Workers returning to their job after an injury are more likely to quit or be fired if their job requires more hours than the traditional 40-hour week. Allard Dembe, associate professor and chair of health services management and policy, Ohio State, found that injured employees working an extended week are 70% more likely to quit and 81% more likely to be fired than those with a conventional work schedule.

Dembe found that in American there is a need for an integrated process that examines multiple factors of an injured workers’ job because there are too many independent approaches to the rehabilitation process; the lack of factoring in how long recovering employees will work each day is just one example.

The complete text of the article can be in the current edition of the Journal of Occupational Rehabilitation.

Elizabeth Gelfand Miller, Boston College; Barbara E. Kahn, University of Miami; and Mary Frances Luce, Duke University have published their research about waited-for events and stress in the Februrary, 2008, edition of Journal of Consumer Research.

In one of the researchers’ studies participants were asked to wait for either a ‘neutral’ or ‘negative’ event. When the participants were told the event they were waiting for was a neutral event their stress levels were lower when their wait time was short and time remaining announced.

When the participants were told that they were waiting for a negative event the shorter wait times and reminders of how long they would have to wait actually increased stress.

Surprisingly, the researchers found that longer wait times in a patient’s waiting room can facilitate coping with negative events, which may result in less stress.

The University of Michigan and Harvard University researchers studied the concept called “value based insurance design (VBID).” The idea of VBID is that the fewer barriers standing between a chronically ill person and the medications they need helps them to avoid a health crises or disease related complications.

As in the case of co-payment for medication even a $2 increase can create a small financial barrier. If a person doesn’t take their medication, then costly health crises looms in the distance.

The researchers compared to companies that were relative in the number of employees. One company significantly reduced the co-payments by half in most cases. Prescription drug co-payments originally ranged from $5 to $45, but were reduced to $0 to $22.50. The other company’s prescription co-payment ranged from $16 to $29. The difference in range was based on whether generic or brand-name drugs were prescribed.

Patient compliance in taking the prescribed medication increased significantly with the company who reduced their co-payment fees. The company that did not reduce their co-pays did not show any change in the patient’s compliance with prescribed medication.

The intent of the study was to determine patient compliance in taking prescribed medication, not the impact on employee productivity. However, employers like Pitney Bowes and the city of Asheville, NC have used the VBID approach and report a decreased use of health services among chronically ill employees who had their co-payments reduced.

The stress-illness connection has been considered to be cortisol. When danger is perceived a chain reaction of signals releases various hormones–most notably epinephrine (adrenaline), norepinephrine, and cortisol–from the adrenal glands above each kidney. These hormones boost the heart rate, increase respiration, and increase the availability of glucose in the blood producing the “fight or flight” reaction.

Normally, cortisol levels return to normal after 40-60 minutes, but during that time various processes either shut or slow down including: digestion, reproduction, physical growth, and some aspects of the immune system.

Although we often think of stressors as big things like abuse, illness, divorce, grieving, or getting fired. Now research shows that little things can add up to negatively impact on our health like–traffic, workplace politics, noisy neighbors, a long line at the supermarket or bank.

With prolonged stress cortisol inhibits the growth of new neurons, and can cause increased growth of the amygdala–the portion of the brain that controls fear and other emotional responses. Stress hormones also inhibit neuron growth in parts of the hippocampus–an essential area of the brain in forming new memories. The result is that the brain’s ability to put emotional memories in context is impaired. These brain changes are thought to be by some researchers at the heart of the stress — depression link as well as post-traumatic stress disorder (PTSD).

Besides heart disease, PTSD, and depression, chronic stress has been linked to ailments as diverse as intestinal problems, gum disease, erectile dysfunction, adult-onset diabetes, growth problems and even cancer. Chronic rises in stress hormones have been shown to accelerate the growth of precancerous cells and tumors; they also lower the body’s resistance to HIV and cancer-causing viruses like human papilloma virus (precursor to cervical cancer in women).

