two doses of whole milk (one 400-600 milliliter glass, then a 200-400 milliliter glass -- a total of as much as one liter).


The study findings were to be presented Wednesday in Chicago at the annual meeting of the Radiological Society of North America.


The researchers found that VoLumen was better at allowing radiologists to view certain kinds of images. However, 42 percent of VoLumen patients reported abdominal side effects -- Needleman said it can cause diarrhea -- while only 25 percent of the milk patients did.


As to cost, VoLumen was $18 per patient compared to $1.39 for those who drank milk.


"We hope that substituting milk for other contrast agents will reduce the number of people who refuse imaging tests because they do not want to drink the oral contrast, especially children," Dr. Lisa Shah-Patel, a radiology resident at St. Luke's-Roosevelt Hospital in New York City, said in a statement. She is one of the study's authors.


But Dr. Raul N. Uppot, assistant radiologist at Harvard Medical School, is skeptical that milk will be a viable alternative. "I don't believe we should sacrifice image quality for improved tolerability," he said, adding that some patients may not be able to drink milk due to allergy, lack of ability to tolerate milk products, or existing bowel disease.


"This is only a small study, and when applied to the larger population of patients undergoing CT, I feel you will run into more complaints of discomfort and diarrhea (with milk)," he said.


In addition, Uppot said, "most patients at our institution tolerate the VoLumen with a few complaints of diarrhea."


More information

There's more on CT scans at RadiologyInfo.

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New vaccinations may be needed in Miss. Fri Dec 1, 5:19 PM ET



NEWTON, Miss. - Mississippi health officials say 750 children and adults in the Newton area may need new vaccinations because the drugs used initially may have been stored at too cold a temperature and their effectiveness weakened.

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Dr. Tree James, district health officer for East Central Public Health District 6, said officials discovered the problem during their annual inspection in October and replaced the refrigerator where the vaccinations were kept.

The discovery meant any shot the department gave between October 2005 and October 2006 could have been affected, she said.

"Now we're going through each individual chart and trying to determine what revaccinations they might need. We're writing up an individual plan for each individual who might need revaccination," James told The Clarion-Ledger newspaper.

James said the Health Department is sending out certified letters to those whose vaccines came from the faulty refrigerator. The vaccines included shots for hepatitis A, hepatitis B, tetanus and the combination vaccine given to infants and children: diphtheria, tetanus and pertussis.

"We're recommending revaccinations," she said. "It doesn't make it harmful, but it can weaken the effectiveness."

Vaccines that weren't affected by the cold included shots for chicken pox and the combination vaccine for measles, mumps and rubella, she said.

In cases where adults received flu shots, James said officials from the Centers for Disease Control and Prevention did not recommend a second round of injections.

Medical experts say many vaccines are made up of proteins that resemble spaghetti noodles - too hot and they get soft, too cold and they break easily. These changes in temperature cause vaccines to lose their ability to immunize people from disease.

___

Information from: The Clarion-Ledger, http://www.clarionledger.com

107、 No joke: Laughter yoga stretches into OC By GILLIAN FLACCUS, Associated Press Writer
Thu Nov 30, 2:13 PM ET



LAGUNA BEACH, Calif. - This is no joke: It's a typical day at sunny Main Beach and a dozen people are wandering around with their hands in the air, laughing hysterically, squawking like chickens and talking gibberish.

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Now limbered up, they suddenly form a loose circle and begin clapping and chanting before they resume a group stretch.

This is laughter yoga, a sidesplitting new fitness fad that's part traditional yoga, part improv and all silliness.

About 60 U.S. instructors who trained in India with the man who invented the style now instruct thousands of practitioners from California to Connecticut. About one-third of the known American laughter yoga clubs are in California, said Sebastien Gendry, founder of the American School of Laughter Yoga in Pasadena.

Jeffrey Briar, who founded the Laughter Yoga Institute in Laguna Beach a month ago, said his daily yoga lessons are now such a common sight on the beach that dog-walkers and joggers no longer stare. Sometimes they even join in.

Briar has practiced laughter yoga for more than a year and said he has shared his discovery with more than 4,500 people at the daily beachside sessions. It doesn't matter if the laughter is forced or fake in the beginning, he said.

"Most people think they have to feel good first in order to laugh. But you can start from nothing, you can even start feeling unhappy and just laugh as a form of exercise, and happy feelings follow," said Briar, a slight 51-year-old with a perpetual grin, intentionally mismatched Converse sneakers and piercing blue eyes.

Briar, who also teaches more traditional yoga, said laughter enhances the breathing exercises that are so important to yoga and creates social interaction that isn't found in other styles which focus more on inward concentration.

"If you're laughing with a group of other people, fake laughter very quickly becomes real," he said. "It's part of the social phenomenon."