Stress is known to actually enhance one important immune response–inflammation. Ordinarily, inflammation is how a healthy body deals with damaged tissue. The infected or injured cells produce cytokines, which is a chemical that attracts immune cells to the site to help repair it. Cytokines also travel to the brain and are responsible for initiating sickness behavior. Overactive cytokine production has been found to put individuals at greater risk for a variety of aging-related illnesses.

Cytokine is has also been implicated in the link between stress and depression. People suffering from clinical depression have shown 40-50% higher concentrations of certain inflammatory cytokines. And about 50% of cancer patients whose immune responses are artificially boosted through the administration of cytokines show depressive symptoms.

Sleep may be part of this puzzle too, as disturbed sleep, which often goes with anxiety and depression, increases levels of proinflammatory cytokines in the body.

Stress is not inevitable. Even if you are a determined workaholic glued to your cell phone or a fearful and angry urban neurotic, stress-reduction methods are readily available to cope with stress in the short term and even alter perceptions of stressors in the long term.

More information about stress research currently being done in psychology, medicine, neuroscience, and genetics can be found in the December 2007 issue of the Observer. A monthly magazine of the Association for Psychological Science.

Yadin Dudai and colleagues report in the 01/10/2008 journal of Neuron on a study performed on a group of volunteers. The group was divided into those who were susceptible to hypnotic suggestions and those not. Both groups were shown a documentary depicting a day-in-the-life of a young woman.

One week later the participants were placed into a magnetic resonance imaging scanner (MRI) and induced into a hypnotic state. While in a hypnotic state the subjects were given a posthypnotic suggestion to forget the documentary movie viewed a week earlier. They were also given a cue that would restore their memory of the film.

The subjects were brought out of the hypnotic state and asked to recall the documentary. The hypnosis-susceptible group recalled less of the film than the non-susceptible group. The participants were then given a cue to restore their memory of the film and asked again to recall the film. As expected, the hypnosis-susceptible group were now able to recall more of the film.

Researchers observed in the MRI scans a difference between the hypnosis-susceptible group and the non-susceptible group in the occipital, temporal, and prefrontal areas of the brain. Also detected were tell-tale brain activity changes in the hypnosis-susceptible group as they forgot and recalled memory of the movie. Specifically, during memory suppression they showed a reduction of activity in some brain regions and increased activity in other areas. After they were given the cue for memory recall the MRI’s showed that the hypnosis-susceptible group had a recovery of activity in what was previously a suppressed region.

There appears to be a pre-retrieval monitoring process, which decides whether to proceed or not with the memory retrieval. Further studies will be needed to determine whether their findings apply to cases of functional amnesia. Some forms of amnesia may be a consequence of the “pre-retrieval memory abort” mechanism that their findings revealed.

1. Patents sustained predatory prices and excessive margins.
2. Costs and prices were extravagantly increased by large expenditures in marketing.
3. Most of the industry’s new products were no more effective than established drugs already on the market.

Fifty years later things have not changed much. The current debate centers on how much is spent by pharmaceutical companies on promotion versus how much is allocated for research and development. Actual expenditures by the pharmaceutical companies vary depending on who is doing the reporting.

IMS, is a firm that specializes in pharmaceutical market intelligence and considered by many to be the authority for pharmaceutical promotion expenditures. The US General Accounting Office referred to IMS figures when it concluded that “pharmaceutical companies spend more on research and development initiatives than on all drug promotional activities.”

Recently IMS has come under fire for the way it gathers data and its accuracy. The information IMS compiles is through surveys of firms, which raises the possibility of under reporting by pharmaceutical companies for self-serving reasons. Nor does IMS include the cost of meetings and talks the pharmaceutical companies sponsor for doctors and sales representatives. Just in the past few years such meetings have more than tripled from 120,000 in 1998 to 371,000 in 2004. In 2000, the top 10 pharmaceutical companies spent just under $1.9 billion on 314,000 such events.

When IMS was questioned about the procedures they used to collect information on different aspects of promotion they did not choose to provide information regarding the estimated value of unmonitored promotional expenditures. The pharmaceutical companies were approached independently about the figures and they provided the numbers under a confidentiality agreement. When those numbers were compared with additional research it was estimated that 30% of promotional spending was not accounted for in the official IMS figures.

The revised figures show that the pharmaceutical industry appears to spend twice as much on promotion as they do on R&D. While the amount spent on promotion is not in itself a confirmation of Senator Kefauver’s depiction of the pharmaceutical industry, it does confirm the public’s image of a marketing-driven industry.

What wasn’t known about thioredoxin is its ability to open ion channels, which allow the movement of ions. Ions are electrically charged atoms across a cell’s membrane that carries out a variety of functions, such as pain transmission, timing of the heart beat, and regulation of blood glucose. Until now, the only two ways known for activating the ions was a change in cell voltage and the binding of chemical factors.

Professor Beech and colleagues, University of Leeds, discovered that thioredoxin can also activate ion channels. It is known that inflammatory diseases cause the production of high levels of thioredoxin–in fact with rheumatoid arthritis it is striking how much thioredoxin is present in affected joints. Now, with a better understanding that thioredoxin can also activate ion channels there is the opportunity for developing drugs that mimic the effect of thioredoxin and provide future development for treatments of arthritis and related diseases.

An older patient that is taking at least five medications has a 1 in 3 chance of experiencing an adverse drug reaction each year. Approximately 2/3′s of these patients will require medical attention. Surprisingly, 95% of these reactions are predictable, with 28% being preventable as reported by the researchers.

Beers Criteria is a widely-adopted list of medications that are “potentially inappropriate” for older patients or for older patients with a specific medical condition. The study suggests physicians avoid the drugs on this list and to use alternatives. If an alternative is not available, then start with the lowest effective dose and discontinue use when possible.

As the number of medications prescribed to a patient increases so does the risk of adverse drug interactions. To reduce the danger of potential drug interactions the study suggests the “brown-bag” approach, which is when a patient brings all of their medication to the physician’s office. About 20% of the patients can drop at least one of their drugs, while 29% of the patients can have a change in medication.

There is also the risk of under prescribing in older patients. Sometimes symptoms may be thought of as symptoms of a degenerative disease or old age when they are really treatable conditions, such as heart disease, depression, osteoporosis, and pain.

Another factor concerning older patients is noncompliance, which can be caused by a variety of issues like physician-patient communication, cognitive decline, and the cost of medication. The researchers suggest the best solution is to focus on education by using cognitive aids. When cost is a factor the patient may not raise the issue, which can be addressed by the physician asking whether the patient plans to use his or her prescription and hopefully begin a dialog about the costs of a patient’s prescriptions. Sometimes a generic substitute or a combination of less expensive drugs can be prescribed.

Dr. Juan Botas, associate professor of molecular and human genetics, Baylor College of Medicine, hopes that his recent discovery will attract the attention of pharmaceutical companies and stimulate further drug research.

Symptoms for both Huntington’s disease and Spinocerebellar Ataxia 1 show up in adulthood and are both polyglutamine disorders. Polyglutamine interferes with how protein is used by the cell.

What Botas found is that Huntington’s disease and Spinocerebellar Ataxia 1 share genetic modifiers that cause nerve cell damage. This is something that may make developing treatments for the diseases more attractive to biotech companies.

The researchers compared the 2 diseases in models of fruit flies and found that some genes modify the polyglutamine similarly for both diseases.

The reason we consume more calories than needed is often thought to be psychological, but Maribel Rios, PhD, and Thaddeus Unger, graduate student at Sackler School, Tufts University School of Medicine, Boston, believe that appetites are regulated by 2 primary regions of the brain.

Researchers deleted a protein called brain-derived neurotrophic factor (BDNF) in animals and found they became significantly heavier than those animals with BDNF intact. Because the animals in the study were genetically altered to delete the BDNF gene in adulthood the researchers feel that it is a strong indication that BDNF acts as a satiety signal in the mature brain.

Because the animals did not show any signs of aggression, depression, or hyperactivity suggest that BDNF is not linked to behavioral control.

When the animals with the deleted BDNF gene were placed on a restricted diet, with the same level of calories as normal animals, they maintained a normal weight.