Numerous scientific studies have found that daily laughter can help lift depression, lower blood pressure and boost the immune system, but yoga and health experts say little has been done to study the combined effects of chuckles and chakras.

Roger Cole, a San Diego-based certified yoga instructor and Ph.D. in health psychology, said laughter yoga builds on the idea that certain poses can combat depression. But he worries about the forced nature of laughter yoga.

"The idea that putting a posture, as it were, on your face ― a smile ― is an idea that's not foreign to yoga," Cole said. "But the whole concept seems pretty contrived and uncomfortable. I think it could work, but there are more tried and true versions out there."

Back at the beach, Briar's daily class looks a lot like a scene from "One Flew Over the Cuckoo's Nest."

Some are bundled in jackets and scarves against the winter chill, and they begin by warming up with trills and chirps as they stretch their arms overhead and rotate their hips.

Then it's on to the really serious stuff: a 45-minute series of light yoga poses interspersed with improv-style exercises that include telling an imaginary joke in gibberish, opening a phantom "milkshake of happiness," playing on an imaginary swing set and scurrying around the beach while flapping and squealing like a seagull.

The class ends with members lying on their backs on the sand, murmuring in gibberish, chuckling spontaneously and beating their chests and stomachs. Briar's only rule is they can't use any real words ― only nonsense ― as they wind down.

Mercedes Cedillo, 45, attended her first laughter yoga class with a friend this week. At first she was self-conscious as Briar led the group through childish pantomimes, but that all changed by cool-down time.

"At the beginning I was like, 'Oh my God. What am I doing? This is very silly,'" said Cedillo. "But then you get connected to the inner child and the things that we normally would get stressed about you can laugh at."

_____

On the Net:

Laughter Yoga Institute at Laguna Beach: http://www.joyfulb.com

Laughter Yoga International: http://www.laughteryoga.org

American School of Laughter Yoga: http://www.laughangeles.com

108、No joke: Laughter yoga stretches into OC By GILLIAN FLACCUS, Associated Press Writer
Thu Nov 30, 2:13 PM ET



LAGUNA BEACH, Calif. - This is no joke: It's a typical day at sunny Main Beach and a dozen people are wandering around with their hands in the air, laughing hysterically, squawking like chickens and talking gibberish.

ADVERTISEMENT

Now limbered up, they suddenly form a loose circle and begin clapping and chanting before they resume a group stretch.

This is laughter yoga, a sidesplitting new fitness fad that's part traditional yoga, part improv and all silliness.

About 60 U.S. instructors who trained in India with the man who invented the style now instruct thousands of practitioners from California to Connecticut. About one-third of the known American laughter yoga clubs are in California, said Sebastien Gendry, founder of the American School of Laughter Yoga in Pasadena.

Jeffrey Briar, who founded the Laughter Yoga Institute in Laguna Beach a month ago, said his daily yoga lessons are now such a common sight on the beach that dog-walkers and joggers no longer stare. Sometimes they even join in.

Briar has practiced laughter yoga for more than a year and said he has shared his discovery with more than 4,500 people at the daily beachside sessions. It doesn't matter if the laughter is forced or fake in the beginning, he said.

"Most people think they have to feel good first in order to laugh. But you can start from nothing, you can even start feeling unhappy and just laugh as a form of exercise, and happy feelings follow," said Briar, a slight 51-year-old with a perpetual grin, intentionally mismatched Converse sneakers and piercing blue eyes.

Briar, who also teaches more traditional yoga, said laughter enhances the breathing exercises that are so important to yoga and creates social interaction that isn't found in other styles which focus more on inward concentration.

"If you're laughing with a group of other people, fake laughter very quickly becomes real," he said. "It's part of the social phenomenon."

Numerous scientific studies have found that daily laughter can help lift depression, lower blood pressure and boost the immune system, but yoga and health experts say little has been done to study the combined effects of chuckles and chakras.

Roger Cole, a San Diego-based certified yoga instructor and Ph.D. in health psychology, said laughter yoga builds on the idea that certain poses can combat depression. But he worries about the forced nature of laughter yoga.

"The idea that putting a posture, as it were, on your face ― a smile ― is an idea that's not foreign to yoga," Cole said. "But the whole concept seems pretty contrived and uncomfortable. I think it could work, but there are more tried and true versions out there."

Back at the beach, Briar's daily class looks a lot like a scene from "One Flew Over the Cuckoo's Nest."

Some are bundled in jackets and scarves against the winter chill, and they begin by warming up with trills and chirps as they stretch their arms overhead and rotate their hips.

Then it's on to the really serious stuff: a 45-minute series of light yoga poses interspersed with improv-style exercises that include telling an imaginary joke in gibberish, opening a phantom "milkshake of happiness," playing on an imaginary swing set and scurrying around the beach while flapping and squealing like a seagull.

The class ends with members lying on their backs on the sand, murmuring in gibberish, chuckling spontaneously and beating their chests and stomachs. Briar's only rule is they can't use any real words ― only nonsense ― as they wind down.

Mercedes Cedillo, 45, attended her first laughter yoga class with a friend this week. At first she was self-conscious as Briar led the group through childish pantomimes, but that all changed by cool-down time.

"At the beginning I was like, 'Oh my God. What am I doing? This is very silly,'" said Cedillo. "But then you get connected to the inner child and the things that we normally would get stressed about you can laugh at."

_____

On the Net:

Laughter Yoga Institute at Laguna Beach: http://www.joyfulb.com

Laughter Yoga International: http://www.laughteryoga.org

American School of Laughter Yoga: http://www.laughangeles.com

109、Older schizophrenia drug works, costs less: study
Fri Dec 1, 2006 6:04pm ET

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More Health News... Email This Article | Print This Article | Reprints [-] Text [+] By Julie Steenhuysen and Kim Dixon

CHICAGO (Reuters) - A new study finds that an older antipsychotic drug is cheaper and equally effective for some patients with schizophrenia, sending makers of newer drugs scrambling to defend their products on Friday.

The American Journal of Psychiatry study concluded that the older, first-generation antipsychotic drug perphenazine was less expensive and as effective as newer medications such as AstraZeneca Plc's Seroquel and Eli Lilly and Co.'s Zyprexa.

Funded by the U.S. National Institutes of Health, the $42.6 million study suggests doctors should consider the use of older antipsychotics as a first choice for patients with schizophrenia, a group of psychotic diseases marked by delusions and hallucinations.

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"There could be a very useful role -- from a clinical and cost-effectiveness standpoint -- for greater utilization of some older-generation medications," said Dr. Jeffrey Lieberman, a psychiatrist at Columbia University Medical Center and the study's lead author.

Currently, the lion's share of antipsychotic prescriptions -- more than 90 percent -- are written for second-generation drugs, which also include Johnson & Johnson's Risperdal, known by the chemical name risperidone, and Pfizer Inc.'s Geodon, also known as ziprasidone.

The brand name drugs cost about $200 to $300 per month, or 40 to 50 percent more than the older generic drugs, according to the study.

Lieberman said physicians should not automatically exclude perphenazine and other older drugs from the range of options.

"It's not like you are practicing antiquated medicine by using the older medications," he said. "These results will enable doctors to be aware of the cost considerations when they are making their choice in treatments."   Continued...




Introduced in the 1990s, second-generation antipsychotic drugs now account for some $10 billion in U.S. sales, a bill paid largely by the government.

Makers of newer antipsychotic drugs downplayed the findings, criticizing the study's design and saying that different medications will work for different patients.

Arthur Lazarus, senior director of clinical research at AstraZeneca, warned that older drugs were subject to serious long-term side effects, such as tardive dyskinesia (TD), a movement disorder characterized by facial grimacing, tongue protrusion, rapid eye blinking and other involuntary motion.

"Why expose them to a lifetime of therapy when the risk of TD with these drugs is approximately 50 percent?" he said.

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Shares of AstraZeneca fell as much as 2.2 percent on fears that demand for Seroquel, known by the chemical name quetiapine, would be hurt. The drug is the Anglo-Swedish group's second-biggest seller, with 2005 sales of $2.8 billion, and is the most prescribed U.S. treatment of its type.

The newer antipsychotic drugs, however, are associated with their own set or risks, including weight gain and an increased risk of diabetes, Lieberman said.

Lilly said the study found its drug -- Zyprexa or olanzapine -- was the most cost effective among the four newer-generation drugs studied.

The company said the study's high dropout rate limited the collection of long-term data, and suggested it not be used to limit access to newer drugs, a sentiment echoed by The National Alliance on Mental Illness, a patient group.

Most anti-psychotic drugs prescribed in the United States are paid by government agencies such as Medicaid, the state-federal health insurance program for the poor, because the illness often renders people unable to work.   Continued...


"There is a growing anxiety in the community when we see studies like this, that it will give Medicaid directors permission" to add restrictions to drugs, said Ken Duckworth, medical director at the alliance.

Lieberman said he and his research colleagues hope policymakers will exercise restraint.

"It is our great hope that this not come at the expense of restricting the access and choice that patients and doctors have," he said.

Shares of Lilly fell 0.2 percent on the New York Stock Exchange, while Pfizer's shares rose 1.4 percent after an upbeat analyst meeting on Thursday.

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(Additional reporting by Ben Hirschler in London)